I'd just been eaten by a giant rainbow-colored moth

August 16, 2010 10:25 PM

Chantix (aka Champix) is a drug developed to help people quit smoking. It works by binding nicotine receptors in the brain. It has side effects -- nausea, gas, suicidal ideation, and strange dreams. "Strange dreams"? Yep, it's right there in the official side-effects from Pfizer (17.13). Here's a strange dream. Here's another. Here's some more.

So pretty psychedelic, right? Maybe some people are using Chantix for recreational purposes but nicotine patches are a whole lot cheaper. And there are other side-effects from Chantix, like uncontrollable rage (also mentioned in the links above). There may be more not yet identified. The lawyers are already gathering. (Previously)

posted by CCBC (62 comments total)

But all these dreams are true.
posted by TwelveTwo at 10:32 PM on August 16, 2010

Jesus, I've had weirder and more disturbing dreams than these every single night for years. Is that a problem? No one told me it was a problem.
posted by decagon at 10:43 PM on August 16, 2010 [4 favorites]

Considering that quitting smoking can leave you even more depressed than you probably already were, this "suicidal ideation" bit strikes me as something of an obstacle. That's why it's funny that they prescribe Stilnox to sad people who can't sleep. And not "funny ha ha".
posted by turgid dahlia at 10:44 PM on August 16, 2010 [1 favorite]

I didn't have any nausea, not that much gas (I could always get out of the room in time), didn't attack any one (though I considered it), nor have any dreams that much weirder than I usually do. After a week on the stuff i didn't even think about cigarettes.

And I'm still here -- but I quit the stuff after two months. And started smoking again three weeks after that.
posted by Some1 at 10:46 PM on August 16, 2010

When I was on the nicotine patch I had the most incredibly vivid dreams of my life. I would have dreams that would last subjectively for days, dreams that had multiple interconnected narratives and levels, high-fidelity full-sensory dreams that felt more real than my waking life. They were never nightmares, exactly, but they were sometimes intense or action-packed to the point of being terrifying (I had one that at one point involved being trapped in the back seat during a car chase and eventual shootout - my thought through the whole thing was "holy shit, I'm going to die"). Some nights I would have deep and involved conversations with people I knew (or invented). Other nights I would wander through neighborhoods just like the ones I grew up in but somehow darker, more rundown, and more overgrown. These were both the most realistic and (at times) the most surreal dreams I've ever had, and certainly the most I've ever had over any period of time. I have never experienced anything like the dreams I had on the nicotine patch.
posted by OverlappingElvis at 10:53 PM on August 16, 2010 [13 favorites]

Now that I had the cat, it was time for him to clean up his mess. Carrying the cat by the scruff of the neck, I hauled it to the table and proceeded to wipe up the mess with the little cretin.

Cats are not nearly as absorbent as you might think. I spent quite a while wiping it up and down, back and forth across the table, but the only thing I accomplished was spreading the milk around. Figuring that it must have been saturated, I dragged the cat to the sink and dunked it in the dishwater for a rinse. I don't know how long I did this, but I finally had to pause when I caught myself laughing maniacally while thinking about wringing out my cat like a dishrag.

Man.
posted by disillusioned at 10:54 PM on August 16, 2010 [5 favorites]

I know somebody who had a similar freak-out on Wellbutrin, prescribed for smoking cessation. It pretty much wrecked his life for the next year or so. He fell into a black depression, flunked out of school, alienated all his friends, and started drinking heavily, all during the space of about one month. And, um, he still smokes two years later.

What is it with all these drugs that make you kill yourself, anyway? I keep seeing these ads for Lunesta, and the voice-over goes on for something like two minutes listing all the horrible side effects. No one even knows how it works, and you may experience suicidal ideation, aggressiveness, hallucinations, confusion, or depression. Your tongue might swell up and kill you, it's habit-forming, and you may walk, talk, eat, fuck, or drive in your sleep without remembering it the next day. Call this number and get your first week free!

And like turgid dahlia said, it's for "sad people who can't sleep". You can get insurance to cover this stuff, but not therapy... something's topsy-turvy here.
posted by vorfeed at 10:56 PM on August 16, 2010 [3 favorites]

Nicotine patches also have "vivid dreams" as a side effect, luckily for me that's an incentive.
posted by drinkyclown at 11:00 PM on August 16, 2010 [1 favorite]

Am I just weird? I have dreams with soap-opera plots, a complete cast of characters, and a point every night, and I've never even dreamed (har) of taking Chantix or any other mind-altering drug. (I smoke a lot of cigarettes, though)
posted by deep thought sunstar at 11:21 PM on August 16, 2010 [1 favorite]

I remember reading once that there's no such thing as a "side" effect. They're all effects of the drug. A friend of mine loved the dreams she had on the patch. She said they were so vivid, she never took it off at night as directed.

I was prescribed antidepressants as a teenager few years later a few studies concluded that "suicidal ideation" was a common side-effect, especially for teens. It didn't help that another "side" effect was anxiety attacks (for which I was prescribed benzos) and insomnia (sleeping pills). Depressed teen + lots of medication + suicidal ideation = wendell.

On the other hand, I know some people for whom antidepressants have been life saving, or chantix was just the help they needed.

I have crazy dreams almost every night, and I feel sorry for my mom, she never dreams (or doesn't remember).
posted by thankyouforyourconsideration at 11:30 PM on August 16, 2010

Oh, and Lunesta makes everything taste like metal the next morning. So weird.
posted by thankyouforyourconsideration at 11:34 PM on August 16, 2010

nausea, gas, suicidal ideation, and strange dreams.

