抗焦虑药和抗抑郁剂用于戒烟
2009/07/30
目的：评价抗焦虑药和抗抑郁剂对于长期戒烟的作用。
检索策略：我们搜索烟草成瘾实验协作网的显示的实验能在一下的索引中找到，包括：Medline, Embase, SciSearch and PsycLit, 和会议摘要.
入选标准：抗焦虑药或抗抑郁剂对安慰剂或替代疗法的随机对照戒烟，剔除随访少于6周的实验。
数据收集和分析：抽取的数据来自研究人数的规模，药物治疗的性质，结果的测量，随机方法相同，以及完成随访的研究。主要的结果测量是戒烟从基线开始至少随访6个月。对于每个实验我们要求最严格的戒烟的定义，生物化学验证。Meta-分析用的是固定效应模型。
主要结果：一个抗焦虑药（安定、眠尔通、美托洛尔、心得平）的实验，两个丁螺环酮的实验，两个去甲替林的实验，他们都没有显示出能够帮助戒烟的证据，有一个抗抑郁药的实验（百忧解，摩氯苯胺），两个去甲替林的实验，四个安非他酮的实验。去甲替林和安非他酮可以提高戒烟的效果，其他抗抑郁药也可能有效。一个实验发现：安非他酮联合尼古丁贴片效果优于单用尼古丁贴片。
实验结论：有很少的证据显示抗焦虑能够帮助戒烟，一些抗抑郁剂（安非他酮，去甲替林）可以帮助戒烟，这些作用是不是特异性的还不太清楚。
（刘超武编译 刘国梁审校）
Cochrane Database Syst Rev. 2000;(2):CD000031
Update in: Cochrane Database Syst Rev. 2000;(4):CD000031
Anxiolytics and antidepressants for smoking cessation.
Hughes JR, Stead LF, Lancaster T.
Department of Psychiatry, University of Vermont, 38 Fletcher Place, Burlington, Vermont 05401-1419, USA. john.hughes@uvm.edu
BACKGROUND: There are two reasons to believe antidepressants and anxiolytics might help in smoking. First, anxiety and depression are symptoms of nicotine withdrawal, and smoking cessation sometimes precipitates depression. Second, smoking appears to be due, in part, to deficits in dopamine, serotonin and norepinephrine, all of which are increased by anxiolytics and antidepressants.
OBJECTIVES: The aim of this review is to assess the effectiveness of such drugs in aiding long term smoking cessation. The drugs include bupropion; buspirone; diazepam; doxepin; fluoxetine; imipramine; meprobamate; moclobemide; nortriptyline; tryptophan; ondansetron; venlafaxine and the beta-blockers metoprolol, oxprenolol and propanolol.
SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register which includes trials indexed in Medline, Embase, SciSearch and PsycLit, and meetings abstracts.
SELECTION CRITERIA: We considered randomized trials comparing anxiolytic or antidepressant drugs to placebo or an alternative therapeutic control for smoking cessation. We excluded trials with less than 6 months follow-up.
DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of study population, the nature of the drug therapy, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed effects model.
MAIN RESULTS: There was one trial each of the anxiolytics diazepam, meprobamate, metoprolol and oxprenolol. There were two trials of the anxiolytic buspirone. None of these showed evidence of effectiveness in helping smokers to quit. There was one trial each of the antidepressants fluoxetine and moclobemide, two of nortriptyline, and four trials of bupropion. Nortriptyline and bupropion increased cessation and other antidepressants might also be effective. One trial found combined bupropion and nicotine patch produced higher quit rates than patch alone.
REVIEWER’S CONCLUSIONS: There is little evidence that anxiolytics aid smoking cessation. Some antidepressants (bupropion and nortriptyline) can aid smoking cessation. It is not clear whether these effects are specific for individual drugs, or a class effect.
PMID: 10796472 [PubMed - indexed for MEDLINE]
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用于戒烟的尼古丁替代疗法
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尼古丁受体部分激动剂用于戒烟
