Smoking Cessation Interventions for Patients with Depression: A Systematic Review and Meta-analysis

Abstract

OBJECTIVES:We conducted a systematic literature review of smoking cessation interventions for patients with histories of depressive disorders or current significant depressive symptoms. We examined the comparative effectiveness of smoking cessation strategies on abstinence rates, differential effects of cessation strategies by depression status (i.e., history positive vs. current depression), and differential effects by gender. DATA SOURCES: Peer-reviewed literature in MEDLINE, Embase, PsycINFO, and Cochrane Library. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: Randomized controlled trials or secondary analysis of RCT data comparing two or more smoking cessation interventions or intervention to control, and reporting cessation outcomes in adults with depression. STUDY APPRAISAL AND SYNTHESIS METHODS: Two trained researchers screened articles for inclusion. When possible, we estimated pooled risk ratios with 95% confidence intervals by using a random effects model with the Mantel-Haenszel method. We synthesized other studies qualitatively. We classified each intervention as antidepressants, nicotine replacement therapy (NRT), brief smoking cessation counseling, smoking cessation behavioral counseling, or behavioral mood management. RESULTS: We identified 16 unique RCTs, of which, only three trials recruited participants with current depression. Meta-analysis demonstrated a small, positive effect of adding behavioral mood management (RR = 1.41, 95% CI 1.01-1.96). All included antidepressant trials showed small, positive effects, but risk ratio summary was not significant (RR = 1.31, 95% CI 0.73-2.34). Three NRT trials demonstrated small, positive effects on smoking cessation rates. We found insufficient evidence to examine gender and depression status moderator effects. LIMITATIONS: Few RCTs exist that test smoking cessation interventions among adults with depression. To make meaningful comparisons, we created broad intervention categories that contained heterogeneity. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:Few trials enrolled smokers with current depression. Most of data identified were from subgroup analyses of patients history-positive for depression. However, several promising interventions exist. Healthcare providers should consider encouraging their patients with significant depressive symptoms or depression histories to seek smoking cessation services that include NRT and behavioral mood management.

Depression and cigarette smoking behavior: A critical review of population-based studies

“…It may be beneficial to target these aspects of smoking when developing and administering pharmacological and behavioral smoking cessation services to adults with depression. In addition, smoking interventions that include mood management components improve quit outcomes compared to standard interventions (83,84) suggesting the importance of addressing depressive symptoms during smoking cessation efforts.…”

Co-morbid tobacco use disorder and depression: A re-evaluation of smoking cessation therapy in depressed smokers

“…46 A systematic review 47 of 49 randomized controlled trials examining smoking cessation outcomes in smokers with past or current depression found that adding a psychosocial mood management component to a standard smoking cessation intervention, compared with standard smoking cessation alone, increases cessation rates for smokers with current or past depression. In addition, a recent review 48 found that including a behavioral mood management component as well as nicotine replacement therapy has a small, beneficial effect on depressed smokers' ability to quit. These findings suggest that smokers with past or current depression are capable of quitting and may benefit from the development of treatments specifically tailored to their dual diagnosis.…”

Perceived risks to smoking cessation among treatment-seeking French light smokers

“…In line with this reasoning, light smokers who described using cigarettes as antidepressants or prop for moral support would understandably be more likely to relapse, especially women (Weinberger et al, 2012). A more intensive follow-up combining cessation counselling with psychological support or negative affect management may facilitate cessation among light smokers presenting with an anxio-depressive profile (Blalock et al, 2008;Gierisch et al, 2012;Weinberger et al, 2012).…”