I smoke and I already have these things. Plus, I look cool. Will the Pukey-Farty-Suicidey-Heebie-Jeebie drug make me look as cool? I doubt it.

Advantage: Tobacco.
posted by Alvy Ampersand at 11:36 PM on August 16, 2010 [8 favorites]

A description of how Chantix (varenicline) works by 'binding nicotine receptors in the brain' is about as useful as the linked site's explanation of how nicotine works.

"Uh, nicotine, tiny receptors, other cells, something somthing... Dopamine! You know, the pleasure neurochemical?"

Nicotinic receptors are cholinergic in nature (i.e., receptors for acetylcholine). Not dopamine receptors. While it's fair to say that downstream changes in dopaminergic activity may occur as a result of the activity of a nicotinic antagonist, it would be just as fair to point to any other neuromodulatory system. They all work together in order to maintain adaptive global states.

Mihalak, Carroll, and Luetje (2006): Varenicline Is a Partial Agonist at α4β2 and a Full Agonist at α7 Neuronal Nicotinic Receptors

The way that cholinergic neuromodulators affect REM sleep is ill-understood, at best. If the focus is of the post is on this particular side effect, don't water it down with extremely half-assed 'pharmacology' links. The Wikipedia page on nicotine is a hell of a lot better than a drug-peddlers Geocities-ass monstrosity.
posted by solipsophistocracy at 11:38 PM on August 16, 2010 [5 favorites]

I know somebody who had a similar freak-out on Wellbutrin, prescribed for smoking cessation.

Perhaps a different outcome if mixed with sertraline...
posted by Tube at 11:41 PM on August 16, 2010

Oh Baby! I'll have me some of that glorified toaster...

Is that a glorified toaster in your pocket or are you just glad to see me?
posted by Oyéah at 11:51 PM on August 16, 2010

What is it with all these drugs that make you kill yourself, anyway?

When a person is seriously depressed, like can't get out of bed depressed, there is not enough energy or organization to commit suicide. Once an anti-depressant is begun, the person "improves" a little bit, before the anti-depressant is at full strength in the persons system, and there is a little more energy and enough organization for suicide to be carried out.
posted by mlis at 12:03 AM on August 17, 2010 [2 favorites]

My ex, while on Amytriptiline woke up one night screaming at the "tentacles from the a/c vent". Asked what tentacles, he was shocked the cat's jumping and growling at them hadn't woken me up. The cat was fast asleep at the foot of the bed.

The one time I was on the nicotine patch, I took it off the first night and had the first truly lucid dream I'd had in years. Extremely vivid, totally real with the full knowledge I was dreaming. Was on the patch for six days (hospital stay), and took off as directed nightly. Was only somewhat disappointed at no more dreams, but I needed the more restful, non-lucid sleep more than the dreams at that point. I think when I decide to quit smoking, I'll leave the patch on over night a few times.
posted by MuChao at 12:16 AM on August 17, 2010

What is it with all these drugs that make you kill yourself, anyway?

I'm not a doctor, but a patient. I've been heavily addicted to nicotine for about twenty years. I recently (as in last week) tried quitting smoking for about the tenth or twelfth time - and failed because the withdrawal related depression seriously pushed me too close to the edge. As in right now, crawling back out of it for the Nth time this year.

I've only had one experience with an SSRI and I'm extremely wary about trying that ever again. My information is anecdotal, if you need help with depression please talk to a real doctor that you like and trust, etc.

I'm going to talk about this from a very subjective, personal and unscientific viewpoint - but I'm very self-aware and sensitive to how drugs react with my body and mind. Not just drugs, but food, sleep, and all the things that go into what makes us humans, functional or not.

My one experience with an SSRI was with Zoloft which is supposedly fairly mild. At first it was great. I was really hoping it was going to work, and for a very short time it did.

On the very first day I started taking it I noticed effects - which in retrospect was a warning sign. It's not supposed to be noticeable that soon, but I noticed it. On the first day I had increased energy and a bit of mild side effects like nervous energy and very mild dizziness.

By the third or fourth day I felt great. Colors were brighter like I had been seeing the world in grayscale my entire life. Food tasted better and I craved really healthy food. I could smell flowers from dozens of feet away. My general moods went from black to gray to clear and bright. It wasn't recreational or entertaining like a recreational drug, it was more like someone had just peeled back a thick layer of wet, greasy wool felt from around my senses. As much as I dislike the word, it felt "normal".

By seven days I was on fire in a good way. Side effects were minimal. I felt like I could actually feel the emotions that a lot of other people may take for granted, and enjoy or deal with them appropriately. I wasn't fearful. I was actually deeply interested in the people around me instead of being mired in and distracted by pain. At around this point things stabilized and were steady for about the next two weeks. A little glitchy, but a breath of fresh air.

But then things went terribly wrong. It's like I could feel my serotonin levels crashing and flatlining. I went from "bright and clear" and "not gray" and plummeted right through the floor of where I had been before I started taking Zoloft for depression and PTSD and kept plummeting straight into a pit so dark and so black I really don't like to think about it, reflect on it or talk about it too much. I remember the day it crashed very clearly because it was awful. It was like going blind again after briefly being teased with the ability to see for the first time, ever.

I did everything right. I kept taking it like clockwork every morning for another 7-10 days hoping it would stabilize and actually work like I was told it should work. But it didn't. I kept plummeting. I spent those 7-10 days in excruciating mental and physical pain, laying down but never able to really rest or sleep, spending most of my time just standing in the rain and chain-smoking like some kind of zombie.

