title: A naturalistic study of the association between antidepressant treatment and outcome of smoking cessation treatment.
abstract: OBJECTIVE
  Psychiatric, medical, and substance use comorbidities are highly prevalent among smokers, and many of these comorbidities have been found to be associated with reduced rate of success in clinical trials for smoking cessation. While much has been established about the best available treatments from these clinical trials, little is known about the effect of concomitant psychiatric medications on quit rates in smoking cessation programs. On the basis of results in populations with tobacco dependence and other substance use disorders, we hypothesized that smokers taking antidepressants would have a lower rate of quitting in an outpatient smoking cessation program.
  
  
  METHODS
  We performed a naturalistic chart review of veterans (N = 144) enrolled in the Veterans Affairs Greater Los Angeles Mental Health Clinic Smoking Cessation Program from March 2011 through July 2013, who met DSM-IV-TR criteria for nicotine dependence. The primary outcome was smoking cessation with treatment, as evidenced by a patient report of at least 1 week of abstinence and an exhaled carbon monoxide level of ≤ 6 ppm (if available) at the end of acute treatment, with comparators including concomitant psychotropic medication treatment, psychiatric and medical comorbidities, and the presence of a substance use disorder history. We utilized stepwise binary logistic regression as the main statistical technique.
  
  
  RESULTS
  We found that current antidepressant treatment (P = .003) and history of substance use disorder (P = .01) (particularly cocaine [P = .02]) were associated with a lower rate of quitting smoking. Furthermore, the association between antidepressant treatment and reduced rate of smoking cessation was primarily seen in patients with a history of substance use disorder (P = .003).
  
  
  CONCLUSIONS
  While preliminary, these results suggest an important clinical interaction meriting future study. If these findings are confirmed, clinicians may want to consider the risk of reduced ability to quit smoking in patients with a history of substance use disorder who are taking antidepressants.
authors.affiliation: Department of Psychiatry, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, B210/2nd Floor, Los Angeles CA 90073 tzorick@mednet.ucla.edu.
authors.forename: Todd
authors.initials: T
authors.lastname: Zorick
authors.forename: Mark A
authors.initials: MA
authors.lastname: Mandelkern
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Brody
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003863:Depression / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000627:therapeutic use; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000150:complications* / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D011619:Psychotropic Drugs