Mea Culpa

February 3, 2008 5:16 PM

Chantix may not be so hot, after all. It appears that the smoking cessation drug varenicline may have significant psychiatric side effects. I have recommended the drug in several AskMe's about smoking and so feel it is important to get the word out that it may not be as benign as originally thought.
posted by TedW (56 comments total)

Any drug treatment for smoking addiction that isn't a simple graduated step down of nicotine is either dumb science or clever marketing (or both, of course).
posted by Burhanistan at 5:20 PM on February 3, 2008

Any drug treatment for smoking addiction that isn't a simple graduated step down of nicotine is either dumb science or clever marketing (or both, of course).

Dumb science? What kind of position are you in to second guess the FDA?

_{"Chantix has proven to be effective in smokers motivated to quit, but patients and health care professionals need the latest safety information to make an informed decision regarding whether or not to use this product," said Bob Rappaport, M.D., director of the FDA's Division of Anesthesia, Analgesia and Rheumatology Products. "While Chantix has demonstrated clear evidence of efficacy, it is important to consider these safety concerns and alert the public about these risks. Patients should talk with their doctors about this new information and whether Chantix is the right drug for them, and health care professionals should closely monitor patients for behavior and mood changes if they are taking this drug."}

The drug was approved in 2006. Evidence shows it works, and it's a prescription drug specifically to quit smoking. But I guess those FDA scientists were just blined by clever marketing, right?
posted by delmoi at 5:26 PM on February 3, 2008 [1 favorite]

Woah dude, do you work for Chantix??
posted by PostIronyIsNotaMyth at 5:39 PM on February 3, 2008

I was all set to agree with delmoi until I got to But I guess those FDA scientists were just blined by clever marketing, right?

It's happened before.
posted by DU at 5:45 PM on February 3, 2008

If you're talking Chantix, the Carter Albrecht case is worth looking into.
posted by First Post at 6:01 PM on February 3, 2008

Bullets For My Beast.
posted by nickyskye at 6:04 PM on February 3, 2008 [1 favorite]

TedW, I respect your integrity in making this post.

Dang, the Carter Albrecht under the influence of Chantix story is a sad way to die.

When people want to quit and need support the drug may be a risk and it may be a lifesaver. Lung cancer, no fun. One of my friends quit by going to 12 step meetings for nicotine addicts, said that depression could be camouflaged by the habit and when the drug is kicked many people may struggle with intense feelings of depression. Could be blood types or constitutional aspects that make it wonderful for some and anathema for others.

I do think joining a support group, online, or offline, can be useful.

The Ask a Patient comments for Chantix had a wide range, some adored it, some couldn't hack it for a few days. Sounds like better to taper off the drug slowly. Interesting the number of people who became really aggressive after stopping. Wonder what part of the brain this works on?

Champix is the UK name.
posted by nickyskye at 6:10 PM on February 3, 2008

Zyban all over again, innit?
posted by pompomtom at 6:10 PM on February 3, 2008

Any drug treatment for smoking addiction that isn't a simple graduated step down of nicotine is either dumb science or clever marketing (or both, of course).

Chantix worked for my father (a smoker for 45+ years, 3 packs a day most of his adult life), when nothing else did.
posted by JeffL at 6:12 PM on February 3, 2008

It's happened before.

Has it? I've heard of doctors being sucked in by advertising, but not the FDA itself. Do you have any Citations or anything like that?
posted by delmoi at 6:13 PM on February 3, 2008

A few weeks ago, I had a taxi driver go out of his way to bring up the fact that he had been a smoker, solely so that he could exult about how fantastic this drug was, how it totally removed his desire to smoke, after smoking for something like 40 years (and to drink, after drinking a case of beer every day after work for years). So while it's great that the FDA is there to make people aware of the risks, it would take a lot for this drug to do more harm than good, it would seem to me.
posted by Dasein at 6:15 PM on February 3, 2008

I have seen anecdotal evidence to the drug working to stop the smoking craving. Two people, specifically, who both said it utterly and completely took away the desire to smoke.

This "side effect" business is troubling, though. As usual, clinical trials will never catch all the long-term possibilities, and it's not like a clinical trial has never been skewed or fudged by a drug manufacturer, either.

