**Question:** A 35-year-old female presents to your OPD for smoking cessation. She was diagnosed with depression 2 years ago and took SSRIs for 6 months. She has been off medication for 1.5 years and is now mentally healthy. She started smoking at the age of 25 years and has attempted quitting on her own using nicotine gum multiple times, but is unable to sustain abstinence for more than 1 month. What would be the best recommendation for this patient?

A. Nicotine replacement therapy (NRT) alone
B. NRT combined with cognitive behavioral therapy (CBT)
C. Oral antidepressants for depression relapse prophylaxis
D. Oral antidepressants for nicotine withdrawal symptoms

**Correct Answer:** B. Nicotine replacement therapy (NRT) combined with cognitive behavioral therapy (CBT)

**Core Concept:**

In this scenario, the patient has a history of nicotine addiction and quitting smoking, as well as a history of depression and having previously used SSRIs. The best recommendation would be a combination therapy targeting both smoking cessation and mental health aspects.

**Why the Correct Answer is Right:**

The patient has previously used SSRIs (Selective Serotonin Reuptake Inhibitors) for her depression, indicating a need for a comprehensive approach that addresses both smoking cessation and mental health. Nicotine replacement therapy (NRT) is a widely used method for smoking cessation, including nicotine gum, patch, and inhaler. However, this alone might not be sufficient for this patient due to her history of depression and failed attempts with nicotine gum.

Combining NRT with cognitive behavioral therapy (CBT) can provide a more effective approach. CBT addresses psychological aspects of smoking cessation and helps the patient cope with stress, anxiety, and mood swings that may occur during the quitting process. This combined therapy offers a comprehensive approach, addressing both nicotine addiction and mental health issues.

**Why Other Options are Incorrect:**

A. Using only Oral antidepressants for nicotine withdrawal symptoms: While SSRIs provided relief from her depression, they were ineffective in helping her quit smoking. Oral antidepressants are not specifically designed for nicotine withdrawal symptoms, while NRT is specifically formulated for this purpose.

C. Using oral antidepressants for depression relapse prophylaxis: Though the patient has a history of depression, using oral antidepressants for relapse prophylaxis is not ideal due to the patient's history of depression and the previous unsuccessful use of SSRIs for smoking cessation. A more appropriate approach would be to combine NRT with CBT.

D. Using oral antidepressants for nicotine withdrawal symptoms: As mentioned, oral antidepressants are not specifically designed for nicotine withdrawal symptoms, while NRT is specifically formulated for this purpose.

**Clinical Pearl:**

In this case, combining NRT (nicotine replacement therapy) with CBT (cognitive behavioral therapy) is the recommended approach for this patient