title: Smoking and antidepressants pharmacokinetics: a systematic review.
abstract: BACKGROUND
  Despite an increasingly recognized relationship between depression and smoking, little is known about how smoking influences antidepressant response and treatment outcomes. The aim of this study was to systematically review the evidence of the impact of smoking on new-generation antidepressants with an emphasis on the pharmacokinetic perspective.
  
  
  METHODS
  We present a systematic review of clinical trials comparing the serum levels of new-generation antidepressants in smokers and nonsmokers. Data were obtained from MEDLINE/PubMed, Embase, and other sources. Risk of bias was assessed for selection, performance, detection, attrition, and reporting of individual studies.
  
  
  RESULTS
  Twenty-one studies met inclusion criteria; seven involved fluvoxamine, two evaluated fluoxetine, sertraline, venlafaxine, duloxetine or mirtazapine, and escitalopram, citalopram, trazodone and bupropion were the subject of a single study. No trials were found involving other common antidepressants such as paroxetine or agomelatine. Serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone were significantly higher in nonsmokers compared with smokers.
  
  
  CONCLUSIONS
  There is evidence showing a reduction in the concentration of serum levels of fluvoxamine, duloxetine, mirtazapine and trazodone in smoking patients as compared to nonsmokers. The evidence regarding other commonly used antidepressants is scarce. Nonetheless, smoking status should be considered when choosing an antidepressant treatment, given the risk of pharmacokinetic interactions.
authors.affiliation: Psychiatry Department, Coimbra Hospital University Centre, Praceta Mota Pinto, 3000-075 Coimbra, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Oliveira
authors.affiliation: Psychiatry Department, Coimbra Hospital University Centre, Praceta Mota Pinto, 3000-075 Coimbra, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Ribeiro
authors.affiliation: Documentation Department, Coimbra Hospital University Centre, Coimbra, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Donato
authors.affiliation: Psychiatry Department, Coimbra Hospital University Centre, Praceta Mota Pinto, 3000-075 Coimbra, Portugal.
authors.forename: Nuno
authors.identifier: 0000-0001-5009-8841
authors.initials: N
authors.lastname: Madeira
keywords: Antidepressant agents; Depressive disorder; Pharmacokinetics; Smoking