Hughes J R, Stead L F, Lancaster T
Department of Psychiatry, University of Vermont, 38 Fletcher Place, Burlington, Vermont 05401-1419, USA.
Cochrane Database Syst Rev. 2000(4):CD000031. doi: 10.1002/14651858.CD000031.
There are two reasons to believe antidepressants might help in smoking cessation. First, depression may be a symptom of nicotine withdrawal, and smoking cessation sometimes precipitates depression. Second, smoking appears to be due, in part, to deficits in dopamine, serotonin and norepinephrine, all of which are increased by antidepressants.
The aim of this review is to assess the effectiveness of antidepressant medications in aiding long term smoking cessation. The drugs include bupropion; doxepin; fluoxetine; imipramine; moclobemide; nortriptyline; selegiline; sertraline, tryptophan and venlafaxine.
We searched the Cochrane Tobacco Addiction Group trials register which includes trials indexed in Medline, Embase, SciSearch and PsycLit, and other reviews and meeting abstracts.
We considered randomized trials comparing antidepressant drugs to placebo or an alternative therapeutic control for smoking cessation. We excluded trials with less than 6 months follow-up.
We extracted data in duplicate on the type of study population, the nature of the drug therapy, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed effects model.
There was one trial each of moclobemide, sertraline and venlafaxine, two of fluoxetine and nortriptyline, and five trials of bupropion, one of which tested long term use to prevent relapse. Nortriptyline and bupropion both increased cessation. In one trial the combination of bupropion and nicotine patch produced higher quit rates than patch alone.
REVIEWER'S CONCLUSIONS: Some antidepressants (bupropion and nortriptyline) can aid smoking cessation. It is not clear whether these effects are specific for individual drugs, or a class effect.
有两个理由相信抗抑郁药可能有助于戒烟。其一，抑郁可能是尼古丁戒断的一种症状，且戒烟有时会引发抑郁。其二，吸烟似乎部分归因于多巴胺、血清素和去甲肾上腺素的缺乏，而抗抑郁药会增加这些物质的含量。
本综述的目的是评估抗抑郁药物在帮助长期戒烟方面的有效性。这些药物包括安非他酮；多塞平；氟西汀；丙咪嗪；吗氯贝胺；去甲替林；司来吉兰；舍曲林、色氨酸和文拉法辛。
我们检索了Cochrane烟草成瘾小组试验注册库，其中包括在Medline、Embase、SciSearch和PsycLit中索引的试验，以及其他综述和会议摘要。
我们纳入了比较抗抑郁药物与安慰剂或用于戒烟的替代治疗对照的随机试验。我们排除了随访时间少于6个月的试验。
我们对研究人群类型、药物治疗性质、结局指标、随机化方法和随访完整性的数据进行了重复提取。主要结局指标是基线时吸烟的患者在至少6个月随访后戒烟情况。我们对每个试验使用了最严格的戒烟定义，如有可用数据则采用生化验证率。在适当情况下，我们使用固定效应模型进行荟萃分析。
吗氯贝胺、舍曲林和文拉法辛各有1项试验，氟西汀和去甲替林各有2项试验，安非他酮有5项试验，其中1项测试了长期使用以预防复发。去甲替林和安非他酮均提高了戒烟成功率。在1项试验中，安非他酮与尼古丁贴片联合使用产生的戒烟率高于单独使用贴片。
一些抗抑郁药（安非他酮和去甲替林）可帮助戒烟。尚不清楚这些效果是个别药物特有的，还是类效应。
