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.