You know how bad it hurts when you slam your finger in a door or hit it with a hammer? My whole body felt like that for about a month. My eyes, my brain, my body and skin, everything hurt like that. I actually have a hard time accurately describing how bad it hurt, I don't have the adjectives. It was fucking excruciating. I think the pain of fire would be pleasantly distracting compared to the phantom brain-body pains that I was experiencing, an itch that couldn't be scratched, a wound that didn't bleed or heal.

I finally broke down and went in and talked to my (ex) doctor who simply said "Oh, so stop taking it." and sent me on my way. Grar. I still think he prescribed too early. It was our first visit, he's not a psychiatrist but a GP. I didn't have a case history built up yet with my therapist and he sent me home the day of our first visit with a bottle of pills. In hindsight I wouldn't have done that, but I was at the doctor's asking for help because I was at the end of my rope.

So. I stopped taking them. The withdrawals were intense. Ever have one of those hypnagogic jerks as you're falling asleep where it feels like someone zapped or shocked your brain suddenly awake? That falling, startled and panicky feeling? The withdrawals were a lot like that, but stronger and scarier, and much more frequent - with the added joy of it feeling like someone was electrocuting my brain and CNS. This happened every few minutes at first, to once an hour, to a few times an hour over the space of weeks. I could barely hold a coffee cup or glass of water for the first week.

The informal name for these side effects are the "brain zaps". The formal name is SSRI discontinuation syndrome. And it's terrifying. It's like your brain is having miniature seizures while you're awake, and there's absolutely nothing that you can do about it except hang on and plow through it.

Oh, and keep in mind you're trying to hang on and plow through it while everything hurts, you're so depressed you can't even see straight and for me personally my internal monologue went from a relatively polite and quiet "Hey, your life sucks. You're kind of broken. Maybe you should kill yourself. The pain will stop. You'll be free. Ok, maybe not. Just saying you should think about it, is all." a couple of times a day or per week to an internal monologue that sounded like a Norwegian Black Death Metal band growling and shrieking "KILLYOURSELFKILLKILLKILLYOURSELFWITHFIREYOUFUCKINGSUCKSWALLOWYOUROWNTONGUEDIEDIEDIE RRRAHAHAHRHGH" through the mother of all sound systems set up right inside my own skull.

Needless to say this was not ok at all.

I'm not the strongest person in the world, but probably stronger than most. I've been through a lot, and I've lived an interesting and unusual life. But I damn near gave in. If it wasn't for the fact I was living with a very close friend who I knew loved me very much, if I hadn't been in contact with friends and family online (this means you) and off I probably would have just gone for it. The pain was incredible. Worse then what was previously the worst pain I'd ever felt which was a double ear infection with two infected, abscessing and impacted wisdom teeth and a fever pushing 105-107 thrown into the mix just for seasoning and spice.

I knew I had problems before the Zoloft and I have the same problems after but they seemed positively lovely and felt like home compared to the bad reactions I had to it.

So, yeah, that's why these drugs sometimes make people kill themselves. How? I don't know. I'm not a doctor.

I personally think they're over-prescribed and very dangerous. While I do believe they've helped many people, I also firmly believe that they're very, very powerful tools with very real risks involved and they need to be treated with extreme caution, respect and care. I personally think they're much more dangerous and risky then cannabis or LSD. I'm pretty sure I'm still dealing with long lasting side effects from the sertraline (zoloft) almost six months later.

Ultimately I think we need a revolution in health care in general, mental and otherwise, because physical and mental health are related. How many doctors are there out there that are willing to say "Well, you're obviously depressed. How about we look at your diet and exercise habits and general health before we try putting you on a powerful drug that we still don't really know how it works? Maybe you should try some swimming or bicycling first? When was the last time you had a really great salad?"

Moreover, I think we need a revolution in how we live our lives and view the health of our communities and our socialization because this whole "staring at glowing rectangles, eating packaged machine food and disconnected from reality because reality sucks" thing isn't working very well, either, and is ultimately tied to our physical and mental health just as much as the air we breathe and the water we drink.
posted by loquacious at 12:27 AM on August 17, 2010 [88 favorites]

I've always had occasional really bad nightmares, but they were never as bad as when I was on Lexapro. They took a turn WAY for the worse after I posted that AskMe, and I ended up quitting Lexapro cold turkey just to make the adrenaline-fueled nightmares that were making me scared of sleeping stop. It was a combination, I think-- the Lexapro plus a really stressful winter-- but they stopped when I stopped taking the drugs.

The weird thing is that I got a rather different sort of dreams that started once I started on a new antidepressant (Effexor). They don't happen much anymore, but I got them a lot during the adjustment period, and I get them again if I forget to take a dose. The Lexapro nightmares were emotional things, where I was driven by fear, guilt, helplessness or some combination of the three that lingered, sometimes for days, after I woke up. The Effexor dreams are a whole different animal-- just regular dreams, but full sensory in a way that I've never had before. I lost a tooth in the first one I had and I could feel the texture of my gums-- something I haven't felt in years-- with my tongue, and I could taste the blood.

I've never been the type to believe dreams told me anything except the obvious-- the nightmares I had last winter were about the things I had on my mind-- and none of my experience with dreaming on antidepressants have changed that, but the experiences with those dreams, with the quality of what, exactly, is made vivid-- have been alternately fascinating and horrifying.
posted by NoraReed at 12:31 AM on August 17, 2010 [1 favorite]

What is it with all these drugs that make you kill yourself, anyway?

Also they can induce mania in some people.
posted by fshgrl at 12:38 AM on August 17, 2010 [1 favorite]

I am not familiar with zug.com. Is anybody else? Their byline of "Prank you very much" makes me skeptical of anything that I read on their site. And these articles (with accompanying pictures) are written like poorly edited Onion articles.

