Effectiveness of topiramate for tobacco dependence in patients with depression; a randomised, controlled trial

Javier García Campayo¹ , Natalia Sobradiel¹^,7 , Marta Alda²^,7 , Adoración Mas³^,7 , Eva Andrés¹^,7 , Rosa Magallón⁴^,7 , Arantxa Crucelaegui⁵^,7 and Beatriz Sanz⁶^,7

¹Servicio de Psiquiatría, Hospital Miguel Servet y Universidad de Zaragoza, Spain

²Servicio de Psiquiatría. Hospital de Alcañiz, Teruel, Spain

³Centro de Salud Perpetuo Socorro, Huesca, Spain

⁴Centro de Salud Arrabal, Zaragoza, Spain

⁵Servicio de Urgencias. Hospital de Tudela, Navarra, Spain

⁶Hospital de la Defensa, Zaragoza, Spain

⁷Grupo Aragonés de Investigación en Atención Primaria. Red de Actividades Preventivas y de Promoción de la Salud (REDIAPP) (G03/170). Instituto Aragonés de Ciencias de la Salud (IACS)

author email corresponding author email

BMC Family Practice 2008, 9:28doi:10.1186/1471-2296-9-28


Published:	7 May 2008

Abstract

Background

Tobacco 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/design

Design: 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).

Discussion

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.

Trial registration

Current Controlled Trials ISRCTN93532081