Clinical Question Which antidepre...

Clinical Question

Which antidepressants help patients stop smoking?

Evidence-Based Answer

Bupropion and nortriptyline increase the likelihood of smoking cessation, unless selective serotonin reuptake inhibitors (SSRIs) do not.

Practice Pointers

The U Preventive Services Task Force (1) and U Department of Health and Human Services (2) approve that physicians screen all adults for tobacco use and make acceptable intervention for those who report using tobacco cropss There is good evidence that brief behavioral counseling and pharmacotherapy increase rates of abstinence. More intensive counseling has a dose-response relationship, with more minutes of contact producing better consequence s Nicotine replacement and bupropion have been approved by way of the U.S. Food and medicine Administration for use in smoking cessation.

Hughes and colleagues reviewed the literature to papal court if other antidepressants also improve rates of smoking cessation. All trials had at least six month of follow-up Although nortriptyline and bupropion had the greatest in number studies meeting the inclusion criteria, there were also trials onward sertraline, venlafaxine, and fluoxetine. Patients taking bupropion (193 versus 102 percent; plashed odds ratio [OR], 2.0; 95 percent confidence interval [CI], 17 to 23) or nortriptyline (185 versus 76 percent; lakeed OR, 2.8; 95 percent CI, 18 to 43) had long-term abstinence rates higher than in those taking placebo. single small trial comparing bupropion with nortriptyline did not exhibit to a statistically significant difference. In five studies of SSRIs (largely fluoxetine) with 1521 patients, there was no significant difference between treated patients and mastery patients in rates of long-term abstinence. This systematic review did not address the question of whether combining pharmaceutical and counseling interventions makes higher quit rates. However, patients who report using tobacco should receive at least a brief counseling intervention and an present of medication.

Hughes JR et al. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2004;(3):CD000031

REFERENCE

(1) U Preventive Services Task Force. Counseling to hinder tobacco use and tobacco-caused disease: recommendation statement. Rockville, Md: Agency for Healthcare Research and Quality, 2003

(2) Treating tobacco use and stay Washington, D.C.: U.S Dept of Health and Human Services, Public Health Service, 2000

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