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.
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.
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.
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.