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Antidepressants for smoking cessation

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Hajizadeh, Anisa, Howes, Seth, Theodoulou, Annika, Klemperer, Elias, Hartmann-Boyce, Jamie, Livingstone-Banks, Jonathan, Lindson, Nicola·2023·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd000031.pub6PMC PMC10207863
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Abstract

BACKGROUND: The pharmacological profiles and mechanisms of antidepressants are varied. However, there are common reasons why they might help people to stop smoking tobacco: nicotine withdrawal can produce short-term low mood that antidepressants may relieve; and some antidepressants may have a specific effect on neural pathways or receptors that underlie nicotine addiction. OBJECTIVES: To assess the evidence for the efficacy, harms, and tolerability of medications with antidepressant properties in assisting long-term tobacco smoking cessation in people who smoke cigarettes. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group Specialised Register, most recently on 29 April 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) in people who smoked, comparing antidepressant medications with placebo or no pharmacological treatment, an alternative pharmacotherapy, or the same medication used differently. We excluded trials with fewer than six months of follow-up from efficacy analyses. We included trials with any follow-up length for our analyses of harms. DATA COLLECTION AND ANALYSIS: We extracted data and assessed risk of bias using standard Cochrane methods. Our primary outcome measure was smoking cessation after at least six months' follow-up. We used the most rigorous definition of abstinence available in each trial, and biochemically validated rates if available. Our secondary outcomes were harms and tolerance outcomes, including adverse events (AEs), serious adverse events (SAEs), psychiatric AEs, seizures, overdoses, suicide attempts, death by suicide, all-cause mortality, and trial dropouts due to treatment. We carried out meta-analyses where appropriate. MAIN RESULTS: = 0%; 3 studies, 417 participants), although this result was subject to imprecision. Findings were sparse and inconsistent as to whether antidepressants, primarily bupropion and nortriptyline, had a particular benefit for people with current or previous depression. AUTHORS' CONCLUSIONS: There is high-certainty evidence that bupropion can aid long-term smoking cessation. However, bupropion may increase SAEs (moderate-certainty evidence when compared to placebo/no pharmacological treatment). There is high-certainty evidence that people taking bupropion are more likely to discontinue treatment compared with people receiving placebo or no pharmacological treatment. Nortriptyline also appears to have a beneficial effect on smoking quit rates relative to placebo, although bupropion may be more effective. Evidence also suggests that bupropion may be as successful as single-form NRT in helping people to quit smoking, but less effective than combination NRT and varenicline. In most cases, a paucity of data made it difficult to draw conclusions regarding harms and tolerability. Further studies investigating the efficacy of bupropion versus placebo are unlikely to change our interpretation of the effect, providing no clear justification for pursuing bupropion for smoking cessation over other licensed smoking cessation treatments; namely, NRT and varenicline. However, it is important that future studies of antidepressants for smoking cessation measure and report on harms and tolerability.

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  • Research has demonstrated that patients with StUD who have not achieved initial treatment goals may benefit from extended treatment with EBIs to facilitate long-term recovery.

    “Research has demonstrated that patients with StUD who have not achieved their treatment goals during the initial phase of treatment may benefit from extended treatment with EBIs to facilitate long-term recovery.95,99,103,104”

    From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [104]

    The Results (Description of studies; page unavailable) discuss treatment duration and follow-up for smoking cessation, not extended treatment for patients with stimulant use disorder who missed initial treatment goals. A References entry mentions a study of smoking cessation in stimulant-dependent individuals, but does not report the claimed benefit. Searches for initial treatment goals and extended treatment found no supporting passage in our copy. (LLM, conf=0.76)

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Authors
Hajizadeh, A., Howes, S., Theodoulou, A., Klemperer, E., Hartmann-Boyce, J., Livingstone-Banks, J., & Lindson, N.
Affiliations
  • University of Oxford (GB)
  • University of Vermont (US)
  • Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford UK
Corresponding author
Lindson, Nicola
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2023-05-24
Volume
2023
Issue
5
Pages
CD000031-CD000031
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd000031.pub6
PMC
PMC10207863
OpenAlex
W4377966591
Cited by
84
References
27
Citations by year
2026: 12 · 2025: 23 · 2024: 39 · 2023: 6 · 2022: 1 · 2020: 3
FWCI
2.85
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • U.S. Department of Defense
  • United States Agency for International Development
  • U.S. Department of Veterans Affairs
  • Eli Lilly and Company
  • Pfizer (WS2391913)
  • GlaxoSmithKline
  • World Health Organization
  • Tobacco-Related Disease Research Program
  • University of South Carolina
  • International Development Research Centre
  • Cancer Research UK
  • National Institute for Health and Care Research (NIHR132114)
  • University of Toronto
  • National Institutes of Health (DA027840, RR01070)
  • Pfizer Pharmaceuticals
  • National Institute on Drug Abuse (DA027840, P50DA027840, R01DA024674-01A1, K23DA020482, R25DA020537, K12DA000357)
  • National Cancer Institute
  • National Institute of Child Health and Human Development
  • National Center for Research Resources
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD055885)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
Keywords
antidepressants, smoking cessation, nicotine withdrawal, bupropion, nortriptyline, nicotine replacement therapy, varenicline, depression, adverse events, treatment discontinuation, nicotine dependence, long-term abstinence, suicide risk, drug overdose, mortality, treatment tolerability
MeSH terms
Varenicline, Adolescent, Adult, Antidepressive Agents, Child, Humans, Nortriptyline, Smoking Cessation, Bupropion, Nicotinic Agonists, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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