I quit smoking cold-turkey somewhere around Xmas, I think, and still want a cigarette BAD every day. Don't think I'll be messing with that stuff, wither way, even if I go back to smoking, which I'm considering, because not smoking is sucking, right now.
posted by Devils Rancher at 6:17 PM on February 3, 2008

I was friends with Carter Albrecht and spent a good 8 hours online posting in various forums where people were bashing him and posting lies about his death before the facts came out. He was a genuinely nice guy and I miss seeing him around town (after seeing him almost every day for two years in my apartment in college, he felt like a brother when I was about 19).

I also posted in one of the AskMes about Chantix causing psychotic blackouts, hallucinations, vivid nightmares and suicidal behavior. Everyone poo-pooed me then.

Sucks that my friend had to die that way, and with such a bad reputation in the public. Don't take it and drink. Don't take it with antidepressants. Don't take it if you have a history of depression, or other mental health issues.

I'd say don't take it at ALL, but there appear to be people in this thread who have benefited from it, and I won't argue with the fact that it has worked for some people.

Fen/Phen worked for some people too, you know. So did ephedrine. So did Vioxx.

I asked around town and lots of my friends have had strange dreams and episodes on it. Just because the articles link cite stats like 400 episodes of suicidal behavior and 37 suicides doesn't mean that's all there was; that's all they've got documented so far.

To me, it's only a matter of time before it gets recalled.
posted by Unicorn on the cob at 6:25 PM on February 3, 2008 [12 favorites]

Just because the articles link cite stats like 400 episodes of suicidal behavior and 37 suicides doesn't mean that's all there was; that's all they've got documented so far.

It's been prescribed 4 million times. It's important that people be aware of the effect that drugs can have on their mood, so that if they do get depressed they will realize what the problem is. But the idea that it will be recalled is pretty silly. Regular anti-depressants cause can cause suicide too, and they've never been recalled. And the fact is that smoking is very harmful for your health. Smoking cigarettes is a slow-motion suicide in itself.
posted by delmoi at 6:34 PM on February 3, 2008

And just to add, penicillin caused sever allergic reactions in some people to the point that it would kill them. But it saved millions and millions of lives. The question with any drug is whether it will kill more people then it saves, and a drug that helps people quit smoking will probably save a lot of lives.
posted by delmoi at 6:36 PM on February 3, 2008 [4 favorites]

For once I am happy to see a Fark and Digg story show up here.

Chantix has been the closest I have been to quitting in 12 years, I am amazed at how well it works. The other time was when I had hepatitis A. One of the symptoms of hepatitis is that smokers find the smell of cigarettes disgusting, this stuff is very similar.

I have been taking Chantix for 3 weeks and 2 days. At no point have I had to use extreme will force. I just try to extend the time between cigarettes. On week one, I could get to 3 or 4 hours between cigarettes. By week two, it was down to one cig in the morning, one after dinner. I have not smoked a single cigarette for the last 10 days. I tried once a few days ago, but got nauseous and had to throw it away after 3 puffs.

On the other hand, I have been feeling like shit. Yesterday I was awake for 5 hours, and then went back to sleep for fourteen. I have been feeling very anxious and bored at the same time. For the last ten days or so, nothing has felt good, everything is meh. I have tried to quit before, this is different.

It has been hard on my wife, and last night she got so worried she started doing some research.She found several forums, with people having all kinds of weird symptoms, and experiencing all kinds of adverse effects. Google "chantix" plus thyroid, suicide, divorce or violence if you are interested.

Now the question is: How much I am willing to risk and go through to quit smoking? For me the answer is to finish the 6 pills left in the box, and take it the old fashioned way from now on.

Sorry for the length, but if I start editing I will never post.
posted by Dr. Curare at 6:40 PM on February 3, 2008 [4 favorites]

Forgot to mentions: The vivid dreams were great, I had not had such intense and cool dreams since I was a kid. Until they turned into nightmares. I woke up screaming twice last night.
posted by Dr. Curare at 6:42 PM on February 3, 2008

For me the answer is to finish the 6 pills left in the box, and take it the old fashioned way from now on.

