Chengappa K N, Kambhampati R K, Perkins K, Nigam R, Anderson T, Brar J S, Vemulapalli H K, Atzert R, Key P, Kang J S, Levine J
Western Psychiatric Institute and Clinic, University of Pittsburgh, Mayview State Hospital, PA 15213, USA.
J Clin Psychiatry. 2001 Jul;62(7):503-8. doi: 10.4088/jcp.v62n07a01.
Patients with depressive disorders smoke tobacco more often than the population at large and find quitting more difficult. Furthermore, when they quit smoking, they are more likely to suffer a relapse of depression. We evaluated the addition of bupropion sustained release (SR) for smoking cessation among patients with a history of depressive disorders being maintained in a euthymic state with selective serotonin reuptake inhibitor (SSRI) antidepressants.
Twenty-five adults with DSM-IV major depressive disorder or depressive disorder NOS currently receiving SSRI maintenance treatment and smoking > or = 15 cigarettes per day participated in the 9-week study. Bupropion SR, 150 mg/day, was added to SSRI treatment and increased to 300 mg/day. Subjects were counseled on smoking cessation measures and chose a target quit date 2 or 4 weeks after the initiation of bupropion SR. Self-reported smoking status, expired carbon monoxide (CO) measurements, Hamilton Rating Scales for Depression and Anxiety scores, and weight were measured at each visit. Subjects were abstinent if they reported not smoking during the prior 7 days, confirmed with an expired-air CO value of < or = 10 ppm.
Eight (32%) of 25 subjects were abstinent after 9 weeks. At 3-month follow-up, 3 subjects remained abstinent, 3 relapsed, and 2 were lost to follow-up. Eleven subjects (44%) were nonresponders, and 6 (24%) dropped out prior to 3 weeks of treatment due to side effects (N = 3) or were lost to follow-up (N = 3). Mean weight gain was approximately 0.5 lb (0.2 kg) for those completing 9 weeks of bupropion SR treatment. During the 9-week study and the 3-month follow-up, there was no evidence of emergent depression in any subject. Four subjects (16%) spontaneously reported an improvement in SSRI-associated sexual dysfunction.
These open data suggest modest effectiveness for and the safety of bupropion SR as a smoking cessation agent in individuals with depression maintained on treatment with SSRIs. Minimal weight gain, lack of emergent depressive episodes, and improvement of SSRI-associated sexual dysfunction are added advantages.
与普通人群相比，抑郁症患者吸烟更为频繁，且戒烟更为困难。此外，当他们戒烟时，更有可能出现抑郁症复发。我们评估了在使用选择性5-羟色胺再摄取抑制剂（SSRI）类抗抑郁药维持在心境正常状态的抑郁症病史患者中加用安非他酮缓释剂（SR）用于戒烟的效果。
25名患有DSM-IV重度抑郁症或未特定的抑郁症且目前正在接受SSRI维持治疗、每天吸烟≥15支的成年人参与了这项为期9周的研究。在SSRI治疗基础上加用150毫克/天的安非他酮SR，并增至300毫克/天。向受试者提供戒烟措施咨询，并让他们选择在安非他酮SR开始使用后2或4周的目标戒烟日期。每次访视时测量自我报告的吸烟状况、呼出一氧化碳（CO）含量、汉密尔顿抑郁和焦虑量表评分以及体重。如果受试者报告在前7天内未吸烟，且呼出气体CO值≤10 ppm，则判定为戒烟成功。
25名受试者中有8名（32%）在9周后戒烟成功。在3个月的随访中，3名受试者仍保持戒烟状态，3名复发，2名失访。11名受试者（44%）无反应，6名（24%）在治疗3周前因副作用（N = 3）退出或失访（N = 3）。完成9周安非他酮SR治疗的受试者平均体重增加约0.5磅（0.2千克）。在9周的研究和3个月的随访期间，没有任何受试者出现新发抑郁症的迹象。4名受试者（16%）自发报告SSRI相关性功能障碍有所改善。
这些开放性数据表明，对于使用SSRI治疗的抑郁症患者，安非他酮SR作为戒烟药物有一定疗效且安全。体重增加极少、无新发抑郁发作以及SSRI相关性功能障碍得到改善是额外的优点。
