NORTRIPTYLINE AND COGNITIVE-BEHAVIORAL THERAPY IN THE TREATMENT OF CIGARETTE-SMOKING

Background: A history of major depressive disorder (MDD) predicts fail ure to quit smoking. We determined the effect of nortriptyline hydroch loride and cognitive-behavioral therapy on smoking treatment outcome i n smokers with a history of MDD. The study also addressed the effects of diagnosis and treatment condition on dysphoria after quitting smoki ng and the effects of dysphoria on abstinence. Methods: This was a 2 ( nortriptyline vs placebo) x 2 (cognitive-behavioral therapy vs control ) x 2 (history of MDD vs no history) randomized trial. The participant s were 199 cigarette smokers. The outcome measures were biologically v erified abstinence from cigarettes at weeks 12, 24, 38, and 64. Mood, withdrawal, and depression were measured at 3, 5, and 8 days after the smoking quit date, Results: Nortriptyline produced higher abstinence rates than placebo, independent of depression history. Cognitive;behav ioral therapy was more effective for participants with a history of de pression. Nortriptyline alleviated a negative affect occurring after s moking cessation. Increases in the level of negative affect from basel ine to 3 days after the smoking quit date predicted abstinence at late r assessments for MDD history-negative smokers. There was also a sex-b y-depression history interaction; MDD history-positive women were less likely to be abstinent than MDD history-negative women, but depressio n history did not predict abstinence for men. Conclusions: Nortriptyli ne is a promising adjunct for smoking cessation. Smokers with a histor y of depression are aided by more intensive psychosocial treatments. M ood and diagnosis interact to predict relapse. Increases in negative a ffect after quitting smoking are attenuated by nortriptyline.