This is me, too. Actually, I've been enjoying the way-vivid dreams.
posted by Bookhouse at 6:43 PM on February 3, 2008

Any drug treatment for smoking addiction that isn't a simple graduated step down of nicotine is either dumb science or clever marketing (or both, of course).

Chantix worked for my father (a smoker for 45+ years, 3 packs a day most of his adult life), when nothing else did.
posted by JeffL at 6:12 PM on February 3 [+] [!]

Same here, my father smoked for 40+ years at least a pack a day. After many failed attempts with other methods, he quit smoking using this drug. It worries me that there are side effects, but the fact that he is no longer smoking means he will probably live alot longer. That said i wouldnt be surprised if the side effects where glossed over during approval.

Though, if you think about it, considering how psychologically deeply seeded smoking can become for some individuals, its not surprising that in shutting off the desire, you might screw up some other areas of the brain.
posted by Merik at 7:10 PM on February 3, 2008

Dr. Curare, just toss those last 6 pills. Seriously. Craving a cigarette and not having one anyway is possible, I've been doing it for a month. The craving's gotta stop sooner, or later.
posted by Devils Rancher at 7:10 PM on February 3, 2008

My worst side effect was that I developed muscle tremors in my lips. Seriously. Frankly, I didn't even know my lips could do that.

I took Chantix for two weeks prior to my quit, then quit Chantix a week into having quit. I credit it with my success, but the lip thing got to be too much for me. You never realize how dangerous a smirk can be until you're just out there, doing it involuntarily all day.

One of my friends has also had success with it. Another friend, though, had to quit taking it due to - you guessed it - suicidal thoughts. And this is my perfect friend, who looks perfect and has the perfect partner and perfect life and is always perfectly happy. So either A) there's some truth to the suicidal ideation side effect, or B) perfect Steve actually has some depth to his perfect personality that nobody ever sees, which ultimately would creep me out even more than the Chantix-amplified dreams ever did.
posted by zylocomotion at 7:24 PM on February 3, 2008

How many people experience depression or suicidal ideation just from nicotine withdrawal?
posted by meehawl at 7:40 PM on February 3, 2008 [1 favorite]

Any drug treatment for smoking addiction that isn't a simple graduated step down of nicotine is either dumb science or clever marketing (or both, of course).

Way to pull something out of your ass.

While I won't be shocked to find out there's more to this drug than so far seen, it makes Zyban look like breath mints when it comes to helping heavy, intractable smokers quit the habit. I've been warning people to be aware of possible psych-active side effects and ideally to have a loved one monitor them as well, but so far haven't seen any problems.
posted by docpops at 8:13 PM on February 3, 2008

This is a timely notice, because just two weeks ago someone I know tried it, and had intense thoughts of suicide, not the usual thing with her. "I don't think I'm going to do anything," she said, "but when I look at the knives in the drawer all I can think of is the ways each one could cut me."

She felt an urge to chop all her hair off. She identified this %100 with the Chantrix, stopped immediately and was a mess for about a week. She thinks she went pretty much back to normal but wonders if there is some lingering dark mood.

Now she spooked on taking any new drugs.
posted by StickyCarpet at 8:14 PM on February 3, 2008 [1 favorite]

Can somebody explain to me in a brief post why they are prescribing this over Wellbutrin/Zyban nowadays? I used that a few years back with no ill effects. I did quite for almost a year although I do indulge a bit much on the weekends again nowadays.

I'm quitting again next week though...
posted by Octoparrot at 8:16 PM on February 3, 2008

The advice I've gotten from ex smokers is to go cold turkey. All four people I know who have quit after a lifetime of smoking have done so cold turkey. Although I haven't quit yet, moving into a no smoking apartment has caused me to go from a pack a day to a pack every three sometimes four days.
posted by Sailormom at 8:23 PM on February 3, 2008

I had "depression and suicidal idealiation" from Avelox recently; I never thought that an antibiotic could cause things like that. I'm not allergic to any meds and never had side effects like that from anything else - it was so bad that I stopped taking them after 5-6 days.
posted by mrbill at 8:25 PM on February 3, 2008

Also, my wife was prescribed Chantix a few months ago to try to quit smoking, but she read up it first and never touched the pills due to the side effects discussed here. She's now just going cold-turkey.
posted by mrbill at 8:26 PM on February 3, 2008

