Effectiveness of topiramate for tobacco dependence in patients with depression; a randomised, controlled trial.
BACKGROUND
Tobacco dependence management is a multi-component intervention that includes pharmacological treatments such as Nicotine Substitution Therapy (NST) or bupropion, and psychological therapy. There are some preliminary reports on topiramate efficacy for tobacco dependence. The aim of this study is to determine whether topiramate is as effective as the standard NST treatment for tobacco cessation at 1-year follow-up in patients with depression.


METHODS



METHODS
A randomised, controlled trial involving two groups, one of which is the control group consisting of patients on the standard pharmacological treatment for tobacco cessation (NST) and the other is the intervention group consisting of patients on topiramate as pharmacological treatment.


METHODS
29 primary care health centres in the city of Zaragoza, Spain.


METHODS
180 patients, aged 18-65 years, diagnosed with major depression, smoke more than 20 cigarettes/day, who have voluntarily asked for tobacco cessation therapy.


METHODS
A multi-component programme for tobacco cessation is offered to all of the patients in the study. This programme is made up of pharmacological therapy + group cognitive-behavioural therapy. Pharmacological therapy consists of NST for the control group and topiramate (200 mg/day) for the intervention group. Psychological therapy is made up of 16 sessions of manualised group therapy.


METHODS
Cessation will be assessed by patient self-declared abstinence, expired air carbon monoxide levels, and cotinine levels in saliva. Questionnaires on tobacco dependence, anxiety, depression, impulsiveness and self-efficacy will be administered. The interviewers will not know which group the patient belongs to (blind). The assessments will be carried out at baseline, D (cessation day) -1, D+1, weeks 1, 2, 3, 4, 6, 8, 10 and 13, and months 4, 5, 6, 8, 10 and 12.


METHODS
Tobacco cessation rates and tobacco dependence.


METHODS
The analysis will be per intent to treat. We will use the general linear models of the SPSS version 15 statistical package, to analyse the effect of the treatment on the result variable (tobacco cessation rate).


CONCLUSIONS
It is necessary to develop new and more effective pharmacological treatments for tobacco cessation. This randomised clinical trial will determine whether topiramate is effective for tobacco cessation in patients with depression.


BACKGROUND
Current Controlled Trials ISRCTN93532081.
García Campayo
Javier
J
Servicio de Psiquiatría, Hospital Miguel Servet y Universidad de Zaragoza, Spain. jgarcamp@arrakis.es
Sobradiel
Natalia
N
Alda
Marta
M
Mas
Adoración
A
Andrés
Eva
E
Magallón
Rosa
R
Crucelaegui
Arantxa
A
Sanz
Beatriz
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D003865:Major Depressive Disorder / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D009538:Nicotine / Q000008:administration & dosage / Q000009:adverse effects; D011613:Psychotherapy / Q000379:methods; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D014029:Tobacco Use Disorder / Q000188:drug therapy* / Q000523:psychology / Q000628:therapy; D000077236:Topiramate
D018696:Neuroprotective Agents; D000077236:Topiramate; D005632:Fructose; D009538:Nicotine