Nicotine patch (15mg) for 8w br / Common components: support at clinic visits at baseline, 2w, EOTOutcomesAbstinence at 1 year (sustained) br / Validation: CO 10ppmNotesFunding not reported em Risk of bias /em BiasAuthors’ judgementSupport for judgementRandom sequence generation (selection bias)Unclear riskRandomization method not described.Allocation concealment (selection bias)Unclear riskAllocation concealment not described.Blinding (performance bias and detection bias) br / All outcomesHigh riskNot described but presumably no blinding, as participants will have known assignment based on patch versus pillIncomplete outcome data (attrition bias) br / All outcomesUnclear riskNot described. Haggstr?m 2006 MethodsBUPROPION & NORTRIPTYLINE br / Randomized controlled trial br / Setting: Smoking cessation clinic, Brazil br / Recruitment: community volunteers.Participants156 smokers, FTND at least 4; 70% F placebo & nortriptyline, 59% Bup, av. in July 2013. Selection criteria We considered randomized trials comparing antidepressant medications to placebo or an alternative pharmacotherapy for smoking cessation. We also included trials comparing different doses, using pharmacotherapy to prevent relapse or re\initiate smoking cessation or to help smokers reduce cigarette consumption. We excluded trials with less than six months follow\up. Data collection and analysis We extracted data and assessed risk of bias using standard methodological procedures expected by the Cochrane Collaboration. The main outcome measure was abstinence from smoking after at least six months adhere to\up in individuals smoking at baseline, indicated like a risk percentage (RR). We used the most demanding definition of abstinence available in each trial, and biochemically validated rates if available. Where appropriate, we performed meta\analysis using a fixed\effect model. Main results Twenty\four new tests were identified since the 2009 upgrade, bringing the total quantity of included tests to 90. There were 65 tests of bupropion and ten tests of nortriptyline, with the majority at low or RS 8359 unclear risk of bias. There was high quality evidence that, when used as the sole pharmacotherapy, bupropion significantly increased long\term cessation (44 tests, N = 13,728, risk percentage [RR] 1.62, 95% confidence interval [CI] 1.49 to 1 1.76). There was moderate quality evidence, limited by a relatively small number of tests and participants, that nortriptyline also significantly increased long\term cessation when used as the sole pharmacotherapy (six tests, N = 975, RR 2.03, 95% CI 1.48 to 2.78). There is insufficient evidence that adding bupropion (12 tests, N = 3487, RR 1.19, 95% CI 0.94 to 1 1.51) or nortriptyline (4 tests, N = 1644, RR 1.21, 95% CI 0.94 to 1 1.55) to nicotine replacement therapy (NRT) provides an additional extended\term benefit. Based on a limited amount of data from direct comparisons, bupropion and nortriptyline look like equally effective and of related effectiveness to NRT (bupropion versus nortriptyline 3 tests, N = 417, RR 1.30, 95% CI 0.93 to 1 1.82; bupropion versus NRT 8 tests, N = 4096, RR 0.96, 95% CI 0.85 to 1 1.09; no direct comparisons between nortriptyline and NRT). Pooled results from four tests comparing bupropion to varenicline showed significantly lower giving up with bupropion than with varenicline (N = 1810, RR 0.68, 95% CI 0.56 to 0.83). Meta\analyses did not detect a significant increase in the pace of severe adverse events amongst participants taking bupropion, though the confidence interval only narrowly missed statistical significance (33 tests, N = 9631, RR 1.30, 95% CI 1.00 to 1 1.69). There is a risk of about 1 in 1000 of seizures associated with bupropion use. Bupropion has been associated with suicide risk, but whether this is causal is definitely unclear. Nortriptyline has the potential for severe side\effects, but none happen to be seen in the few small tests for smoking cessation. There was no evidence of a significant effect for selective serotonin reuptake inhibitors on their own (RR 0.93, 95% CI 0.71 to 1 1.22, N = 1594; 2 tests fluoxetine, 1 paroxetine, 1 sertraline) or as an adjunct to NRT (3 tests of fluoxetine, N = 466, RR 0.70, 95% CI 0.64 to 1 1.82). Significant effects were also not recognized for monoamine oxidase inhibitors (RR 1.29, 95% CI RS 8359 0.93 to 1 1.79, N = 827; 1 trial moclobemide, 5 selegiline), the atypical antidepressant venlafaxine (1 trial, N = 147, RR 1.22, 95% CI 0.64 to 2.32), the natural therapy St John’s wort (hypericum) (2 tests, N = 261, RR 0.81, 95% CI 0.26 to 2.53), or the dietary supplement SAMe (1 trial, N = 120, RR 0.70, 95% CI 0.24 to 2.07). Authors’ conclusions The antidepressants bupropion and nortriptyline