Abstract
BackgroundTobacco dependence management is a multi-component intervention that includes pharmacological treatments such as Nicotine Substitution Therapy (NST) or bupropion, and psychological therapy. There are some preliminary reports on topiramate efficacy for tobacco dependence. The aim of this study is to determine whether topiramate is as effective as the standard NST treatment for tobacco cessation at 1-year follow-up in patients with depression.Method/designDesign: A randomised, controlled trial involving two groups, one of which is the control group consisting of patients on the standard pharmacological treatment for tobacco cessation (NST) and the other is the intervention group consisting of patients on topiramate as pharmacological treatment.Setting: 29 primary care health centres in the city of Zaragoza, Spain.Sample: 180 patients, aged 18–65 years, diagnosed with major depression, smoke more than 20 cigarettes/day, who have voluntarily asked for tobacco cessation therapy.Intervention: A multi-component programme for tobacco cessation is offered to all of the patients in the study. This programme is made up of pharmacological therapy + group cognitive-behavioural therapy. Pharmacological therapy consists of NST for the control group and topiramate (200 mg/day) for the intervention group. Psychological therapy is made up of 16 sessions of manualised group therapy.Measurements: Cessation will be assessed by patient self-declared abstinence, expired air carbon monoxide levels, and cotinine levels in saliva. Questionnaires on tobacco dependence, anxiety, depression, impulsiveness and self-efficacy will be administered. The interviewers will not know which group the patient belongs to (blind). The assessments will be carried out at baseline, D (cessation day) -1, D+1, weeks 1, 2, 3, 4, 6, 8, 10 and 13, and months 4, 5, 6, 8, 10 and 12.Main variables: Tobacco cessation rates and tobacco dependence.Analysis: The analysis will be per intent to treat. We will use the general linear models of the SPSS version 15 statistical package, to analyse the effect of the treatment on the result variable (tobacco cessation rate).DiscussionIt is necessary to develop new and more effective pharmacological treatments for tobacco cessation. This randomised clinical trial will determine whether topiramate is effective for tobacco cessation in patients with depression.Trial registrationCurrent Controlled Trials ISRCTN93532081
Highlights
Tobacco dependence management is a multi-component intervention that includes pharmacological treatments such as Nicotine Substitution Therapy (NST) or bupropion, and psychological therapy
It is necessary to develop new and more effective pharmacological treatments for tobacco cessation. This randomised clinical trial will determine whether topiramate is effective for tobacco cessation in patients with depression
Was subsequently approved as an anticonvulsant. It has increasingly been used in the treatment of numerous psychiatric conditions and it has been associated with weight loss, potentially relevant in reversing weight gain induced by psychotropic medications [14]
Summary
Tobacco dependence management is a multi-component intervention that includes pharmacological treatments such as Nicotine Substitution Therapy (NST) or bupropion, and psychological therapy. In Spain, the latest available data from the National Health Survey (Encuesta Nacional de Salud) in 2003 [2] describe a prevalence of tobacco consumption of 31%, with a decrease in consumption by males, and a small but significant increase in consumption by females, mainly in adolescents and young women. For these reasons tobacco use is considered a public health problem and its treatment constitutes a challenge for health services. There are some preliminary reports of its effectiveness for the treatment of tobacco dependence, despite these reports being substudies of other trials on alcohol dependence [16], uncontrolled studies with small samples [17] or short-term studies [18]
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