Cited by 159Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesCardiac Health and Mental Health

Smoking cessation interventions for smokers with current or past depression

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van der Meer, Regina M, Willemsen, Marc C, Smit, Filip, Cuijpers, Pim·2013·Cochrane Database of Systematic Reviews

Abstract

BACKGROUND: Individuals with current or past depression are often smokers who are more nicotine dependent, more likely to suffer from negative mood changes after nicotine withdrawal, and more likely to relapse to smoking after quitting than the general population, which contributes to their higher morbidity and mortality from smoking-related illnesses. It remains unclear what interventions can help them to quit smoking. OBJECTIVES: To evaluate the effectiveness of smoking cessation interventions, with and without specific mood management components, in smokers with current or past depression. SEARCH METHODS: In April 2013, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, other reviews, and asked experts for information on trials. SELECTION CRITERIA: Criteria for including studies in this review were that they had to be randomised controlled trials (RCTs) comparing smoking cessation interventions in adult smokers with current or past depression. Depression was defined as major depression or depressive symptoms. We included studies where subgroups of participants with depression were identified, either pre-stated or post hoc. The outcome was abstinence from smoking after six months or longer follow-up. We preferred prolonged or continuous abstinence and biochemically validated abstinence where available. DATA COLLECTION AND ANALYSIS: When possible, we estimated pooled risk ratios (RRs) with the Mantel-Haenszel method (fixed-effect model). We also performed subgroup analyses, by length of follow-up, depression measurement, depression group in study, antidepressant use, published or unpublished data, format of intervention, level of behavioural support, additional pharmacotherapy, type of antidepressant medication, and additional nicotine replacement therapy (NRT). MAIN RESULTS: Forty-nine RCTs were included of which 33 trials investigated smoking cessation interventions with specific mood management components for depression. In smokers with current depression, meta-analysis showed a significant positive effect for adding psychosocial mood management to a standard smoking cessation intervention when compared with standard smoking cessation intervention alone (11 trials, N = 1844, RR 1.47, 95% CI 1.13 to 1.92). In smokers with past depression we found a similar effect (13 trials, N = 1496, RR 1.41, 95% CI 1.13 to 1.77). Meta-analysis resulted in a positive effect, although not significant, for adding bupropion compared with placebo in smokers with current depression (5 trials, N = 410, RR 1.37, 95% CI 0.83 to 2.27). There were not enough trial data to evaluate the effectiveness of fluoxetine and paroxetine for smokers with current depression. Bupropion (4 trials, N = 404, RR 2.04, 95% CI 1.31 to 3.18) might significantly increase long-term cessation among smokers with past depression when compared with placebo, but the evidence for bupropion is relatively weak due to the small number of studies and the post hoc subgroups for all the studies. There were not enough trial data to evaluate the effectiveness of fluoxetine, nortriptyline, paroxetine, selegiline, and sertraline in smokers with past depression.Twenty-three of the 49 trials investigated smoking cessation interventions without specific components for depression. There was heterogeneity between the trials which compared psychosocial interventions with standard smoking cessation counselling for both smokers with current and past depression. Therefore, we did not estimate a pooled effect. One trial compared nicotine replacement therapy (NRT) versus placebo in smokers with current depression and found a positive, although not significant, effect (N = 196, RR 2.64, 95% CI 0.93 to 7.45). Meta-analysis also found a positive, although not significant, effect for NRT versus placebo in smokers with past depression (3 trials, N = 432, RR 1.17, 95% CI 0.85 to 1.60). Three trials compared other pharmacotherapy versus placebo and six trials compared other interventions in smokers with current or past depression. Due to heterogeneity between the interventions of the included trials we did not estimate pooled effects. AUTHORS' CONCLUSIONS: Evidence suggests that adding a psychosocial mood management component to a standard smoking cessation intervention increases long-term cessation rates in smokers with both current and past depression when compared with the standard intervention alone. Pooled results from four trials suggest that use of bupropion may increase long-term cessation in smokers with past depression. There was no evidence found for the use of bupropion in smokers with current depression. There was not enough evidence to evaluate the effectiveness of the other antidepressants in smokers with current or past depression. There was also not enough evidence to evaluate the group of trials that investigated interventions without specific mood management components for depression, including NRT and psychosocial i

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Authors
van der Meer, R. M., Willemsen, M. C., Smit, F., & Cuijpers, P.
Affiliations
  • STIVORO, Dutch Expert Centre on Tobacco Control; The Hague Netherlands
  • Maastricht University (NL)
  • Trimbos Institute (NL)
  • Vrije Universiteit Amsterdam (NL)
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2013-08-21
Volume
2013
Issue
8
Pages
CD006102-CD006102
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
OpenAlex
W1698788306
Cited by
159
References
199
Citations by year
2026: 1 · 2025: 9 · 2024: 8 · 2023: 14 · 2022: 10 · 2021: 14 · 2020: 7 · 2019: 10 · 2018: 13 · 2017: 15 · 2016: 18 · 2015: 19 · 2014: 12 · 2013: 6 · 2012: 2
FWCI
2.02
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • VU Research Portal (publishedVersion)
  • Pure Amsterdam UMC (submittedVersion)
  • Multilingual Matters (Channel View Publications) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
smoking cessation, depression, mood management, nicotine dependence, nicotine withdrawal, relapse, bupropion, nicotine replacement therapy, antidepressants, psychosocial interventions, smoking abstinence, relapse prevention, smoking cessation pharmacotherapy, behavioral support, tobacco dependence treatment
MeSH terms
Adult, Major Depressive Disorder, Humans, Smoking, Randomized Controlled Trials as Topic, Smoking Cessation, Bupropion, Treatment Outcome, Antidepressive Agents, Second-Generation, Tobacco Use Cessation Devices

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