The News-Times

Smoker weighs trying Chantix again

- Keith Roach, M.D. Readers may email questions to: ToYourGood­Health@med or mail questions to 628 Virginia Dr., Orlando, FL 32803.

Dear Dr. Roach: I am a 68-year-old female smoker in good health aside from having osteoporos­is. I am addicted to smoking and have tried everything available to quit without any success. I tried taking Chantix 15 years ago and became suicidal. At that time, my late husband and I decided we would quit together using Chantix. He became very hostile and nasty, which resulted in me becoming depressed and suicidal. I did not act on my thoughts; we immediatel­y stopped taking the medication and life went back to normal for the both of us.

I want to know your thoughts on trying Chantix again. I have asked my doctors for advice and have received conflictin­g answers. Aside from the incident 15 years ago, I have no history of depression. I am a happy-go-lucky type of person in a great marriage. I could not find any research that addressed this situation. I know that

Chantix can lead to suicidal thoughts but I am hoping that may not happen the second time with me given that my current spouse is very supportive. What are your thoughts?


Answer: For almost all smokers, quitting smoking is the single most important thing to do for one’s health. On average, smoking cuts eight to 12 years off a person’s life, and quitting smoking always leads to getting some of that time back. And the sooner, the better, as the body has capacity to repair much of the damage.

There are many aids to help people quit. Before considerin­g other treatments, it’s worthwhile to consider why you are addicted to smoking, and what other activities would be better to address any psychologi­cal issues that might be present.

Vareniclin­e (Chantix) is one of the most used and successful smoking cessation aids, and works by attaching to and stimulatin­g the nicotine receptor, which reduces withdrawal symptoms and cravings, but it also blocks nicotine from binding to the receptor, which reduces the effects of smoking that tend to perpetuate smoking behaviors.

Depression and suicidal ideation are well-known side effects of vareniclin­e therapy, although they are rare — about 1.3% in a welldone trial, similar to that seen with other medicines or with placebo. Quitting smoking itself is difficult and leads to changes in brain chemistry resulting in behavioral changes. Anyone who has tried to quit smoking (and those who love them) knows. It is impossible in any given person to know whether it was the drug or the combinatio­n of the behavior of your spouse and trying to quit smoking that was responsibl­e for your acute depression and suicidal thoughts.

Chantix is not the only smoking cessation aid. Smoking cessation group classes have proven to be effective. Nicotine replacemen­t therapy also increases the chances of successful­ly quitting. An antidepres­sant, bupropion (Wellbutrin or Zyban), has additional effectiven­ess on top of group sessions and nicotine replacemen­t.

It seems to me prudent to try a different therapy with roughly equivalent effectiven­ess before you try Chantix again. You may have tried these already, but another attempt may still work.

If you do decide to try Chantix again, you should be on the careful lookout for recurrence of depressive symptoms, and be ready to stop treatment immediatel­y if they do recur.

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