Dalack G W, Glassman A H, Rivelli S, Covey L, Stetner F
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York.
Am J Psychiatry. 1995 Mar;152(3):398-403. doi: 10.1176/ajp.152.3.398.
Two smoking cessation studies provided venues to 1) look for differences in affective symptoms between cigarette smokers with and without a history of major depression or other psychiatric diagnoses who were not currently depressed and 2) evaluate the efficacy of fluoxetine in ameliorating affective symptoms in smokers with a history of major depression but not currently depressed.
Part I: Three hundred sixty-eight smokers who enrolled in a smoking cessation treatment study completed baseline self-rating scales. The relationship between the scale scores and a history of major depression and other psychiatric diagnoses was examined. Part II: Thirty-nine smokers with a history of major depression were enrolled in a randomized, double-blind study that examined the utility of fluoxetine as an aid to smoking cessation. Self-rated scales were compared at baseline and after 3 weeks of medication treatment before the attempt to quit.
A history of major depression had significant main effects across all scale scores; subjects with such a history rated themselves as more symptomatic. The effects of other psychiatric diagnoses were neither as pervasive nor as robust. There were no differences in baseline scores between the fluoxetine- and placebo-treated groups and no change within the placebo group after 3 weeks. There was significant improvement from baseline in several subscale scores for the group treated with fluoxetine. However, comparison of the score changes for the placebo and fluoxetine groups did not show a statistically significant difference, which limited the ability to conclude that active treatment was better than placebo.
Subjects with a history of major depression, but without current affective illness, reported themselves to be more symptomatic than those without such-a history. Furthermore, in a group of smokers with a history of major depression, affective symptoms, without concurrent syndromal illness, may be ameliorated by treatment with fluoxetine.
两项戒烟研究提供了这样的契机：1）探究目前未患抑郁症的有或无重度抑郁史或其他精神疾病诊断的吸烟者在情感症状方面的差异；2）评估氟西汀改善有重度抑郁史但目前未患抑郁症的吸烟者情感症状的疗效。
第一部分：参与戒烟治疗研究的368名吸烟者完成了基线自评量表。研究了量表得分与重度抑郁史及其他精神疾病诊断之间的关系。第二部分：39名有重度抑郁史的吸烟者参与了一项随机双盲研究，该研究考察了氟西汀辅助戒烟的效用。在尝试戒烟前，比较了用药治疗3周前后的基线自评量表得分。
重度抑郁史对所有量表得分均有显著的主效应；有该病史的受试者自我评定症状更多。其他精神疾病诊断的影响既不普遍也不显著。氟西汀治疗组和安慰剂治疗组的基线得分无差异，安慰剂组在3周后也无变化。氟西汀治疗组的几个子量表得分较基线有显著改善。然而，安慰剂组和氟西汀组得分变化的比较未显示出统计学上的显著差异，这限制了得出积极治疗优于安慰剂这一结论的能力。
有重度抑郁史但目前无情感疾病的受试者自我报告的症状比无该病史的受试者更多。此外，在一组有重度抑郁史的吸烟者中，对于无并发综合征性疾病的情感症状，氟西汀治疗可能会有所改善。
