T. Blondal et al., The effects of fluoxetine combined with nicotine inhalers in smoking cessation - a randomized trial, ADDICTION, 94(7), 1999, pp. 1007-1015
Citations number
24
Categorie Soggetti
Public Health & Health Care Science","Clinical Psycology & Psychiatry
Aims. Nicotine replacement therapy (NRT) is an established aid in stopping
smoking, while the role of antidepressants remains uncertain. Antidepressan
ts added to NRT might improve abstinence rates. Our aim was to determine th
e efficacy of nicotine inhaler and fluoxetine vs. nicotine inhaler and plac
ebo in attempts to quit smoking. Design. A randomized, double-blind, placeb
o-controlled trial. Setting. A smoker's cessation clinic. Participants. One
hundred volunteers smoking 10 cigarettes/day or more. Interventions. Subje
cts were instructed to start taking a daily dose of 10 mg of fluoxetine or
placebo 16 days before stopping smoking, then 20 mg 10 days before quitting
, continuing for up to at least 3 months. Subjects were instructed to use 6
-12 units per day of nicotine inhalers after stopping smoking for up to 6 m
onths. Measurements. Continuous abstinence rates recorded at various time p
oints up to 12 months from the quit date. Findings. The sustained abstinenc
e rate for the inhaler-fluoxetine group was 54%, 40%, 29% and 21% after 1.5
, 3, 6 and 12 months, respectively, compared to 48%, 40%, 32% and 23% for t
he inhaler-placebo group. The differences were not significant at ally time
point. Abstinence up to 3 months was more likely in older smokers, those w
ith a lower Beck Depression Inventory Score (BDI), lower Fagerstrom Test of
Nicotine Dependence (FTND) score and no history of alcoholism. Fluoxetine
appeared to increase abstinence rates among high BDI smokers compared to hi
gh BDI smokers assigned placebo. Serum levels of nicotine during treatment
in the inhaler-fluoxetine group were lower than in the inhaler-placebo grou
p so that fluoxetine may have reduced inhaler use through a common site of
action. Conclusions. We found no evidence that fluoxetine treatment when us
ed as an adjunct to NRT in unselected smokers is effective, but there may b
e an advantage to using it in depressed smokers.