Despite mountains of evidence confirming the dangers of tobacco, smoking continues to be one of the world’s greatest public health crises. Habitual smokers face greater risks of heart disease, stroke, cancer, and breathing disorders like chronic obstructive pulmonary disease. The nicotine in tobacco is powerfully addictive, making smoking cessation an uphill battle. Typical nicotine withdrawal symptoms include anxiety, depression, sleep disturbances, and irritability. Both pharmaceutical and behavioral interventions improve the odds of abstinence, but there’s still no “silver bullet” for smoking cessation. Research on the use of antidepressants in smoking cessation has delivered mixed results.
Previous studies have shown that selective serotonin reuptake inhibitors, the most commonly prescribed antidepressants today, reduce the initial withdrawal symptoms from nicotine, including depression and anxiety. However, these reductions do not correlate with higher rates of long-term abstinence. Instead, nicotine replacement therapies plus behavioral counseling appears to offer the greatest odds of successful smoking cessation. A recent study in the United Kingdom tested the effectiveness of combining Aventyl (nortriptyline), a tricyclic antidepressant, with nicotine replacement therapy. Nearly 900 participants were enrolled in the study from stop-smoking clinics affiliated with the U.K. National Health Service. About half received the medication, and the remainder received placebo. All participants had their choice of nicotine replacement therapy. Phone interviews and follow-up saliva testing were the primary methods for determining withdrawal symptoms and successful abstinence.
As expected, Aventyl was more successful than placebo at reducing initial anxiety and depression. Side effects of the medication were generally minor and included dry mouth and difficulty urinating. These effects diminished with time. In the long run, however, Aventyl was not more effective at producing abstinence. Rates of smoking cessation at 6 months and 1 year were not significantly greater in the medication group as opposed to the placebo group. Nonadherence may partially account for this disparity. As the worst of the withdrawal symptoms pass, patients are vulnerable to letting their guard down and relapsing.
Researchers concluded that, while taking Aventyl is not dangerous, there’s no compelling reason to add Aventyl to a smoking cessation regimen. It’s no more effective than nicotine replacement therapy alone. In cases where anxiety or depression are preexisting or anticipated to be severe, then perhaps antidepressants have a purpose. Otherwise, the benefits are far too slight to justify the potential risks.
- Aveyard, P., Johnson, C., Fillingham, S., Parsons, A., Murphy, M. (2008). Nortriptyline plus nicotine replacement versus placebo plus nicotine replacement for smoking cessation: Pragmatic randomized controlled trial. BMJ, 336(7655), 1223-1227.
- PubMed Health [Internet]. (n.d.). Bethesda, MD: National Library of Medicine. Nortriptyline. Retrieved March 27, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000732/
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