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Antidepressants for smoking cessation.

John R Hughes1, Lindsay F Stead, Jamie Hartmann-Boyce

  • 1Dept of Psychiatry, University of Vermont, UHC Campus, OH3 Stop # 482, 1 South Prospect Street, Burlington, Vermont, USA, 05401.

The Cochrane Database of Systematic Reviews
|January 10, 2014
PubMed
Summary
This summary is machine-generated.

Antidepressants bupropion and nortriptyline effectively aid long-term smoking cessation, with rare serious side effects. Bupropion is less effective than varenicline, but selective serotonin reuptake inhibitors do not aid cessation.

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Area of Science:

  • Pharmacology
  • Addiction Medicine
  • Clinical Trials

Background:

  • Nicotine withdrawal can mimic depressive symptoms, and nicotine itself may have antidepressant effects, suggesting antidepressants could aid smoking cessation.
  • Some antidepressants may target neural pathways or receptors involved in nicotine addiction, offering a potential mechanism for cessation support.

Purpose of the Study:

  • To evaluate the efficacy and safety of various antidepressant medications for achieving long-term smoking cessation.
  • To assess antidepressants including bupropion, nortriptyline, selective serotonin reuptake inhibitors (SSRIs), and others in smoking cessation.

Main Methods:

  • Conducted a systematic review of randomized controlled trials comparing antidepressant medications to placebo or other pharmacotherapies for smoking cessation.
  • Included trials with at least six months follow-up, extracting data and assessing bias using standard Cochrane Collaboration procedures.
  • Performed meta-analyses to determine the risk ratio for smoking abstinence, using biochemically validated rates where available.

Main Results:

  • High-quality evidence shows bupropion significantly increases long-term smoking cessation when used alone (RR 1.62).
  • Moderate-quality evidence indicates nortriptyline also significantly increases long-term cessation as monotherapy (RR 2.03).
  • Bupropion and nortriptyline showed similar efficacy to nicotine replacement therapy (NRT), but bupropion was less effective than varenicline. SSRIs and monoamine oxidase inhibitors did not demonstrate significant cessation benefits.

Conclusions:

  • Bupropion and nortriptyline are effective aids for long-term smoking cessation, with generally mild side effect profiles.
  • Their efficacy appears independent of their antidepressant properties and comparable to NRT, though varenicline may be more effective than bupropion.
  • Selective serotonin reuptake inhibitors and monoamine oxidase inhibitors were not found to aid smoking cessation.