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Addictive Disorders & Their Treatment:
doi: 10.1097/ADT.0000000000000042
Original Articles

Effects of Depression History and Sex on the Efficacy of Sequential Versus Standard Fluoxetine for Smoking Cessation in Elevated Depressive Symptom Smokers

Minami, Haruka PhD*,†; Kahler, Christopher W. PhD; Bloom, Erika L. PhD*,†; Strong, David R. PhD§; Abrantes, Ana M. PhD*,†; Zywiak, William H. PhD*,†; Price, Lawrence H. MD*,†; Brown, Richard A. PhD*,†

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Abstract

Objective: The potential benefits of antidepressant pharmacotherapy with fluoxetine for smoking cessation among vulnerable subpopulations of depressed smokers have not been well explored. This study examined whether the efficacy of a sequential course of fluoxetine for smoking cessation differed as a function of depression history (none vs. single vs. recurrent episodes) and sex.

Methods: Data were from a randomized controlled trial that evaluated the efficacy of sequential fluoxetine treatment (SEQ-FLUOX; 16 wk, starting 8 wk prequit) in comparison with standard fluoxetine treatment (ST-FLUOX; 10 wk, starting 2 wk prequit) and transdermal nicotine patch only (TNP) for 216 smokers with elevated depressive symptoms.

Results: Cox regression analyses revealed significant moderating effects of depression history (recurrent vs. single), but not sex, on the efficacy of SEQ-FLUOX versus ST-FLUOX on latency to relapse. Among smokers with recurrent major depressive disorder (MDD) episodes, those receiving SEQ-FLUOX were slower to relapse, compared with those receiving ST-FLUOX, but not relative to TNP. No such treatment difference was observed in smokers with no MDD history or a single past MDD episode. Furthermore, those with recurrent MDD receiving SEQ-FLUOX reported significantly lower levels of depressive symptoms over 26 weeks after quitting, compared with those receiving ST-FLUOX, but not relative to TNP.

Conclusions: Findings suggest the possible specific benefits of treating elevated depressive symptom smokers with recurrent MDD using fluoxetine in a sequential manner (vs. standard). However, given the small sample size, the reliability of this difference is unknown. Replication with a larger sample of recurrent MDD history is needed.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved

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