Impact of Nicotine Replacement Therapy on Post-Cessation Mood Profile by Pre-Cessation Depressive Symptoms
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Impact of Nicotine Replacement Therapy on Post-Cessation Mood Profile by PreCessation Depressive Symptoms Tellervo Korhonen1,3, Taru H. Kinnunen1, Arthur J. Garvey2 1
Tobacco Dependence Treatment and Research, Harvard School of Dental Medicine, Boston, MA; 2 Smoking Cessation Research Program, Harvard School of Dental Medicine, Boston, MA; 3 Department of Public Health, University of Helsinki, Finland This study was conducted within the Harvard School of Dental Medicine, Boston, USA. ABSTRACT: We evaluated the effects of Nicotine Replacement Therapy (NRT) on the Profile of Mood States (POMS), testing whether pre-cessation depressive symptoms modify NRT’s effects on POMS. Out of 608 smokers attempting to quit with NRT, this secondary analysis included 242 participants abstinent for at least two weeks. We measured pre-cessation depressive symptoms with the Center for Epidemiological Studies Depression Scale. At 1, 7, and 14 post-cessation days we examined 6 self-reported POMS, i.e. feeling ‘anxious’, ‘sad’, ‘confused’, ‘angry’, ‘energetic’ and ‘fatigue’. The results of the ANCOVA models suggested no NRT effects on feeling anxious, energetic or fatigue. We found that pre-cessation depression modified NRT effects in some specific mood states, such as depression by NRT- interaction effects on feeling confused and feeling angry. On average, the depressed participants in the placebo groups had the highest symptom scores. However, those depressed in NRT conditions did not have significantly higher symptom scores compared to the non-depressed groups. In treating those negative moods NRT may be particularly important for persons with depressive symptoms before cessation. KEYWORDS: Smoking cessation, Profile of Mood States, Depression, CES-D INTRODUCTION Prolonged tobacco use triples mortality rates, whereas smoking cessation halves or even avoids those hazards [1]. According to the PHS Clinical Practice Guidelines [2] two main treatments for tobacco dependence are behavioural counselling and pharmacotherapy. Six first-line pharmaco-therapies have been
identified that increase smoking abstinence, such as five forms of nicotine replacement therapy (NRT), including nicotine gum, inhaler, nasal spray, patch, and lozenge, and nonnicotine bupropion SR. Most smokers would like to stop smoking, but for many of them it is very difficult because of withdrawal symptoms [2]. According to the DSM-
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IV diagnostic criteria for nicotine withdrawal [3], the symptoms can appear within two hours after the last use of tobacco, and usually last from a few days to four weeks. Among the withdrawal signs several measurable symptoms have been identified, i.e. depressed mood, insomnia, irritability, anxiety, difficulty concentrating, restlessness, decreased heart rate, weight gain and craving [4]. These withdrawal signs may be conceptualized as cognitive, affective, somatic, and craving, although they are not mutually exclusive. For example, difficulty concentrating and impaired cognitive performance are ident
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