Effectiveness of pharmacological or psychological interventions for smoking cessation in smokers with major depression or depressive symptoms: A systematic review of the literature

Background: Smokers with major depressive disorder (MDD) or depressive symptoms (DS) represent a subgroup in need of attention since they have specific clinical features and prognosis. Methods: A systematic review of the literature (Cochrane, MEDLINE, ScienceDirect, Web Of Science databases from inception to June 2017) of randomized clinical trials assessing the effectiveness of pharmacological, psychological or combined interventions for smoking cessation in subjects with current or past MDD/DS without medical or comorbid psychiatric disorder(s) was run following the PRISMA guidelines. Results: Twenty-seven studies met the inclusion criteria. Nicotine, varenicline, Stage Care Intervention were more effective in smokers with current MDD; nicotine, fluoxetine plus nicotine were more effective in smokers with DS; nicotine plus fluoxetine or naltrexone were more effective in smokers with severe current DS. Cognitive Behavioural Therapy and Cognitive and Behavioural Cessation and relapse prevention skills training were superior to placebo in smokers with past MDD. Conclusions: More research is needed into effectively addressing smoking in people with concurrent mental disorder. Data currently available are in need to be confirmed in randomized trials aimed at replicating the results and disentangling the effects of each therapeutic ingredient when a combination therapy is proposed. Studies on tolerability of treatments are warranted as well as those aimed at identifying factors of vulnerability to adverse effects.