BIG PHARMA strikes again!
posted by brandz at 8:54 PM on February 3, 2008

Oh man, I'm starting a program with Chantix next week, and then this thread (and a frantic phone message from my mother) intervene. I also just started taking meds for an underactive thyroid, which my doctor assured me would have no interaction with the Chantix. Looks like I'm going to be up half the night doing research.
Thanks for posting this, TedW.
posted by maryh at 9:08 PM on February 3, 2008

37 suicides versus FOUR FUCKING HUNDRED FUCKING TWENTY FUCKING THOUSAND deaths (and that's only in the US) from tobacco per year? 20% of all deaths in the US are smoking related!

This reminds me of Robert Mugabe turning down food aid because the food was GMO.
posted by ethnomethodologist at 10:22 PM on February 3, 2008 [1 favorite]

"I don't think I'm going to do anything," she said, "but when I look at the knives in the drawer all I can think of is the ways each one could cut me."

That's a very vivid statement, and I'm glad you posted it. It actually gave me chills.
posted by davejay at 10:33 PM on February 3, 2008

Can somebody explain to me in a brief post why they are prescribing this over Wellbutrin/Zyban nowadays?

Well, it's not like Wellbutrin doesn't cause suicidal thoughts in some people as well. So why use Wellbutrin when you can take this? Especially if this works better then other options.

Anyway, I still don't understand why you people are freaking out. From reading the thread it sounds like more people have odd thoughts on the drug then indicated in the article, but it still seems like most people don't have these side effects. And fantasizing about a quick suicide seems better then an actual slow suicide caused by smoking cigarettes. I'd much rather have strange thoughts and vivid dreams then be addicted to smoking.

Like ethnomethodologist said, 420,000 deaths due to smoking vs. 37 suicides. It would be insane not to take this drug because of the possibility psychological side effects (now, obviously if one individual was very strongly effected they wouldn't want to keep taking it). It would like refusing to take penicillin because of the possibility of a lethal allergic reaction.
posted by delmoi at 11:08 PM on February 3, 2008

Delmoi, seriously, it wouldn't be insane not to take Chantix because of possible side effects. Anyone who has reason to believe they might be predisposed to such side effects has a very good reason not to take Chantix; just as anyone with a penicillin allergy has an excellent reason not to take penicillin. Anyone who fears this kind of side effect can look into alternative strategies for quitting smoking, too.

If there is a risk of suicidal ideation with the drug, best that it be publicised, so that people can:

(a) Make an informed choice. This is what modern medicine is all about.
(b) Monitor themselves for this kind of problem while using the drug.
posted by tiny crocodile at 4:42 AM on February 4, 2008

The advice I've gotten from ex smokers is to go cold turkey.

This is the archetypal consequence of taking advice on quitting from ex-addicts. They know about what worked for *them*. What they completely ignore are the zillions of people who try and fail using cold turkey.

Many 12 steppers are the same. It's as though all those people who join the program and drop out a week later have somehow disappeared into a black hole.

As someone who has smoked two packs a day for the last twenty years, I'm really tempted to go out and try Chantix ASAP. I trust myself to stop taking it if I start noticing suicidal ideation or any other peculiar side effects.
posted by PeterMcDermott at 4:54 AM on February 4, 2008 [1 favorite]

I also believe that the 420K death figure trumps a lot, but I would start at a lower dose, like 1/4 or 1/8 the normal prescription, and ramp up. This is true for many medications, the pharmaceutical companies are under pressure to have their tests show results, so they start high. Also doctors don't want to be bothered titrating a patient over weeks and months.