I'd like to join in with my own tales of psycho-pharmaceuticals and dreams, but these anecdotal stories are not even entirely believable.

And besides, if you are taking drugs that play with your brain, you shouldn't at all be surprised when they play with your dreams as well. I'm not.
posted by chemoboy at 12:54 AM on August 17, 2010

Wellbutrin helped me and still does. It wasn't prescribed for quitting smoking but for an off-label use. Also Gabapentin. YMMV.
posted by krinklyfig at 12:58 AM on August 17, 2010

You know how bad it hurts when you slam your finger in a door or hit it with a hammer? My whole body felt like that for about a month. My eyes, my brain, my body and skin, everything hurt like that.

Not that I would know, but that sounds an awful lot like cocaine withdrawals. I've always wondered why the symptoms of SSRI withdrawal and running out of coke is pretty much the same.
posted by deep thought sunstar at 1:57 AM on August 17, 2010 [1 favorite]

Argh, the brain zaps. I miss one day of Effexor-XR and there they come. I feel like I need to change (I've kinda flatlined - nothing quite as bad as loqacious but I doubt they're doing anything) because it sucks when the only time you feel high-functioning is the 3 days you're in love.

As for vivid dreams: these sort of dreams, multi-narrative hyper-real semi-lucid epics; I've had them ever since I could remember (and this goes back to about age 5). It's the mundane dreams, the stereotypical rotten-teeth/naked-in-class/etc ones that make me wonder. Is there a certain brain chemistry thing that makes people prone to vivid dreams? Something to worry about?
posted by divabat at 2:43 AM on August 17, 2010

All I can say is that this thread just made me much more sympathetic to smokers.
posted by idle at 2:53 AM on August 17, 2010 [1 favorite]

Shit, I'm glad I picked Swedish snus as a cigarette alternative instead of trying to quit with Chantix.

When I forget that I have a snus portion in at night (after a couple months it's easy to do), I find that I do have some pretty incredible dreams. Maybe not anything quite like the ones described here, but on the bright side, I haven't flipped out and mopped up milk with a cat or tried to kill myself, either.

I'm pretty sure I will have an even harder time quitting snus, but frankly I enjoy it. I can't remember the last time I truly enjoyed smoking, so that's something.
posted by Clamwacker at 3:00 AM on August 17, 2010 [2 favorites]

solipsophistocracy: Sorry you don't approve of the plebian explanation of how Chantix works that I linked. I did look at some others, but nothing like the study you've linked. That's a very interesting paper. I didn't really understand whether the authors were saying that vareclinine (Chantix) has no efficacy against nicotine addiction (which some people have stated) or not. The Wikipedia article states clearly that increased dopamine levels are thought to contribute to nicotine addiction. However, as you said, this is all ill-understood. The focus of the FPP is on unintended effects of drugs meant to counter this or that condition. Strange Dreams, whether from nicotine patch or Chantix, seem to me to indicate some part of brain function not properly understood and therefore a warning sign against administering drugs that excite these reactions. Smoking is harmful. Is it harmful enough so that these side effects (and possibly others not yet identified) are warranted?
posted by CCBC at 3:11 AM on August 17, 2010

Correction: varenicline. Somehow I find that a difficult word to spell.
posted by CCBC at 3:16 AM on August 17, 2010

How about we look at your diet and exercise habits and general health before we try putting you on a powerful drug that we still don't really know how it works? Maybe you should try some swimming or bicycling first?

A seriously depressed person is often pretty much incapable of taking the initiative and getting out to do some swimming or bicycling. Don't get me wrong, a lot of doctors no doubt throw antidepressants around with little care but that's a different issue.

I personally think they're over-prescribed and very dangerous.

Over prescribed? No doubt. Very dangerous? Naaah. Not as medication goes. They're extremely safe in that respect; you're overgeneralizing from your own experience. Your reaction isn't unknown but it is very rare. But a few people have serious or life-threatening reactions to any medicine, including aspirin or the like.

Hell, one of the worst ways to die has got to be what happens to a small number of people who do nothing but take a common antibiotic. The skin over 90% of their body SLOUGHS OFF and they die. It's awful. But the risk of that happening is extremely low, just as the risk of what you experienced is also low. Although not as low as your skin sloughing off from common medications.

That said, the most dangerously overprescribed medications are undoubtedly antibiotics. Not because they will are necessarily dangerous to the person taking them but because their overuse is causing resistant strains. This is by a huge margin the biggest problem.

The next closest is almost certainly the various stimulants used to treat things like ADHD. Giving people speed should really be a method of last resort. But it is handed out like popcorn. Crystal meth? Demon drug! Desoxyn or Adderall? Wonderful!

Anti-depressants don't even rate on that scale. We should make sure they are only used when necessary but I really do think you're seriously overstating their danger based on a very atypical response.
posted by Justinian at 3:47 AM on August 17, 2010 [10 favorites]

Someone I know had oppressive suicidal thoughts after taking Chantix.

She said that when she opened the knife drawer in the kitchen, all that she could think of was how each knife could cut her.

This whole nightmare stopped as soon as she stopped taking Chantix.
posted by StickyCarpet at 4:07 AM on August 17, 2010

Interesting. Larium (an anti-malarial) is also widely ascribed to have "vivid dreaming" side-effects; this is one of the reasons I avoided taking it (and got malaria). In hindsight I probably would have preferred the dreams.

Funny thing is, my wife recently kicked smoking with Chantix and I was all set to take it myself when I decided instead to just go cold turkey. So once again I've missed my opportunity for fucked up vivid dreams.
posted by Civil_Disobedient at 4:08 AM on August 17, 2010 [3 favorites]

"Uh, nicotine, tiny receptors, other cells, something somthing... Dopamine! You know, the pleasure neurochemical?"

