smoking cessation

An antidepressant may boost nicotine patch's effectiveness.

* THE QUESTION Most people find it hard to stop smoking. Wearing a nicotine patch helps many people break the habit, but it does not work for everyone. Would combining an antidepressant with the patch be more effective?

* THIS STUDY randomly assigned 158 adults who smoked at least 10 cigarettes a day to wear a nicotine patch for eight weeks. Half the group also took the antidepressant nortriptyline daily, starting two weeks before their quit date and continuing for 12 weeks; the others took a placebo on the same schedule. After six months, 23 percent of those who took the antidepressant and wore the patch had stopped smoking, compared with 10 percent of those who only wore the patch. Nicotine withdrawal symptoms were similar for both groups.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People who want to quit smoking, especially those who already tried to quit with a nicotine patch but were unsuccessful.

* CAVEATS Those who took nortriptyline reported more side effects than the placebo group, with 38 percent having dry mouth (vs. 8 percent) and 20 percent feeling drowsy (vs. 3 percent). The study did not assess the effect of combination treatment on people with depression.

* BOTTOM LINE Smokers who did not succeed in quitting with the help of a nicotine patch may want to ask a doctor about combining the patch with nortriptyline.

* FIND THIS STUDY Nov. 8 issue of the Archives of Internal Medicine; abstract available online at www.archinternmed.com.

* LEARN MORE ABOUT smoking cessation at www.smokefree.gov and www.familydoctor.org.

Hay fever

Acupuncture seems to reduce allergic symptoms temporarily.

* THE QUESTION Traditional Chinese medicine often uses acupuncture to treat inflamed nasal passages. Does it hold up as an effective treatment for allergic rhinitis, or hay fever?

* THIS STUDY randomly assigned 72 children and teens with chronic allergic rhinitis to receive either acupuncture or fake acupuncture twice a week for eight weeks. For the fake treatment, acupuncture needles were not inserted fully and were not manipulated. Based on medical exams and symptom diaries kept by the youths' parents, those treated with acupuncture experienced more days without symptoms than the fake treatment group (11 percent vs. 4 percent during the treatment period, and 13 percent vs. 2 percent in the three subsequent months). The amount of medication taken to relieve symptoms did not differ between the groups.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Children with a recurrent stuffy nose accompanied by itchy, watery eyes and, perhaps, allergy symptoms that affect the skin or breathing passages.

* CAVEATS The effects of the acupuncture wore off after about 10 weeks.

* BOTTOM LINE Parents of children with hay fever may want to talk with an acupuncturist about treatment.

* FIND THIS STUDY Nov. 5 issue of Pediatrics; abstract available online at www.pediatrics.org.

* LEARN MORE ABOUT chronic allergic rhinitis at www.aaaai.org and www.lungusa.org.

social anxiety disorder

Children's social fears may be ameliorated with medication.

* THE QUESTION Day-to-day situations -- conversing with friends, playing sports, giving a class presentation -- make some children and teens extremely anxious. Paxil (paraoxetine) can help adults with this condition, called social anxiety disorder. Does it also help young people?

* THIS STUDY randomly assigned 322 youths with the disorder to take Paxil or a placebo daily for 16 weeks. Participants ranged in age from 8 to 17. Overall, 78 percent of those who took the drug showed improvement, most within the first four weeks, compared with 38 percent of the placebo group. By the end of the study, the disorder was deemed in remission for 35 percent of the Paxil group vs. 8 percent of the others.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Young people with social anxiety disorder. More than 5 million Americans have this disorder, which usually begins in childhood or adolescence.

* CAVEATS Use of antidepressants by people under 18 has raised concerns about an increased risk of suicide. In this study, four young people taking Paxil reported such thoughts, but no case was considered serious and the incidents were not attributed to the study medication. Youths who took Paxil reported more side effects, especially insomnia, decreased appetite and vomiting. The effect of long-term use of the drug remains unclear. The study was funded by GlaxoSmithKline, which makes Paxil; six of the nine authors worked for the drug company and the other three have received fees from it.

* BOTTOM LINE Parents of a child with social anxiety disorder may want to talk with a doctor about Paxil.

* FIND THIS STUDY November issue of Archives of General Psychiatry; abstract available online at www.archgenpsychiatry.com.

* LEARN MORE ABOUT social anxiety disorder at www.nimh.nih.gov and www.adaa.org.

-- Linda Searing