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Antidepressant may help people stop smoking when used with nicotine patch

The JAMA Network Journals

CHICAGO - When used with a transdermal nicotine patch, nortriptyline--an antidepressant medication--may aid in smoking cessation, according to an article in the November 8 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to background information in the article, smoking is an important preventable cause of death. However, current cessation methods are only partially successful. Several different types of antidepressant medications have been effective in helping people quit smoking.

Allan V. Prochazka, M.D., M.Sc., from the University of Colorado Health Sciences Center, Denver, and colleagues tested the efficacy of nortriptyline in helping people quit smoking cigarettes. Study participants, aged 18 to 65 years, were randomly assigned to one of two groups: one group received nortriptyline (n = 79) and one group received placebo (n = 79). Researchers started both groups with 25 milligrams per day of either nortriptyline or placebo 14 days before the set quit date, and then increased dosage to 75 milligrams per day, as tolerated. A transdermal nicotine patch was administered to all study participants on the determined quit day and was worn for eight weeks.

The researchers found that at six months, cessation rates were 23 percent for those taking nortriptyline and 10 percent for those taking placebo. Neither group experienced a reduction in withdrawal symptoms. However, the nortriptyline group had a significantly higher rate of adverse effects than the placebo group, with 38 percent of participants experiencing dry mouth and 20 percent experiencing drowsiness. Nortriptyline was discontinued in 13 percent of participants due to adverse effects.

The authors write, "...there are several possible mechanisms of action for nortriptyline's effect in enhancing smoking cessation. Nortriptyline may reduce depressive symptoms and the need for 'negative affect reduction smoking.' Other antidepressant agents are also effective in smoking cessation, suggesting that the antidepressant effect may be the common mechanism."

The researchers conclude: "It is also clear from our data that subjects treated with nortriptyline require close monitoring for adverse events...However nortriptyline combined with transdermal nicotine may prove to be a useful alternative for smokers in whom first-line smoking cessation therapies have failed."

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(Arch Intern Med. 2004; 164:2229-2233. Available post-embargo at archinternmed.com.)

Editor's note: This study was supported by a grant from the Department of Veterans Affairs, Washington, DC.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

To contact Allan V. Prochazka, M.D., M.Sc., call Dana Berry at 303-315-5571.

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