Uh, dopamine doesn't give you pleasure. It basically makes you edgy and tense. Someone who's addicted to cigarettes might have a lot of dopamine going through their brains when they really want a smoke and have the motivation to drive out at 2AM to get some. Dopamine is what comes before you get what you want.
posted by delmoi at 4:45 AM on August 17, 2010

I took Larium for three months. The dreams were awesome! And not getting malaria was also awesome.
posted by Drexen at 4:47 AM on August 17, 2010

I used it a couple of years ago to successfully end a 35 year, 2 pack a day habit. My dreams were indeed vivid, but not really all that fucked up. No bears chasing me, or sex with movie stars, just boring dreams in High Def.
posted by lobstah at 4:55 AM on August 17, 2010

Shit, I have vivid, whacked-out dreams all the time and I'm not even taking any drugs.
posted by bwg at 5:10 AM on August 17, 2010

That poor, poor cat. I'd be more understanding about a momentary loss of temper under the influence of an inadequately warned psychoactive drug. But this fuck offhandedly mentioned that they had him declawed. Take up smoking again, Jep. Soon.
posted by aeschenkarnos at 5:10 AM on August 17, 2010 [1 favorite]

I've always been sort of insomniac. Can't get to sleep, other times can stay asleep. Very rarely do I actually sleep through the night and feel rested in the morning, and that coincides with a night where I actually dreamed. The doctor said "watch out for the side effects, you might feel keyed up and edgy and tense for a week or so. Try to tough it out." HA! Literally on day one of taking Wellbutrin, I was finally able to sleep and dream normally. As in: having dreams at all. The next day I awoke and felt great: calm, in control, etc. I guess this is a sign that my dopamine system really wasn't working properly. I would imagine that for someone who has a normally functioning dopamine system, it would make the dreams whacked out and crazy.

I can't speak for anyone else, or for Chantix, but if it's like Wellbutrin, the "intense rage" is probably the dopamine reward system retuning itself. The brain chemicals saying "this thing that is happening is harshing your mellow, make it stop NOW!"

Uh, dopamine doesn't give you pleasure. It basically makes you edgy and tense. Someone who's addicted to cigarettes might have a lot of dopamine going through their brains when they really want a smoke and have the motivation to drive out at 2AM to get some. Dopamine is what comes before you get what you want.

I'd always thought that, but never saw it anywhere. That makes a ton of sense. My interpretation, however, is that it is the good kind of edgy and tense. That cleaning the house because a date is coming over kind of edgy. I guess as long as you have something rewarding to point the energy toward, it's a good thing.
posted by gjc at 5:17 AM on August 17, 2010

When my doctor prescribed me Chantix she told me about the dream side effect and said that a lot of her patients had really vivid sex dreams. When I take Chantix I have vivid dreams maybe 4 nights a week and only one of those dreams involves sexytimes.

When I was on Chantix the first time got serious nausea and abdominal cramping that lasted for hours. When I took it after my gastric bypass surgery the cramping got worse, but there was no nausea, and the whole thing lasted less than a minute. I'd start counting as soon as the cramping started and never once got to sixty.

No suicidal thoughts or depression, but definite uncontrollable rage. However, quitting smoking also gives me uncontrollable rage, so...

I've taken the stuff three times. I think it makes it too easy to quit. There's no incentive to stay quit after you're done. After a cold turkey quit all you can think about is how gruelling it was and how you never, ever want to go through that again. If you relapse after Chantix? No big deal, I'll just take it again!
posted by elsietheeel at 5:50 AM on August 17, 2010

loqacious, you just explained my withdrawal from Paxil perfectly. I was only on it a month and I hated it. My doctor kept telling me to stick with it because it needed about 6 weeks to fully kick in. Wrong. I quit cold turkey. The zaps were so distressing! I really felt like I was losing control of my mind and body. The after effects lasted about a month. I eventually went on Zoloft (for years) and had no problems and I also quit taking it with no problems.

Chantix. I took it for 2 weeks and it turned me into a zombie. If someone had called to tell me that they would give me $10,000 if I would just drive 15 miles to their house, I wouldn't have done it. The very idea wouldn't have interested me in the least. Still smoking. I am considering taking one pill a day to see if that would help.
posted by futz at 6:10 AM on August 17, 2010

I am not familiar with zug.com. Is anybody else?

He's been around for quite a while. His writing style isn't for everyone, and I'm sure there's some exaggeration-for-comedic-effect going on but I doubt that he's just making it all up from whole cloth.
posted by ook at 6:32 AM on August 17, 2010

I was super excited to go on Lariam and have wacked-out dreams, but I got nothing. I don't even remember dreaming. My awesome side effect was that mosquitos stopped biting me while I was on it (or maybe they were biting and my body just wasn't reacting).

I'd agree that to successfully stop smoking, it helps to have internal motivation. Everyone I know who's quit did it through reading Allen Carr.
posted by Go Banana at 6:37 AM on August 17, 2010

I think it makes it too easy to quit. There's no incentive to stay quit after you're done.

I think the bigger problem is there's no sense of accomplishment or ownership if you don't do it yourself and you're more susceptible to the temptation to give-in. When you kick cold turkey, you feel like you can do anything. You don't want to give up that feeling.
posted by Civil_Disobedient at 6:37 AM on August 17, 2010 [1 favorite]

I'm one of those people for whom SSRIs have nasty side effects. I got the uncontrollable rage effects on both Paxil and Zoloft back when I was in middle school. Tried to seriously harm my brother.

