Smoking Cessation Intervention for Depressed Smokers: Treatment Development

描述(由申请人提供)：为目前患有抑郁症的吸烟者开发有效的戒烟治疗方法，在降低与吸烟有关的总体发病率和死亡率方面可能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，有很大一部分人一生都有严重的抑郁障碍史，而抑郁症与疾病发病率和死亡率的增加密切相关。患有抑郁症的吸烟者似乎是罹患吸烟相关医学疾病的最高风险人群之一。由于戒烟治疗研究传统上排除了目前患有严重抑郁障碍(MOD)的吸烟者，因此对更严重的抑郁症状对戒烟结果的影响知之甚少。然而，有大量数据表明，抑郁症状的亚症状水平预示着戒烟失败。患有当前抑郁障碍的吸烟者的抑郁症状可能会对戒烟构成更大的障碍。这些人可能需要针对他们的抑郁症状进行额外的治疗，才能成功实现禁欲。本研究的目的是初步测试认知行为分析系统心理疗法(CBASP)与标准戒烟疗法(CBASP/ST)联合治疗慢性抑郁症对目前MOD吸烟者短期和长期时点戒断的效果。目前患有MOD的60名吸烟者将被招募并随机分配到CBASP/ST治疗或标准戒烟治疗(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。根据这项初步试验的结果，CBASP/ST治疗方案将进一步完善，并为更大规模的临床试验做好准备。

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.