From the Research
Fluoxetine should not be used as a first-line treatment for nicotine withdrawal related depression, as the most recent and highest quality studies have consistently shown that it does not aid in long-term smoking cessation. According to the most recent Cochrane review 1, which included 53 trials and over 18,000 participants, selective serotonin reuptake inhibitors (SSRIs) like fluoxetine do not have a significant effect on long-term smoking cessation. In contrast, bupropion and nortriptyline have been shown to double the odds of cessation.
The typical approach to managing nicotine withdrawal related depression involves a comprehensive smoking cessation plan that includes behavioral therapy and possibly other medications specifically targeting nicotine cravings, such as varenicline or nicotine replacement therapy. While fluoxetine may be effective in treating depression in general, its use in the context of nicotine withdrawal is not supported by the evidence.
Common side effects of fluoxetine include nausea, headache, insomnia, and sexual dysfunction, and it may take 2-4 weeks to experience the full antidepressant effects. However, given the lack of evidence supporting its use in nicotine withdrawal, other treatment options should be considered first. Always consult with a healthcare provider before starting any medication, especially if you have a history of bipolar disorder, seizures, liver problems, or are taking other medications.
Some key points to consider when developing a smoking cessation plan include:
- The use of bupropion or nortriptyline as first-line treatments for smoking cessation
- The importance of behavioral therapy in supporting smoking cessation
- The potential benefits and risks of using nicotine replacement therapy or other medications to target nicotine cravings
- The need for ongoing monitoring and support to prevent relapse and manage withdrawal symptoms.