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? — A.L.
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. In any event, the ongoing damage from smoking stops as soon as a person quits.
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 well-done 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 (but it should not be used in a person with seizures). 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, especially in combination with other interventions.
If you do decide to try Chantix again, you should be on the careful lookout for recurrence of depressive symptoms, and together with your spouse and physician, be ready to stop treatment immediately if they do recur.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
(c) 2021 North America Syndicate Inc.

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