I'm glad some people benefit so remarkably from SSRIs. Kind of wish I'd been one of them.
posted by Pope Guilty at 6:40 AM on August 17, 2010

This is kind of in response to loquacious, and kind of in response to the theme behind the whole post.

The major problem with neuropharmacology is that we don't understand the brain and nervous system. Not in some dualist or giant metaphysical awe sense--I mean we have a lot of information, some of which fits together, some of which doesn't. We have a lot of questions that we're asking, and then there are a lot of questions we don't even know we should be asking. The parts we do understand, well, we've allowed some pretty weak 'woo' versions of reality to dominate the mainstream* dialogues.

Take SSRIs. Now, leaving aside the part where we still don't know how much of their effect is placebo (I'm gonna hedge and say 'sometimes yes, sometimes no, sometimes I think we need to sit down and come up with better study protocols because the current ones aren't doing the job.') More and more it seems that the most important part of the SSRIs is not that they raise serotonin levels. Something about the way they act seems to be facilitating neuroprotection overall, and more specifically neurogenesis in regions of the hippocampus and basal ganglia. In this state, the brain seems to be able to rewire itself more easily. It may not even be directly dependent on the amount of serotonin increase. In fact, when people are encouraging exercise, etc, instead of pharmaceutical treatment, the best guess is that physiologically, they're advocating changing the neural environment to encourage similar neurogenesis. That's ironic, because very few people I know encourage medication and NO exercise. Socializing facilitates neurogenesis, among other things. Therapy also can change brain states.

What we do know for sure is that some interventions work on some conditions, even if we don't understand the exact reason why. If we waited until we understood the brain before we employed medical treatment, millions of people and animals would suffer and die horribly. Some innovations and interventions that technically come in time are still too late, as in the case of my coworker who got experimental DBS. It cured her OCD, but didn't touch the depression she'd developed from years of life with severe OCD.

When it comes to smoking, things manage to get even more complicated. Smoking is a behavior. Nicotine dependence is probably the primary reason people continue smoking, but it's not a comprehensive explanation. The same nicotine-dependent person will smoke for different reasons over the course of the day, even if they don't recognize that. So Chantix cuts the nicotine dependence, but it doesn't address the rest.

*this is one thing that Big Pharma needs to be smacked down on, because the neurotransmitter model has been outdated since the 1980s. Thanks to the proliferation of neurotransmitter-based explanations in marketing and the media, neurotransmitters were practically the humoral theory of the late 1990s/2000s. You'll see vestiges of this at otherwise excellent lay boards like CrazyMeds--there are a lot of people who speak about neurotransmitters like the four humors.

For that matter, neurotransmitters differ in function depending on which type of receptor and at which site they're attaching: dopamine both gives a sense of reward and stimulates craving. The body is the ultimate in repurposing, so tweaking one bit sometimes leads to totally unpredicted effects elsewhere. Like crazy dreams. So the question is never 'do I want this intervention that will only do 'X'?' The question is 'what is this worth to me? what, hypothetically, am I willing to trade for an effective or partially effective intervention at this point?' Because there is always a trade.
posted by Uniformitarianism Now! at 6:51 AM on August 17, 2010 [5 favorites]

I have to say that those dreams seemed way less vivid and involved than the dreams I normally have. But then I seem to have kind of vivid dreams. I am on medication, and, while it doesn't seem to have affected my dreams, I do remember them more clearly, possibly because I sleep a little more deeply (sleepiness is a bit of a side effect). I avoided much of this story by never starting to smoke in the first place, but that is an easy out....
posted by GenjiandProust at 7:38 AM on August 17, 2010

The thing is, each SSRI is different and each person is going to react differently to each one. There are norms and curves and so on but there's really no predicting it until you try it. I was furious when my son was in middle school and we were spending days in psychiatric offices while they said, "Try this. Or, you know, this might work."
"You're using him like a target," I said angrily, "Just throw drugs at him and see what sticks?"
"Well," said the shrink, "Yes. It's pretty much all we can really do."
Nothing stuck. Straterra made him do his homework on his own for the first time in his life but it also sent him spinning down the rabbit hole into suicidal depression. That's why I stopped allowing him to be used for target practice although five or six years later, I still wonder if I was right.

Wellbutrin sent me into the kind of overarching anxiety where it seemed perfectly normal to spend most of the day curled up in the far back of my closet, just, you know, in case. I didn't smoke while I was taking it but then it's hard to smoke when you're that busy freaking out. Lexapro, on the other hand, I fully credit with saving my life more than once and Klonopin is a godsend. I carried around a prescription for Chantix in my purse for a year or two but I ended up throwing it away. Welbutrin made me wary of miracle stop smoking pills, besides, I already dream like that every night of my life and always have. Adding anything to my dream life is not going to be a bonus.

I might, again, be making a mistake. Maybe Chantix would finally end my decades long smoking habit and I'd be fine. Nobody can tell. I know people who it worked for - and people it didn't. There isn't any way to decide without being, at least briefly, a target. All you can do is educate yourself as best you can and try to know your own body.
posted by mygothlaundry at 7:46 AM on August 17, 2010 [1 favorite]

I tried champix and I was at work and all of a sudden my brain "flickered" and it felt as though I was going to maybe have a seizure or something. Stopped after that.

Also it made the sides of my head hurt, from the temples backwards, as though it was in a vice but not headcrushingly strong. My doctor said Champix was originally planned to be an anti-depressant but when they discovered its NRT properties, it was reclassified. Is this so?

