1 / 21

PROBLEM

WITHDRAWAL SYMPTOMS AMONG DEPRESSED & NON-DEPRESSED SMOKERS: EFFECTS OF NICOTINE REPLACEMENT THERAPY.

penda
Download Presentation

PROBLEM

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. WITHDRAWAL SYMPTOMS AMONG DEPRESSED & NON-DEPRESSED SMOKERS: EFFECTS OF NICOTINE REPLACEMENT THERAPY Problem: Withdrawal symptoms and depression remain major impediments for smoking cessation. We examined how Nicotine Replacement Therapy (NRT) affects tobacco withdrawal symptoms during 2 weeks of post-cessation among depressed and non-depressed smokers. Methods: We recruited 608 smokers, attempting to quit within a randomized controlled trial. Participants were provided nicotine or placebo gum and brief counseling. For this study we analyzed data among 242 (39.8%) quitters who remained abstinent for at least 2 weeks. We measured withdrawal at 1, 7 and 14 post-cessation days. We used the Center of Epidemiological Studies Depression Scale to measure depressive symptoms, and found that 32% of the participants met the criterion for depression at baseline. We measured as withdrawal symptoms anxiety, irritability, depressed mood, difficulties concentrating, fatigue, weight gain, and bradykardia. We used a mixed-design ANCOVA (Depression x NRT x Time, baseline measure as covariate) to assess withdrawal. Tukey’s tests for unequal sample sizes were used as post hoc tests. Results: We found Depression x NRT- interaction effects in irritability, depressed mood, and difficulties concentrating. Depressed in NRT condition had lower symptom scores than depressed in placebo group. Among non-depressed no such difference was found. A significant NRT main effect was found in bradykardia, heart rate levels in placebo groupsbeing lower than those in NRT groups among both depressed and non-depressed.Conclusion: NRT may be particularly helpful among depressed in alleviating affective withdrawal symptoms, such as irritability and depressed mood, and cognitive symptoms, such as difficulties concentrating. In alleviating somatic symptoms NRT has similar effects among depressed and non-depressed. Tellervo Korhonen, PhD, tellervo_korhonen@hsdm.harvard.edu Taru Mustonen (Kinnunen), PhD, taru_mustonen@hsdm.harvard.edu Arthur J. Garvey, PhD, arthur_garvey@hsdm.harvard.edu

  2. PROBLEM

  3. Tobacco withdrawal symptoms & depressive symptoms are major impediments for smoking cessation.

  4. The effectiveness of NRT in smoking cessation has been proved in numerous studies • However, the success rates in clinical trials using NRT have decreased during the past years • Thus, there is need for more information on NRT effects among various subgroups of smokers

  5. How does NRT affect tobacco withdrawal symptoms among quitters high in depressive symptoms compared toquitters low in depressive symptoms?

  6. METHODS

  7. Study Flow Chart 608 smokersrecruited in a RCT with NRT Abstinentat least 2 weeks n=242 Depressed(High in depressive symptoms = CESD>15) Not depressed(Low in depressive symptoms = CESD<15) NRT Nicotine gumn=50 Placebogumn=13 NRT Nicotine gumn=135 Placebogumn=44

  8. Depression Measured at Baseline • To measure depression status at baseline we used the Center for Epidemiological Studies Depression Scale (CESD-D) • 20 items on how frequently a person had experienced a given symptom during the past week • Responses were summed to create a depression score (range from 0 to 60) • Those who scored higher than 15 were classified as depressed (high in depressive symptoms)

  9. Withdrawal Symptoms Measured at 1, 7 and 14 days Post-cessation • Five items from the Profile of Mood States(POMS: each item range 0-4): • Anxiety (Tension) • Irritability (Hostility, Anger, Frustration) • Depressed Mood (Sad Mood) • Difficulty Concentrating • Feeling Fatigue (related to sleeping disorders) • Weight Gain (related to increased appetite) • Bradykardia (related to decreased heart rate )

  10. RESULTS

  11. ANXIETY SCORES AMONG NON-DEPRESSED & DEPRESSED:EFFECTS OF NRT(Results of ANCOVA with baseline score as covariate) Depression main effect (p=.03)

  12. IRRITABILITY SCORES AMONG NON-DEPRESSED & DEPRESSED:EFFECTS OF NRT(Results of ANCOVA with baseline score as covariate) Depression X NRT Interaction (p=.02)

  13. DEPRESSED MOOD SCORES AMONG NON-DEPRESSED & DEPRESSED: EFFECTS OF NRT(Results of ANCOVA with baseline score as covariate) Depressionmain effect (p=.002)NRT main effect(p=.03)Depression xNRT -Interaction(p=.06)

  14. DIFFICULTY CONCENTRATING SCORES AMONG NON-DEPRESSED & DEPRESSED:EFFECTS OF NRT (Results of ANCOVA with baseline score as covariate) DepressionxNRT-Interaction(p=.005)

  15. FEELING FATIGUE SCORES AMONG NON-DEPRESSED & DEPRESSED:EFFECTS OF NRT(Results of ANCOVA with baseline score as covariate) No significant effects

  16. WEIGHT CHANGE AMONG NON-DEPRESSED & DEPRESSED:EFFECTS OF NRT(Results of ANCOVA with baseline score as covariate) No significant effects

  17. BRADYKARDIA AMONG NON-DEPRESSED & DEPRESSED:EFFECTS OF NRT(Results of ANCOVA with baseline score as covariate) NRT main effect (p=.001)

  18. CONCLUSIONS

  19. Among two weeks abstinent participants Depression x NRT -interaction was found in • Irritability/hostility • Depressed mood • Difficulties concentrating

  20. Only NRT main effect was found in heart rate.

  21. In alleviating affective and cognitive withdrawal symptoms NRT may be particularly helpful among depressed. In alleviating somatic symptoms NRT has similar effects among depressed and non-depressed.

More Related