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Smoking cessation interventions for smokers with current or past depression
Open accessAbstract
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analyses, by length of follow-up, depression measurement, depression group in study, antidepressant use, published or unpublished data, format of intervention, level of behavioural support, additional pharmacotherapy, type of antidepressant medication, and additional nicotine replacement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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“given evidence that mood management improves smoking abstinence compared with standard smoking cessation support alone [35].”
From intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): A randomised and controlled, multi-centre, acceptability and feasibility trial with nested qualitative methods (2025) · cites this paper as [35]
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In the citing paper
“The population was representative of IAPT service users in sex, age and education and participants with common mental illness from other RCTs of smoking cessation interventions [35].”
From intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): A randomised and controlled, multi-centre, acceptability and feasibility trial with nested qualitative methods (2025) · cites this paper as [35]
Experimental — accuracy not yet measuredIn the citing paper
“van der Meer and colleagues conducted a Cochrane review of smoking cessation treatments for people with current and historical depression [21] and found that adding psychosocial mood management to usual smoking cessation treatment (e.g., nicotine replacement therapy) moderately increased cessation rates when compared to usual smoking treatment alone (risk ratio of 1.47; 95% confidence interval 1.13 to 1.92) [21],”
In the citing paper
“found that adding psychosocial mood management to usual smoking cessation treatment (e.g., nicotine replacement therapy) moderately increased cessation rates when compared to usual smoking treatment alone (risk ratio of 1.47; 95% confidence interval 1.13 to 1.92) [21]”
In the citing paper
“Studies in patients with severe mental disorders or alcoholism have shown that treating addiction and mental health in parallel results in meaningful improvements in both [17–21].”
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Metadata
- 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
- 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 › Public Health, Environmental and Occupational Health › 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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