Smoking cessation interventions for smokers with current or past depression

Area of Science:

• Clinical Psychology
• Addiction Medicine
• Psychopharmacology

Background:

• Smokers with current or past depression exhibit higher nicotine dependence and relapse rates.
• This population experiences greater morbidity and mortality from smoking-related illnesses.
• Effective smoking cessation interventions for this group remain under investigation.

Purpose of the Study:

• To assess the efficacy of smoking cessation interventions in smokers with current or past depression.
• To compare interventions with and without specific mood management components.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) published up to April 2013.
• Included adult smokers with major depression or depressive symptoms.
• Primary outcome was smoking abstinence at six months or longer, preferably biochemically validated.

Main Results:

• Adding psychosocial mood management to standard cessation interventions significantly increased long-term cessation in smokers with current (RR 1.47) and past depression (RR 1.41).
• Bupropion showed a potential, though not statistically significant, benefit for current depression (RR 1.37) and a significant effect for past depression (RR 2.04), but with weak evidence.
• Insufficient data existed to evaluate other antidepressants (fluoxetine, paroxetine, etc.) or interventions without specific mood management components, including nicotine replacement therapy (NRT).

Conclusions:

• Psychosocial mood management integrated into smoking cessation programs improves long-term abstinence rates for smokers with current and past depression.
• Bupropion may enhance long-term cessation in smokers with past depression, but evidence is limited.
• Further research is needed for other pharmacotherapies and non-mood-focused interventions in this population.