Role of Nicotine GUM and Pretreatment Depressive Symptoms in Smoking Cessation: Twelve-Month Results of a Randomized Placebo Controlled Trial

Abstract

Objective: The aim was to investigate the role of nicotine gum and pre-treatment depressive symptoms in long-term smoking cessation. Methods: 12-month follow-up of 608 participants within a randomized, controlled trial was conducted. Participants received brief counseling plus nicotine or placebo treatment. Based on the Center for Epidemiological Studies Depression Scale pre-treatment score (≥ 16), 32% of the participants were classified as depressed at baseline. Results: At the 12-month follow-up the non-depressed participants with nicotine replacement therapy (NRT) were most successful (20.1%), while the depressed ones with placebo were least successful (5.7%) ( p = .004). However, the depressed participants with NRT (15.1%) were not significantly less successful than the non-depressed ones with NRT (20.1%, p = .23). Survival analysis showed significant depression ( p = .01) and treatment effects ( p = < .001) on the abstinence. Further, when adjusted for marital status and education, the treatment effect remained significant ( p < .001), whereas the depression effect became non-significant ( p = .08). Conclusions: NRT improved cessation both among the depressed and non-depressed. To understand discrepancies in literature reporting depression and smoking cessation outcome, the pharmacological treatment modality and social-demographic variables should be examined as additional variables.