Am J Psychiatry 1995; 152:398-403
Copyright © 1995 by American Psychiatric Association
Mood, major depression, and fluoxetine response in cigarette smokers
GW Dalack, AH Glassman, S Rivelli, L Covey and F Stetner
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York.
OBJECTIVE: Two smoking cessation studies provided venues to 1) look for
differences in affective symptoms between cigarette smokers with and
without a history of major depression or other psychiatric diagnoses who
were not currently depressed and 2) evaluate the efficacy of fluoxetine in
ameliorating affective symptoms in smokers with a history of major
depression but not currently depressed. METHOD: Part I: Three hundred
sixty-eight smokers who enrolled in a smoking cessation treatment study
completed baseline self-rating scales. The relationship between the scale
scores and a history of major depression and other psychiatric diagnoses
was examined. Part II: Thirty-nine smokers with a history of major
depression were enrolled in a randomized, double-blind study that examined
the utility of fluoxetine as an aid to smoking cessation. Self-rated scales
were compared at baseline and after 3 weeks of medication treatment before
the attempt to quit. RESULTS: A history of major depression had significant
main effects across all scale scores; subjects with such a history rated
themselves as more symptomatic. The effects of other psychiatric diagnoses
were neither as pervasive nor as robust. There were no differences in
baseline scores between the fluoxetine- and placebo-treated groups and no
change within the placebo group after 3 weeks. There was significant
improvement from baseline in several subscale scores for the group treated
with fluoxetine. However, comparison of the score changes for the placebo
and fluoxetine groups did not show a statistically significant difference,
which limited the ability to conclude that active treatment was better than
placebo. CONCLUSIONS: Subjects with a history of major depression, but
without current affective illness, reported themselves to be more
symptomatic than those without such-a history. Furthermore, in a group of
smokers with a history of major depression, affective symptoms, without
concurrent syndromal illness, may be ameliorated by treatment with
fluoxetine.