I have also tried patches and get very vivid dreams, although (unfortunately) not sexy dreams.
posted by marienbad at 9:01 AM on August 17, 2010

I'm towards the end of the 3mnths taking Champix. I had never tried giving up before. I've had a tiny bit of nausea when taking the pill on an empty-ish stomach (and thus deserved it). I would say that there has been a mild uptick in the frequency of (and ability to recall) vivid dreams but a lot of that I could just as easily attribute to a changed sleep pattern, such that I awake from deep sleep more often. For me it's no great deal either way or can be viewed as a mildly distracting effect.

I've been a heavy smoker for a loonng time and my approach to the situation has been a year long gradual psyching up towards the cessation of smoking rather than the taking of a cureall pill. In other words, in my view it's likely that development of alternative coping strategies for stress (whether in terms of having a placebo device to occupy the fingers or some sort of calming mantra to repeat in your head and the somesuch) that are learned and deployed at the same time as the tablets will increase the chances of success considerably.

Too often I think people expect the mere obtaining of a script to be their major contribution to overcoming the addiction, but a prepared and disciplined mindset, together with the withdrawl-ameliorating effects of the Champix, strongly increase the chances of long term cessation, says the logic part of my head. I'm optimistic for myself and glad my doc spent the time talking to me and stressing the need to be engaged rather than passive. I guess we all respond differently, and though theme dream effects have had their novelty value, I can't say that I'd be choosing Champix over some other neuroactive substance as a recreational additive to my life.
posted by peacay at 9:04 AM on August 17, 2010

For what it's worth, Champix helped me kick a two decade, two packs a day habit without drama or side effects. I tried zyban a few years before and it made me suicidal, though.
posted by Kasino72 at 9:06 AM on August 17, 2010

Ugh, reading this thread while listening to the slowed down Justin Bieber song is giving me the willies.
posted by Dr. Send at 9:42 AM on August 17, 2010 [3 favorites]

Most of the terrible weird dreams I had when I quit smoking were of me, after weeks, months, and sometimes years of being done with them, for whatever reason starting again.

Every time I'd wake up with this deep feeling of shame and general disgust with myself that I'd been weak enough to re-embrace that vile addiction, only to discover it was all in my head.

It was the fastest you can go from feeling shitty and miserable to absolutely thrilled without having to get out of bed.
posted by quin at 9:54 AM on August 17, 2010 [3 favorites]

My Dad, a 60-year smoker, quit last year using Chantix and has not gone back. He got lucky with the side effects -- no rage (a little extra grumpiness, but nothing to write home about), no suicidal ideations, no depression. He did have the strange dreams, but they were WONDERFUL strange dreams. He reported that he couldn't wait to go to bed each night to see what the dream would be this time. No nightmares, nothing disturbing -- just vibrant lush colors. He wouldn't tell me what they were about, just that they were wonderful and he would have quit smoking years ago if he'd known about the dreams.

His wonderful dreams have gone away now, but he's still off the cigarettes, and good for him. I have considered maybe trying Chantix also, but the price is out of my range, and I'm just too worried about the suicidal ideations part. I'll go with the patch again, or e-cigs.
posted by stennieville at 10:47 AM on August 17, 2010

And there are other side-effects from Chantix, like uncontrollable rage

Latest theories suggest crazy ol' Mel Gibson's on the stuff, which of course excuses him from his vileness.

Or maybe not.
posted by stavrosthewonderchicken at 2:37 PM on August 17, 2010

CCBC, that paper doesn't speak to efficacy of varenicline as a treatment. In fact, it says:

"Although it is possible that one of these actions is critical, it is also possible that that some combination of these actions might work in concert to achieve a desirable smoking cessation outcome. Regardless of the exact mechanism of action, it is ultimately the results of clinical trials that determine the usefulness of varenicline as a smoking cessation therapeutic."

The 'efficacy' mentioned repeatedly in the paper is with respect to the receptor binding propensity at the molecular level.

An FPP about a drug and its side-effects need not contain a primer on neuropsychopharmacology, but linking to pernicious 'information' always sucks. You have plenty of good links in the post without including unnecessary bad ones.

The Wikipedia article states clearly that increased dopamine levels are thought to contribute to nicotine addiction.

Yep, ole DA is probably involved in nicotine addiction. And heroin addiction. And cannabis addiction (note: none of these substances works directly on dopaminergic transmission) And sex addiction, gambling addiction, World of Warcraft addiction, MetaFilter addiction, etc. Because dopamine is probably indirectly involved not only in addiction, but also in just about every damn thing that you do, I try to stay hypervigilant against the Psychology Todayesque "Dopamine!" explanations that are so ubiquitous in our lives these days.

Sorry if I came off too reactionary, but it's fucking well important to stamp out folk reinterpretations of scientific endeavor. Better not to even mention what's going on at the synapse than to promote misinformation about it.


Hey, delmoi. I thought you might show up in a thread sliding down the dopamine slope.

Uh, dopamine doesn't give you pleasure.

Very much correct. The portion of my statement inside the quotes was my interpretation of 'binding nicotine receptors' link. Sorry, forgot the hamburger.

It basically makes you edgy and tense.

Very much incorrect. Operationalize 'edgy' or 'tense' if you want, but dopamine does a fuck of a lot more than make you edgy or tense.

Someone who's addicted to cigarettes might have a lot of dopamine going through their brains when they really want a smoke and have the motivation to drive out at 2AM to get some. Dopamine is what comes before you get what you want.

On the money. It's more like a prediction error signal than a pleasure signal, and dopaminergic activity in the ventral striatum is definitely more closely linked to drug-seeking behavior than the hedonic pleasure/reward associated with drug administration.
posted by solipsophistocracy at 3:22 PM on August 17, 2010 [1 favorite]

Ugh, reading this thread while listening to the slowed down Justin Bieber song is giving me the willies.