Once you've had a bad experience, it's too scary to go back and try a lower dose. Start low, keep a journal, and be observant for subtle effects.
posted by StickyCarpet at 6:25 AM on February 4, 2008

It's important to have all the facts available when you start taking any medication. I think Chantix is a good option for people who have not been successful with other methods, but should not be first-line treatment.
posted by Mister_A at 6:31 AM on February 4, 2008

I've been worried about Chantix since I heard about the Carter Albrecht thing. That said, one of my best friends quit with it in November and hasn't had a cigarette since - and she reports no horrible side effects. I have a prescription but I've been dragging my feet and this solidifies my decision not to do it. Some years ago I tried the Wellbutrin method and that sent me into a spiraling black hole of panic attacks that took weeks to go away - sure, I didn't want a cigarette, but then I was having trouble leaving the back of my closet to get one anyway. It's tough to smoke when you're curled up in a fetal ball, shaking. So as a person who is clearly predisposed to weird psychological side effects, I appreciate this information and when I do go to quit again, I'll do it the old fashioned way. with hypnotherapy, a grief ceremony, perhaps some chanting and one whole hell of a lot of misery and angst.
posted by mygothlaundry at 7:45 AM on February 4, 2008

I can't argue with statistics, you guys. But this medication's only been approved and in wide use since what, May? And Carter didn't kill himself. If you look into his story, you'll see he went to a neighbor's house and banged on the door and the guy shot him. No point in retelling it; the story's out there.

My point being, there are other ways to die on Chantix. Imagine if you were in the car and became so disoriented you didn't know where you were and had a wreck because of it.

I appreciate that it has helped people; it's just unfortunate that there have been so many problems with people taking it and it's only been out there for public use for what, less than a year?

Quoting statistics at me doesn't make me go, well, screw it, so what if Carter died? That's a freak accident, man. It was not a big deal for him to die because millions of people need to quit smoking, and that's the greater good.

Maybe because I'm emotionally affected by someone who died while on it, I can't be as objective as you. I just feel strongly about it.

I myself loved Seldane for my allergies until one day I took one while I was sick with the flu and had a bad reaction with my antibiotics. I collapsed on the floor and laid there for 7 hours unable to move until my roommates came back into town and took me to the hospital. So yeah, I know a little something about medicine that works great, then you have a bad reaction, and hey, guess what? No more Seldane, right? Just saying... if they recalled Chantix, I would NOT be surprised.

When the side effects include suicidal thoughts and psychotic behavior, it's kind of hard to combat that negativity with a press release or two.

I congratulate everyone who managed to quit smoking on it. But if anyone ever asks me about it, I'll tell them I think they should try something else.
posted by Unicorn on the cob at 8:08 AM on February 4, 2008

I wonder why delmoi is such a rabid antismoker (or perhaps just rabidly pro-Chantix)? Is he the same way about obesity, or careless driving, both of which also kill lots of people? We're all going to die some day, so does it really matter if we end up dying a few years sooner because we enjoy smoking cigarettes? There's certainly a lot less negative externalities with cigarette smoking as compared to drinking.

BTW, I'm a former smoker. I quit because I couldn't smoke due to a bad flu, and stuck with it because I had been thinking cigarettes cost too much money. I'm lucky, I suppose, being able to do that.
posted by wierdo at 8:29 AM on February 4, 2008

just as anyone with a penicillin allergy has an excellent reason not to take penicillin.

Of course, but the problem was you didn't know who would be allergic to penicillin until they died a horrifying death.

(In fact, you don't become allergic to something until you are first exposed too it, from my understanding. I could be wrong, though.)
posted by delmoi at 8:42 AM on February 4, 2008

I wonder why delmoi is such a rabid antismoker

I'm not a rabid anti-smoker, although I don't like going to a bar and coming home reeking of tobacco smoke. I think it's gross.

Anyway, what bothers me is the idea that some people have in this thread that because of these side effects the drug should be banned, or the drug is a bad idea, or whatever. The side effects don't sound like fun, but there is such a low risk. And lung cancer or emphysema don't sound like fun either, there is a very high risk of those things if you smoke. Trading a very low risk of psychological side effects for a very high risk of horrible repertory illness is just not a rational thing to do.

Obviously people should be aware of the side effects and pay attention to their moods while on the drugs, and possibly avoid it if they think they are prone to psychological effects (like mygothlaundry above). But this drug could literally save millions of lives, of people who want to quit smoking but haven't been able to do that. The idea that it's somehow 'wrong' or over the top to not want those people to die seems bizarre.
posted by delmoi at 8:52 AM on February 4, 2008

There's quite a bit of interesting reading and links about Chantix/Champix here. After reading through it all, I don't think I'd take it.
posted by Orb at 9:24 AM on February 4, 2008

Devils Rancher : I quit smoking cold-turkey somewhere around Xmas, I think, and still want a cigarette BAD every day. Don't think I'll be messing with that stuff, wither way, even if I go back to smoking, which I'm considering, because not smoking is sucking, right now.

