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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. Tukeys 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 groups being 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_at_hs
dm.harvard.edu
Taru Mustonen (Kinnunen),
PhD, taru_mustonen_at_hsdm.harvard.edu
Arthur
J. Garvey, PhD, arthur_garvey_at_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 to quitters low in depressive symptoms?

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METHODS
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Study Flow Chart
608 smokersrecruited in a RCT with NRT
Abstinent at least 2 weeks n242
Depressed(High in depressive symptoms CESDgt15)
Not depressed(Low in depressive symptoms
CESDlt15)
NRT Nicotine gumn50
Placebogumn13
Placebogumn44
NRT Nicotine gumn135
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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)

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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 )

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RESULTS
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ANXIETY SCORES AMONG NON-DEPRESSED
DEPRESSEDEFFECTS OF NRT(Results of ANCOVA with
baseline score as covariate)
Depression main effect (p.03)
12
IRRITABILITY SCORES AMONG NON-DEPRESSED
DEPRESSEDEFFECTS OF NRT (Results of ANCOVA with
baseline score as covariate)
Depression X NRT Interaction (p.02)
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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)
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DIFFICULTY CONCENTRATING SCORES AMONG
NON-DEPRESSED DEPRESSEDEFFECTS OF NRT (Results
of ANCOVA with baseline score as covariate)
DepressionxNRT-Interaction(p.005)
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FEELING FATIGUE SCORES AMONG NON-DEPRESSED
DEPRESSEDEFFECTS OF NRT (Results of ANCOVA with
baseline score as covariate)
No significant effects
16
WEIGHT CHANGE AMONG NON-DEPRESSED
DEPRESSEDEFFECTS OF NRT (Results of ANCOVA with
baseline score as covariate)
No significant effects
17
BRADYKARDIA AMONG NON-DEPRESSED
DEPRESSEDEFFECTS OF NRT (Results of ANCOVA with
baseline score as covariate)
NRT main effect (p.001)
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CONCLUSIONS
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• Among two weeks abstinent participants
• Depression x NRT - interaction
• was found in
• Irritability/hostility
• Depressed mood
• Difficulties concentrating

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• 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.