aid long\term smoking cessation. Adverse events with either medication appear to hardly ever become severe or lead to preventing medication. Evidence suggests that the mode of action of bupropion and nortriptyline is definitely self-employed of their antidepressant effect and.Placebo and active drug were identical in appearance.” However, no fine detail on who was blinded.Incomplete outcome data (attrition bias) br / All outcomesLow risk30% did not total treatment in placebo and 17% in active organizations. sertraline; St. John’s wort; tryptophan; venlafaxine; and zimeledine. Search methods We looked the Cochrane Tobacco Habit Group Specialised Register which includes reports of tests indexed in the Cochrane Central Register of Controlled Tests (CENTRAL), MEDLINE, EMBASE, and PsycINFO, and additional evaluations and achieving abstracts, in July 2013. Selection criteria We regarded as randomized tests comparing antidepressant medications to placebo or an alternative pharmacotherapy for smoking cessation. We also included tests comparing different doses, using TGFA pharmacotherapy to prevent relapse or re\initiate smoking cessation or to help smokers reduce cigarette usage. We excluded tests with less than six months follow\up. Data collection and analysis We extracted data and assessed risk of bias using standard methodological procedures expected from the Cochrane Collaboration. The main end result measure was abstinence from smoking after at least six months adhere to\up in individuals smoking at baseline, indicated like a risk percentage (RR). We used the most demanding definition of abstinence available in each trial, and biochemically validated rates if available. Where appropriate, we performed meta\analysis using a fixed\effect model. Main results Twenty\four new tests were identified since the 2009 upgrade, bringing the total quantity of included tests to 90. There were 65 tests of bupropion and ten tests of nortriptyline, with the majority at low or unclear risk of bias. There was high quality evidence that, when used as the sole pharmacotherapy, bupropion significantly increased long\term cessation (44 tests, N = 13,728, risk percentage [RR] 1.62, 95% confidence interval [CI] 1.49 to 1 1.76). There was moderate quality evidence, limited by a relatively small number of tests and participants, that nortriptyline also significantly increased long\term cessation when used as the sole pharmacotherapy (six tests, N = 975, RR 2.03, 95% CI 1.48 to 2.78). There is insufficient evidence that adding bupropion (12 tests, N = 3487, RR 1.19, 95% CI 0.94 to 1 1.51) or nortriptyline (4 tests, N = 1644, RR 1.21, 95% CI 0.94 to 1 1.55) to nicotine replacement therapy (NRT) provides an additional extended\term benefit. Based on a limited amount of data from direct comparisons, bupropion and nortriptyline look like equally effective and of related effectiveness to NRT (bupropion versus nortriptyline 3 tests, N = 417, RR 1.30, 95% CI 0.93 to 1 1.82; bupropion versus NRT 8 tests, N = 4096, RR 0.96, 95% CI 0.85 to 1 1.09; no direct comparisons between nortriptyline and NRT). Pooled results from four tests comparing bupropion to varenicline showed significantly lower giving up with bupropion than with varenicline (N = 1810, RR 0.68, 95% CI 0.56 to 0.83). Meta\analyses did not detect a significant increase in the pace of severe adverse events amongst participants taking bupropion, though the confidence interval only narrowly missed statistical significance (33 tests, N = 9631, RR 1.30, 95% CI 1.00 to 1 1.69). There is a risk of about 1 in 1000 of seizures associated with bupropion use. Bupropion has been associated with suicide risk, but whether this is causal is definitely unclear. Nortriptyline has the potential for severe side\effects, but none happen to be seen in the few small tests for smoking cessation. There was no evidence of a significant effect for selective serotonin reuptake inhibitors on their own (RR 0.93, 95% CI 0.71 to 1 1.22, N = 1594; 2 trials fluoxetine, 1 paroxetine, 1 sertraline) or as an adjunct to NRT (3 trials of fluoxetine, N = 466, RR 0.70, 95% CI 0.64 to 1 1.82). Significant effects were also not detected for monoamine oxidase inhibitors (RR 1.29, 95% CI 0.93 to 1 1.79, N = 827; 1 trial moclobemide, 5 selegiline), the atypical antidepressant venlafaxine (1 trial, N = 147, RR 1.22, 95% CI 0.64 to 2.32), the herbal therapy St John’s wort (hypericum) (2 trials, N = 261, RR 0.81, 95% CI 0.26 to 2.53), or the dietary supplement SAMe (1 trial, N = 120, RR 0.70, 95% CI 0.24 to 2.07). Authors’ conclusions The antidepressants bupropion and nortriptyline aid long\term RS 8359 smoking cessation. Adverse events with either medication appear to rarely be severe.