Smoking Cessation Intervention for Depressed Smokers: Treatment Development

描述（由申请人提供）：为当前患有抑郁症的吸烟者开发有效的戒烟治疗方法，可能对降低与吸烟相关的总体发病率和死亡率具有重要的临床和公共卫生意义。每年死于吸烟相关原因的美国人中，有相当一部分人一生中都有重度抑郁症病史，抑郁症与医疗发病率和死亡率的增加密切相关。同时患有抑郁症的吸烟者可能是患吸烟相关疾病风险最大的人群之一。由于戒烟治疗研究传统上排除了患有重度抑郁症（MOD）的吸烟者，因此对于更严重的抑郁症状对戒烟结果的影响知之甚少。然而，有大量的数据表明，亚综合征水平的抑郁症状预示着戒烟失败。目前患有抑郁症的吸烟者的抑郁症状可能对戒烟造成更大的障碍。这些人可能需要额外的治疗，针对他们的抑郁症状之前，他们将成功地实现禁欲。本研究的目的是对心理治疗认知行为分析系统（CBASP）的效果进行初步测试，这是一种现有的治疗方法，已被发现在治疗慢性抑郁症方面有效，与标准戒烟治疗（CBASP/ST）相结合。本研究将招募60名目前患有MOD的吸烟者，随机分配到CBASP/ST治疗组或单独的标准戒烟治疗组（ST）。在这两种情况下，尼古丁贴片都将作为标准治疗的一部分。基于这一初步试验的结果，CBASP/ST治疗方案将进一步完善，并准备进行更大规模的临床试验。

DESCRIPTION (provided by applicant): The development of effective smoking cessation treatments for smokers with current depression may have important clinical and public health significance in reducing the overall morbidity and mortality associated with smoking. A disproportionate number of Americans who die each year from smoking-related causes have a lifetime history of major depressive disorder, and depression is strongly associated with increased medical morbidity and mortality. It seems likely that smokers with co-occurring depression may be among those at greatest risk for developing smoking-related medical disorders. Because smoking cessation treatment studies have traditionally excluded smokers with current major depressive disorder (MOD), very little is known regarding the impact of more severe depressive symptoms on smoking cessation outcome. However, there is a good deal of data showing that subsyndromal levels of depressive symptoms are predictive of smoking cessation failure. Depressive symptoms in smokers with current depressive disorders may pose even greater obstacles to abstinence. These individuals may require additional treatment that targets their depressive symptoms before they will be successful in achieving abstinence. The goal of this study is to provide a preliminary test of the effect of cognitive behavioral analysis system of psychotherapy (CBASP), an existing treatment that has been found to be efficacious in the treatment of chronic depression, in combination with standard smoking cessation treatment (CBASP/ST), on both short and long-term point prevalence abstinence in smokers with current MOD. Sixty smokers with current MOD will be recruited and randomly assigned to either the CBASP/ST treatment or standard smoking cessation treatment alone (ST). The nicotine patch will be included as part of standard treatment in both conditions. Based on the outcome of this preliminary trial, the CBASP/ST treatment protocol will be further refined and readied for larger-scale clinical trials.