Failure to improve cigarette smoking abstinence with transdermal selegiline plus cognitive behavior therapy

Aims To examine the effectiveness of transdermal selegiline for producing cigarette smoking abstinence. Design Adult smokers were randomly assigned to receive selegiline transdermal system (STS) or placebo given for 8 weeks. All participants received cognitive behavior therapy (CBT). Follow-ups were conducted at 25 and 52 weeks. Setting Community smoking cessation clinic. Participants 243 adult smokers (>= 18 years of age; >= 10 cigarettes/day). Measures Expired-air carbon monoxide confirmed 7-day point prevalence abstinence. Findings STS was not superior to placebo. More women than men were abstinent at 52 week follow-up (28% vs 16%, P < 0.05). Behavioral activation (BAS) moderated treatment response (P = 0.01). The survival rate through week 52 for those with high 'drive' scores on the BAS was 47% if assigned to selegiline and 34% if assigned to placebo. The survival rate for those with low 'drive scores' on the BAS was 35% if assigned to selegiline compared to 53% if assigned to placebo. Conclusion Transdermal selegiline does not appear generally effective in aiding smoking cessation though there may be a selective effect in those smokers with low 'behavioral activation'.