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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*,†

Addictive Disorders & Their Treatment: March 2015 - Volume 14 - Issue 1 - p 29–39
doi: 10.1097/ADT.0000000000000042
Original Articles

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.

*Alpert Medical School of Brown University

Butler Hospital

Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI

§University of California San Diego, San Diego, CA

Funding for this study was provided by Grant PBP-104347 from the American Cancer Society, awarded to R.A.B.

L.H.P. reports receiving grant/research support from Medtronic, Neuronetics, NIH, HRSA, and NeoSync; serving on an advisory panel for Abbott; and serving as a consultant for Wiley, Springer, Qatar National Research Fund, and Abbott. The remaining authors declare no conflict of interest.

Reprints: Haruka Minami, PhD, Butler Hospital, 345 Blackstone Blvd. Providence, RI 02906 (e mail:

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