Quit Smoking Advisory

Nortriptyline is a tri-cyclic antidepressant, the family of drugs that were commonly prescribed before the newer and generally more effective class of drugs known as SSRIs.

However, nortriptyline has been found to offer other advantages such as being effective against bedwetting, for migraines and chronic fatigue syndrome (also known as “ME”).

It has also been used as a way to help people quit smoking. Typically, your doctor will not know of this and only a few ever prescribe nortriptyline. We can learn a lot more from looking at clinical studies.

Nortriptyline and Cognitive-Behavioral Therapy in the Treatment of Cigarette Smoking

This most widely cited study conducted in 1998 and published in the Archives of General Psychiatry found that nortriptyline was effective when combined with CBT on patients with a history of depression and showed greater abstinence rates after quitting. It appears that this drug is helpful in countering the immediate effects after quitting.

A Randomized Trial of Nortriptyline for Smoking Cessation

The second most cited study was one published in the Archives of Internal Medicine, also from 1998. This study approached the drug from a different angle. It sought to determine, via randomised, double-blind, placebo-controlled trials - whether tricyclic antidepressants, in particular nortripyline, could be used to increase rates of smoking cessation amongst those otherwise healthy members of the public without symptoms of depression.

They concluded that there was an increased short-term cessation rate versus placebo and additionally reductions in withdrawal symptoms although at the expense of side effects such as dry mouth. At 6 months, 14% of those taking the drug were not smoking, compared to 3% of placebo.

Stopping Smoking: A Prospective, Randomized, Double-Blind Study Comparing Nortriptyline to Placebo

Another study conducted in 2002 and published by the American College of Chest Physicians also tested nortriptyline in a randomised, double-blind, placebo-controlled trial. It found similarly - that “nortriptyline significantly increases the smoking cessation rate in chronic smokers” (55.9% vs 23.3% - time duration unknown).

However, no “significant side effects” were reported in this particular study.

Conclusion

It appears that nortriptyline is effective till at least the “gold standard” of most studies - the 6 month smoking cessation rates. Although the 14% quoted in one study appears low, it is much higher than the 3% quoted for the placebo group, which is typical.

Given the few or relatively minor side effects, I am surprised that this drug is not prescribed more often for smokers who wish to quit. Compared to drugs like varenicline or bupropion, the side effects are much less and the success rate similar.

If you are considering smoking then you will do well to compare the effectiveness of nortriptyline against not just other drugs but also against other smoking cessation methods such as counselling, cognitive behavioural therapy, injections, nicotine replacement therapy and others.