The addition of the antidepressant nortriptyline to conventional smoking cessation therapy didn't improve the chances of long-term success among male prisoners, Australian researchers have found.
Depression and other mental illnesses raise the likelihood of smoking, and quitting can depress a person's mood — which in turn can make it harder to quit. Studies have shown that antidepressants, including nortriptyline, can improve the success of smoking cessation efforts.
And prison inmates are notoriously heavy smokers, with higher rates of depression and other mental illness than the general population.
But the new study found that nortriptyline (marketed as Aventyl) — which is not FDA-approved for smoking cessation but often is used for that purpose - did not seem to help inmate smokers stay tobacco-free over time.
Compliance with the therapy appeared to a significant issue, however, said Robyn Richmond, a public health researcher at the University of New South Wales, in Kensington, who led the study.
Prisoners who were faithful to the treatment as ordered at least three-quarters of the time were much more likely to break their smoking habit than those who could not stick to the regimen, Richmond told Reuters Health.
Another factor, Richmond added, was that the prison population in the study tended to migrate, making follow-up of the participants difficult.
"One thinks that you have a captive audience" in prison studies, she said. "However, half of the prisoners were either transferred to another prison within the study or released into the community."
The study, which appears in the journal Addiction, included 425 male inmates from prisons across Australia. All were smokers, with a habit lasting on average 20 years and more than 23 cigarettes a day.
Nearly three-quarters of the inmates in the study had tried to quit in the previous year, according to the researchers.
All of the prisoners in the study received 10 weeks of smoking cessation therapy consisting of nicotine patches and two sessions of behavioral counseling. To that was added either a dummy pill or nortriptyline.
The researchers recorded the inmates' tobacco use at three, six and 12 months after the end of treatment, relying on self-reporting and direct measurements of exhaled carbon monoxide, a byproduct of smoking.
At the three-month mark, about one-quarter of prisoners who had received the antidepressant had managed to stay off smoking continuously, compared with 16 percent of those who had not taken the drug. But by the one year mark, the abstinence rate had fallen to about 11 percent for both groups.
Psychologist Karen Cropsey, a smoking researcher at the University of Alabama at Birmingham, said most jails and prisons in the United States have significantly restricted tobacco use by inmates. Roughly half of prisons, and many jails, now ban smoking completely, she said, while facilities that permit it typically require inmates to go outside to smoke.
Cropsey, who has studied tobacco use by female inmates, said the latest work is the first to look at smoking by male inmates.