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Few studies in the literature have assessed the effectiveness of nortriptyline, cupidotoronegra which is a tricyclic antidepressant with broad previous clinical experience in therapy for depression. (17,18) This double-blind randomized study evaluated the safety and effectiveness of nortriptyline administered to smokers enrolled in an antismoking program.MATERIALS AND METHODSFrom May 1999 to June 2000, 236 patients were registered by the Smokers'' cupidotoronegra Support Group at the A.C. Camargo Cancer Hospital in Sao Paulo, Brazil. Smokers enrolled in the group spontaneously. At the initial interview with the psychiatrist, the Beck and Fagerstrom test questionnaires were applied.The Beck questionnaire (19) includes 21 questions that screen for depression symptoms. The scoring of this evaluation cupidotoronegra ranges from 0 to 63 points. Patients scoring [greater than or equal to] 20 points were excluded from the study. At the initial interview, the Fagerstrom questionnaire also was used to determine the degree of dependence on nicotine. Individuals who scored [greater than or equal to] 7 points were considered to be highly dependent on nicotine. (20)
The study by Hall et al, (17) which was another placebo-controlled, double blind, randomized study of 199 patients receiving nortriptyline, resulted in an initial abstinence rate at 10 weeks of 40% for patients receiving placebo and 70% for patients receiving nortriptyline. cupidotoronegra The methodology used in our study permitted adjustment in the doses according to the serum cupidotoronegra levels of the patients. This may explain the higher success rates in that study compared to those in our study. Hall et al (17) separately analyzed the rates of smoking cessation in patients with and without previous histories of major depression, receiving or not receiving behavioral or educational intervention, and the association cupidotoronegra with the administration of placebo or nortriptyline. The best results were obtained with educational intervention, in those patients having no personal history of depression, who received the active drug. A negative history of depression was, however, the most important factor for the success of the treatment. Jorenby et al, (30) in a study of the use of bupropion, placebo, the nicotine patch, or the nicotine patch plus bupropion in 893 individuals, cupidotoronegra excluded patients having a previous history of several psychiatric pathologies (eg, panic, psychoses, bipolar disorder, alimentary disorder, dependence on psychoactive drugs, and alcohol). A significant difference in the rate of smoking cessation was observed, as follows: nicotine patch, 48.0%; bupropion, 60.2%; nicotine patch plus bupropion, 66.5%; cupidotoronegra placebo, 33.8%. The exclusion of a large portion of the psychiatric population could account for the effectiveness of the medications used in this study, compared to the study by Hurt et al (16) with bupropion.
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