Clonidine, Depression, and Smoking Cessation

Pharmacologic treatment of smoking is not a new idea.¹However, the search for effective pharmacologic treatments for smoking has increased dramatically in the last ten years due to the realization that smoking is a dependence disorder²; that behavioral strategies are not having a large effect on the prevalence of smoking³; and that nicotine dependence is becoming more prevalent in smokers due to a selection process.⁴This latter process is occurring because smokers who are quitting appear to be smokers who are less dependent on nicotine. Thus, if this trend continues, in ten to 20 years the population of smokers will be almost exclusively smokers who are highly dependent on nicotine. See also page 2863. Nicotine gum was introduced in 1984 as the first proven pharmacologic aid for smoking cessation.⁵Encouraged by this success, other nicotine replacement therapies, eg, nicotine patch⁶and nicotine nasal spray,