It's like a David Lynch film generator. (And a prime candidate for this list.)
posted by punchdrunkhistory at 5:05 PM on August 17, 2010

This is kind of fascinating. Some enterprising chemist could make a fortune by isolating the dream-enhancing properties of these medications from their other effects, and selling an Awesome Dreams pill.
posted by rifflesby at 9:39 PM on August 17, 2010

I just quit smoking a few weeks ago (lost count). I didn't use any drugs. I would have enjoyed the dreams, I think. Instead, i used fear. See, my first 30 hours cigarette free were spent in the intensive care unit at the local hospital. I was having angina.

But after 30 hours of no smoking, they couldn't discover what was wrong with me! Even passed a cardiac stress test without a problem! I was disgusted, because I knew the test was unrealistic, what with me not having a smoke for 30 hours. I don't remember if I failed to articulate this idea, or if it was simply dismissed. I will say, the medical community, at least in Switzerland, seems to have abandoned science in favor of the usual intense hatred towards smoking.

So I was sent home. I was aware that the 30 hours without a cigarette, even though forced, was a start. But I also wanted to keep the stress down. So, I did an experiment. I smoked just a few drags off each cigarette. Usually, not allowing any relaxation while smoking. (The time or 2 I relaxed, I smoked too much). I was angry, and I directed my anger at smoking, and my desire.

It wasn't long at all before the pattern became clear: Smoke even a little, and within minutes I get pain. It became clear, I had to stop smoking. Now. And I did. I did deliberately make an effort to transfer the addiction behavior to cinnamon gum, and that has helped.

Then, damn it all, the pains started getting bad just from physical activity. At the end, it got so walking across the street would leave me in pain. Fortunately, that walk was to a private (non-hospital) cardiologist. He got me into the hospital to have my arteries checked, and woopsi, they were horribly blocked. The pain was all in the wrong place because my arteries were unusual. A couple stents, and that was that.

But the thing is, they tell me now that the nicotine was part of what caused the arteries to become inflamed to the point of mostly closing. I hadn't ever heard THAT part. And yet, I had heard the part about how smoking makes the arteries contract. Frankly, that was what provided the warning in the first place, about a month before things closed so bad that walking across the street produced angina.

So here I am, not smoking (scared half to death of the damned things!), chewing gum (actually I mostly dislike gum), with propped-open arteries. Oh.My.God. It is perfectly clear, my arteries spent a lot of time getting to that 99% blockage point. I feel better than in ages. Oh, and I never even had an actual heart attack, and my heart is undamaged. w00t!

The point? Cold turkey to quit smoking is helped a very great deal by angina! Angina probably works better than any of those drugs to help you quit. I highly recommend it!
posted by Goofyy at 11:51 PM on August 17, 2010 [2 favorites]

*Checks with doctor to see if angina is right for self*
posted by Alvy Ampersand at 11:55 PM on August 17, 2010 [2 favorites]

On non-preview, I should clarify: I feel strongly that the cardiologists at the hospital should have sent me out for a cigarette, or even have had me hooked up to their 12-point EKG and taken me out for a smoke, and shown exactly how it was the cigarettes making my heart freak out. This would have been extremely motivating to quit right away, as well as giving them a more realistic picture of what was happening to me. The fact they did not is the reason they misdiagnosed my problem. I could have, in the mean time, had a heart-damaging myocardial infarction, and died.

I believe strongly that it is their hatred of smoking that prevented science to show them that this was the approach to take. My reality was one that included smoking. They should have tested in the basis of my reality, not their idealistic one, which yielded false results. I'm sure some jackass decided that was like "encouraging" smoking. (like passing out condoms in prison would be condoning prison rape)
posted by Goofyy at 11:57 PM on August 17, 2010

Can the man in the first dreams link be arrested for animal abuse? Without the drug, he cuts off his cats toes (which is unfortunately legal), with the drug, he scares it half to death, dreams about killing it, mops up the floor with the fucking CAT, and dunks it in the dishwasher?

I hope he falls off a cliff. I've taken some nasty drugs and would have never, ever done that, even if I thought the cat was plotting against me.
posted by Malice at 9:09 AM on August 18, 2010

Hmm.. I missed this thread.

When I used the nicotine patch, I had consistent nightmares, the same one night after night. It was a vision of the buddhist "Hell of the Long Ropes," called that because a demon with iron claws rips open your belly and pulls out your intestines and stretches them until they look like long ropes. That was a really unpleasant dream to have over and over, I woke up in a cold sweat almost every night. The solution was to take off the patch well before bedtime. Alas, this made the need to resume the patch in the morning even stronger.

But I failed with the patch. I tried Chantix, it was very effective at stopping the urge to smoke, but I got all the psychological side effects. It gave me suicidal ideation and uncontrollable rages. I haven't been quite the same since, and it's been well over 6 months. I have 6 weeks of Chantix sitting in a drawer, does anyone want them before they expire? I'm sure as hell not going to take them.
posted by charlie don't surf at 9:21 AM on August 18, 2010

The next closest is almost certainly the various stimulants used to treat things like ADHD. Giving people speed should really be a method of last resort. But it is handed out like popcorn. Crystal meth? Demon drug! Desoxyn or Adderall? Wonderful!

To be clear, much of that has to do with the "demon drug" label you used there. There is nothing wrong with using amphetamines to treat ADD, and the unnecessary stigma attached to it creates serious problems when getting prescriptions. It's schedule 2, so it's not quite as easy as you make it.
posted by krinklyfig at 5:03 PM on August 30, 2010 [1 favorite]