You are still addicted to the idea of cigarettes.

I've been doing it for a month. The craving's gotta stop sooner, or later.

Actually, the physical nicotine cravings stop after about three days, and the nicotine has nearly completely left your body after 3 weeks. If you are still craving, it's not the drug that you want, it's the idea of the relief you got from the withdrawal symptoms. The thing is, since you don't have any nicotine left in you, you aren't actually going through withdrawal anymore, your mind is just fucking with you.

It's this empty feeling that causes a lot of people to start eating when they quit smoking.

If you are still having problems, read Alan Carr's The Fast and Easy Way to Quit Smoking.

I figured it was bullshit (come on, a self help book that actually works?) but all it really does is explain the psychology of what you are going through. I quit, and a co-worker who listened to me talk about what I was reading was able to use it to quit as well. That was last May.

Another co-worker opted for the Chantix route. It worked well for him, but I know that he had some depression issues not long after. I now wonder if they were related.
posted by quin at 9:26 AM on February 4, 2008 [1 favorite]

My bad. It's spelled Allen Carr and the title is The Fast and Easy way to Stop Smoking.
posted by quin at 9:31 AM on February 4, 2008

I'm not a rabid anti-smoker
Sorry, you were sounding like one.

Just FWIW, I don't really find the smell of tobacco smoke very offensive, at least until it gets stale. The day after visiting a bar or smoking a cig, as I do a couple of times a year (usually with alcohol), as it is in fact quite enjoyable on occasion, unlike when you have a constant habit, your hair and clothes do smell bad. That's why you wash yourself and your clothes. ;)

I will grant that a heavy smoker's house does smell like ass, but that's because of the stale smoke, not the new smoke. Of course, the smell largely depends on what someone is smoking. Marlboro smells to me like Budweiser tastes..very bad. Winstons (do they even still make those?) smell like dirty socks. Camels are mildly better, but that's like saying Coors is better than Bud. Damning with faint praise, that.

Back on topic, I disagree that psychological side effects are certainly better than the physical side effects of smoking. They certainly could be for people who smoke many packs a day, but for the more usual smoker, unfamiliar psychological side effects could have long lasting traumatic effects, even if they don't actually end up committing suicide. I'm not saying it should be banned, but I am saying that perhaps people ought to think harder about using it, and perhaps think more about other methods of quitting.

God knows it's not easy to quit smoking. For me the problem was finding something to do with my hands. I decided to type more. ;)
posted by wierdo at 9:56 AM on February 4, 2008

Dr. Curare, just toss those last 6 pills. Seriously. Craving a cigarette and not having one anyway is possible, I've been doing it for a month. The craving's gotta stop sooner, or later.

Gee, that's a great way to practically ensure a suicide. These drugs pose the most danger when they are used like that. You have to ramp down on them.
posted by butterstick at 10:23 AM on February 4, 2008

Dr. Curare, just toss those last 6 pills. Seriously. Craving a cigarette and not having one anyway is possible, I've been doing it for a month. The craving's gotta stop sooner, or later.

I quit cold turkey (Jan. 7, 1977, at 7am I smoked my last cigarette). The craving does go away, but even after these 40 odd years (some odder than others, believe me), I still have dreams occasionally that I am smoking again, accompanied by feelings of huge disappointment when I realize it, and enormous relief when I awaken to find it was just a dream.

Nicotine: that's some powerful shit there.
posted by Mental Wimp at 11:48 AM on February 4, 2008

these 40 odd years

Well, it seemed like 40 anyway.
posted by Mental Wimp at 11:49 AM on February 4, 2008 [1 favorite]

There's quite a bit of interesting reading and links about Chantix/Champix here. After reading through it all, I don't think I'd take it.

I might be more convinced if the site didn't have such a heavy ideological bias against the use of anything other than a cold turkey approach. These people appear to think that all pharmacological assistance to stop smoking is bad, m'kay?
posted by PeterMcDermott at 12:10 PM on February 4, 2008

You are still addicted to the idea of cigarettes.

