Summary
This Cochrane systematic review synthesises evidence from randomised controlled trials examining the efficacy and safety of antidepressant medications for tobacco smoking cessation. The review searched trials comparing antidepressants with placebo, no pharmacological treatment, alternative pharmacotherapies, or the same medication used differently, with primary outcome measurement at ≥6 months follow-up. Findings on efficacy appear limited and subject to imprecision, with sparse and inconsistent evidence regarding whether antidepressants (particularly bupropion and nortriptyline) offer particular benefit for smokers with current or previous depression.
Regional applicability
The findings are relevant to UK smoking cessation practice and prescribing guidance, as antidepressants are used within UK NHS services for this indication. However, the review's conclusion of limited and inconsistent evidence suggests caution in promoting antidepressants as a preferred cessation strategy compared to established interventions such as nicotine replacement therapy or varenicline.
Key measures
Smoking cessation rates at ≥6 months follow-up (biochemically validated where available); adverse events; serious adverse events; psychiatric adverse events; seizures; overdoses; suicide attempts; death by suicide; all-cause mortality; trial dropouts due to treatment
Outcomes reported
The study assessed the efficacy of antidepressant medications for long-term smoking cessation (abstinence after at least six months' follow-up) and examined harms including adverse events, serious adverse events, psychiatric complications, seizures, and all-cause mortality.
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