Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and incomplete outcome data in half of the studies, and lack of blinding) and by imprecise results (few outcome events).
A Cochrane review [Abstract] 1 included 33 studies investigatinfg smoking cessation interventions with specific mood management components for depression. In smokers with current depression, meta-analysis showed a significant positive effect for adding psychosocial mood management to a standard smoking cessation intervention when compared with standard smoking cessation intervention alone (RR 1.47, 95% CI 1.13 to 1.92; 11 trials, n=1844). In smokers with past depression there was a similar effect (RR 1.41, 95% CI 1.13 to 1.77; 13 trials, n=1496). Meta-analysis resulted in a positive effect, although not significant, for adding bupropion compared with placebo in smokers with current depression (RR 1.37, 95% CI 0.83 to 2.27; 5 trials, n=410). Bupropion (RR 2.04, 95% CI 1.31 to 3.18; 4 trials, n=404) might significantly increase long-term cessation among smokers with past depression when compared with placebo. There were not enough data to evaluate the effectiveness of fluoxetine and paroxetine for smokers with current depression or fluoxetine, nortriptyline, paroxetine, selegiline, and sertraline in smokers with past depression.
A meta-analysis 2 assessed smoking cessation interventions for smokers with current depression. 16 RCTs and 4 secondary studies were included. 3 types of intervention were examined: psychological (6/30%), pharmacological (6/30%) or combined (8/40%). Smoking cessation interventions appear to increase short-term (RR 1.26, 95% CI 1.12 to 1.41, p < .001, I²=64%) and long-term (RR 1.14, 95% CI 1.01 to 1.29, p = .048, I²=42%). Psychological treatments found a positive trend, although not significant, at both short (RR 1.06, 95% CI 0.90 to 1.24) and long-term follow-up (RR 1.02, 95% CI 0.88 to 1.18). There was stronger effect among studies that provided pharmacological treatments than in studies using psychological treatments. Smoking abstinence appears to be associated with an improvement in depressive symptoms.
Date of latest search: 28 December 2019
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