Actually, the physical nicotine cravings stop after about three days, and the nicotine has nearly completely left your body after 3 weeks. If you are still craving, it's not the drug that you want, it's the idea of the relief you got from the withdrawal symptoms. The thing is, since you don't have any nicotine left in you, you aren't actually going through withdrawal anymore, your mind is just fucking with you.

What is this -- Rational Recovery? I know all of that -- it just so happens, that I LIKE smoking. I enjoy it immensely. So, I miss it, but I don't miss the $15.00 a week I was spending, or the hacking cough, or the idea of dying of lung cancer. I'll get over myself just fine.

Oh, and I didn't realize you'd need to ramp down on the Wonder Drug. For g*d's sake, IANAD! whatever I say about pharmacology is wrong.
posted by Devils Rancher at 2:34 PM on February 4, 2008

Butterstick, This is how the treatment is supposed to work:

1. 1 week half dose
3. 3 to 6 months full dose
4. Stop. No ramp down.

This is easy to look up, before predicting my suicide.
posted by Dr. Curare at 3:12 PM on February 4, 2008

You know what is really really cool Devil's Rancher? Set aside your cigarette money, in my case $25 to $30 a week, and at the end of the month spend it on something really cool and unnecessary. Almost anything you waste that money on will be less stupid than buying cigarettes. Somehow this makes that irrational part of me quiet down and stop missing cigarettes.

Don't forget to say Fuck Philip Morris.
posted by Dr. Curare at 3:19 PM on February 4, 2008

What's interesting about Chantix is that it is a nicotine receptor agonist (aka, it is to cigarettes what methadone is to heroin)-- it prevents the preferred drug from acting by occupying the same receptor, thereby having some of the same effects and also preventing the other drug from acting. The reason people on a stable dose of methadone are not "high" all the time is because of tolerance. It sounds like this drug prevents craving by giving nicotine addicts a form of maintenance that is not due to nicotine, like nicotine replacement.

This explains why people find it hard to stop taking and why craving may return when they do so.

The side effects are also pretty interesting pharmacologically [obviously not if you are having them or are affected by bad effects on others], given the association between these receptors and psychosis and depression. Over 90% of schizophrenics smoke and nicotine is believed to have both antidepressant and antipsychotic actions. It is not surprising that a drug that plays with this same system might have weird side effects that include some depressive and psychotic reactions. An odd fact with these kinds of drugs is that sometimes the "cure" can have the complete opposite effect that it should-- ie, antidepressants causing suicidal thoughts, etc.

it is ridiculous for people to promote "the one true way" for kicking addictions. Just as there is no one way to fall in love and no one way to get over being in love, there are a zillion ways to wind up addicted and a zillion ways to recover. We should be encouraging recovery and encouraging people to accept the fact that every decision involves balancing risks, benefits and unknowns.

It's not possible to have medical progress without risk-- the drug companies certainly shouldn't fudge data or hide risks, but consumer organizations shouldn't expect 100% risk free drugs either.
posted by Maias at 3:20 PM on February 4, 2008

You know what is really really cool Devil's Rancher? Set aside your cigarette money, in my case $25 to $30 a week, and at the end of the month spend it on something really cool and unnecessary.

I did this the other day -- my daughter had $25.00 and wanted a $40.00 leatherman tool because all the cool nerds in her Robotics class had one. I told her I'd make up the difference with my cigarette money I'd saved. She was one overjoyed teenager.
posted by Devils Rancher at 3:28 PM on February 4, 2008

Dr. Curare, I was pointing out that what is under debate in the community is that this suicidal ideation may be a result of SSRI Discontinuation Syndrome (see Paxil), and it is far safer to taper off the drug than not. I understand that the treatment does not specify that users should taper off, but that's why the FDA is urging Pfizer to update their info on the drug.

Part of everyone's problem here is that those instructions you cite above are incomplete, and the risks were not sufficiently disclosed. Thus the FDAs "ongoing safety review".

My s/o is on the stuff, and is tapering down to avoid the Discontinuation Syndrome, and it's working well. That's anecdotal, but I really don't see the benefit in throwing caution to the wind and tossing the rest of your dose.
posted by butterstick at 10:11 AM on February 5, 2008