Influence of fluoxetine on positive and negative affect in a clinic-based smoking cessation trial

Abstract

Rationale-Fluoxetine improves affect in clinical syndromes such as depression and premenstrual dysphoric disorder. Little is known about fluoxetine's influence on mood changes after quitting smoking, which often resemble sub-clinical depression.Objectives-The present study, a re-analysis of previously published data , examined fluoxetine's effect on changes in negative and positive affect following quitting smoking.Methods-Adult smokers (n=175) without clinically significant depression were randomized on a double-blind basis to receive fluoxetine hydrochloride (30 or 60 mg daily) or placebo for 10 weeks in combination with cognitive-behavioral therapy (CBT) for smoking cessation. We postulated that fluoxetine would beneficially influence post-cessation changes in positive and negative affect.Results-Mood change across treatment was analyzed using mixed linear modeling controlling for initial level of nicotine dependence, plasma fluoxetine metabolites, and change in cotinine (a nicotine metabolite) at each visit. Relative to placebo, those on 60 mg fluoxetine experienced an elevation in positive affect that increased across time [t(526) Conclusions-Results indicate that 60 mg of fluoxetine improves both positive and negative mood states after quitting smoking and that diminished positive affect may be an overlooked affective response to smoking cessation.

Genetic variation in the serotonin pathway and smoking cessation with nicotine replacement therapy: New data from the Patch in Practice trial and pooled analyses

“…There is as yet no evidence indicating that 5-HT neurotransmission is a critical neurological substrate for the process of smoking cessation per se or for a putative role in suppressing nicotine withdrawal in smokers administered NRT. Although our results do not support a moderating role of these specific serotonergic candidate gene variants on smoking cessation in treatment seeking smokers using NRT, it remains to be seen whether or not these genetic variants influence the efficacy of other agents such as SSRIs for smoking cessation, which have been associated with decreased craving and negative affect during quit attempts and may portend a modest benefit for smoking cessation (Cook et al, 2004;Killen et al, 2000;Niaura et al, 2002). Indeed, Killen et al (2000) demonstrated that paroxetine reduced tobacco craving, and Cook et al (2004) observed that fluoxetine was associated with lower negative and positive affect during periods of abstinence in smokers undergoing quit attempts.…”

Nicotine effects on affective response in depression-prone smokers

“…Largely neglected has been the question of whether drug self-administration can help overcome pleasure deficits and instantiate positive emotions. In prior work (Werth Cook et al 2004b), we found that anhedonic smokers in early nicotine withdrawal were prone to cigarette cravings that were mediated by decreased positive mood, rather than by increased negative mood. Likewise, the current findings suggest that self-administering nicotine to enhance pleasure is at least as important an aspect of the depression-prone smoker's attachment to cigarettes as is the use of cigarettes to dispel negative mood.…”

Dimensions of depressive symptoms and smoking cessation

“…Studies examining the effects of pharmacotherapies on affect have shown that fluoxetine (Cook, Spring, McChargue, Borrelli et al, 2004), bupropion (Shiffman et al, 2000), and transdermal nicotine (Strasser et al, 2005) elevate (or prevent reductions in) PA in the context of smoking cessation. Given the influence of low PA on outcome, these treatments may be especially useful for smokers with elevated anhedonic-depressive symptoms.…”