197. Specific Populations and Other Topics (Continued)

Treating Tobacco Use and Dependence: 2008 Update

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Evidence of effectiveness of tobacco dependence interventions in specific populations

Population of Smokers	Review of Evidence
Psychiatric disorders including substance use disorders	Meta-analysis (2008): Four studies met selection criteria and were relevant to a 2008 Guideline meta-analysis comparing antidepressants (bupropion SR and nortriptyline) vs. placebo for individuals with a past history of depression. Meta-analytic results showed that antidepressants, specifically bupropion SR and nortriptyline, are effective in increasing long-term cessation rates in smokers with a past history of depression (OR = 3.42; 95% C.I. = 1.70-6.84; abstinence rates = 29.9%, 95% C.I. = 17.5%-46.1%). It should be noted that these studies typically included intensive psychosocial interventions for all participants. Although psychiatric disorders may place smokers at increased risk for relapse, such smokers can be helped by tobacco dependence treatments. Some data suggest that bupropion SR and NRT may be effective for treating smoking in individuals with schizophrenia and may improve negative symptoms of schizophrenia and depressive symptoms. Data suggest that individuals on atypical antipsychotics may be more responsive to bupropion SR for treatment of tobacco dependence than are those taking standard antipsychotics.

Population of Smokers

Review of Evidence

Psychiatric disorders including substance use disorders

Meta-analysis (2008): Four studies met selection criteria and were relevant to a 2008 Guideline meta-analysis comparing antidepressants (bupropion SR and nortriptyline) vs. placebo for individuals with a past history of depression. Meta-analytic results showed that antidepressants, specifically bupropion SR and nortriptyline, are effective in increasing long-term cessation rates in smokers with a past history of depression (OR = 3.42; 95% C.I. = 1.70-6.84; abstinence rates = 29.9%, 95% C.I. = 17.5%-46.1%). It should be noted that these studies typically included intensive psychosocial interventions for all participants.
Although psychiatric disorders may place smokers at increased risk for relapse, such smokers can be helped by tobacco dependence treatments.
Some data suggest that bupropion SR and NRT may be effective for treating smoking in individuals with schizophrenia and may improve negative symptoms of schizophrenia and depressive symptoms. Data suggest that individuals on atypical antipsychotics may be more responsive to bupropion SR for treatment of tobacco dependence than are those taking standard antipsychotics.