Chantix and depression on stopping smoking.

Yesterday I saw a couple of newspaper reports on the potential link between Chantix and psychiatric side effects, including discussion of some of the stories reported by people on this blog.
http://www.nj.com/starledger/stories/index.ssf?/base/news-13/1203831450252170.xml&coll=1

I’ve written before about risks for depression on stopping smoking and we have also talked about psychiatric symptoms occurring while using Chantix. Right now we really don’t know whether these symptoms of depression are directly caused by Chantix, by stopping smoking or by other things but have captured the headlines because over 5 million people have used Chantix in a short space of time. One thing that is clear is that serious psychiatric side effects are rare while using Chantix – probably somewhere between 1% and one per thousand. So it is important to keep the risks in perspective and to bare in mind that right now we are not absolutely sure that Chantix has caused these serious adverse events. Its also important to bare in mind that continued smoking has 50% chance of killing you, and a virtual certainty that it will cause you to suffer non-fatal illnesses that affect your life.

But I’ve been contacted by a number of people who reported that their mood was fine before they started taking Chantix and they became uncharacteristically short tempered and depressed while on it. One particular question that I’ve been asked is how long do these feelings last for? We’ve discussed before how the mood disturbance on stopping smoking typically peaks in the first week and has largely resolved by the fourth week in smokers quitting without taking any medication, but of course that’s the average and there can be big differences between individuals.

So I’d really appreciate it if readers who quit smoking for a period of time could write in and comment on what kind of effect it had on their mood, and the time course of any mood disturbance (i.e. how long after stopping smoking was it at its worst, and how long before it was OK again). Please comment on whether or not you used any medicine (including NRT) at the time and whether you thought the medicine helped or made the mood disturbance worse. I think it may be helpful for those who have experienced mood swings while quitting smoking to hear the experiences of others.

Labels: Chantix, depression, jonathan foulds, smoking cessation, withdrawal

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Getting through the first few weeks

When people quit smoking it is very common for them to experience a temporary increase in certain unpleasant symptoms. The most common nicotine withdrawal symptoms are:
1. Irritability
2. Restlessness
3. Poor concentration
4. Depression
5. Increased appetite
6. Anxiety
7. Insomnia

I discussed these symptoms in previous posts:
What is nicotine withdrawal syndrome? 3/6/07
http://www.healthline.com/blogs/smoking_cessation/2007/03/what-is-nicotine-withdrawal-syndrome.html

Ten tips for coping with nicotine withdrawal. 3/7/07
http://www.healthline.com/blogs/smoking_cessation/2007/03/ten-tips-on-coping-with-tobacco.html

However, I’m bringing this topic up again because I’m noticing a number of people trying to quit smoking by using Chantix who are still experiencing some of the symptoms mentioned above but are concluding that these symptoms are caused by the medicine. Of course with any individual person the best way to figure out the cause of a new or worsening symptom is to discuss the problem in detail with your health professional. But in general, if someone has just quit smoking and they experience one of the symptoms mentioned above, the first explanation to consider is that it is a temporary nicotine withdrawal symptom caused by stopping smoking, rather than a symptom caused by a smoking cessation medicine.

Sometimes similar symptoms can be caused by smoking cessation medicines. For example, insomnia and vivid dreams can also be caused by the 24 hour nicotine patch and by bupropion (Zyban or Welbutrin). Chantix has also been known to cause vivid dreams. Generally, the heavier a smoker the person is, the more likely they will be to experience strong withdrawal symptoms, and the less likely their symptoms are caused by their medication. The opposite is also true. So if a 40-a day smoker experiences insomnia 2 days after quitting smoking while taking the standard dose of a smoking cessation medicine it is more likely to be due to nicotine withdrawal. If a 10 cigarettes per day smoker who never wakes at night to smoke and doesn’t smoke within half an hour of waking in the morning experienced the same insomnia it is might be caused by the medicine. In the case of the patch, they might want to try taking it off a few hours before going to bed, and in the case of Zyban or Chantix they might want to make sure they don’t take the second pill just before going to bed.

My main point here, however, is to caution against blaming the medicine for symptoms that it may actually be helping with, and then stopping using the medicine too soon. Any change in timing or dosage of a medicine should be discussed with your doctor first.

Similarly, it is tempting when a medicine is not giving complete relief of unpleasant symptoms like insomnia, anxiety or cravings to want to try another medicine as well. As always, a decision on what medicines are most likely to help you in any specific situation is best made after a full discussion between you and your doctor. However, when one of the symptoms mentioned above is the problem, and particularly if you were a heavy smoker and have recently quit, then the symptom is likely caused by nicotine withdrawal and will resolve by itself gradually over a couple of weeks. Medicines that have not been approved by the FDA or a similar medicines regulatory authority for smoking cessation will be unlikely to help much.

To tell if you are a “heavy smoker” check out my previous posts on that topic:
How addicted are you to cigarettes? (1) 5/19/07
http://www.healthline.com/blogs/smoking_cessation/2007/05/how-addicted-are-you-to-cigarettes-1.html

How addicted are you? (2) 5/19/07
http://www.healthline.com/blogs/smoking_cessation/2007/05/how-addicted-are-you-2.html

If you are a heavy smoker and are having a rough time quitting I’d strongly encourage you to get as much support as you possibly can. As well as speaking to your own personal health professional, I’d recommend a specialist face-to-face tobacco treatment service if there is one near you (they will have experts in smoking cessation counseling and medicines), as well as use of smoking cessation telephone helplines and internet sites, that were also discussed in previous posts:

Telephone quitlines: do they help smokers to quit? 4/19/07
http://www.healthline.com/blogs/smoking_cessation/2007/04/telephone-quitlines-do-they-help.html

Can smoking cessation internet sites help you to quit? 4/21/07
http://www.healthline.com/blogs/smoking_cessation/2007/04/can-smoking-cessation-internet-sites.html

Key things to remember during the rough times are:
A. Nicotine withdrawal symptoms are worst during the first couple of weeks after you completely quit tobacco and gradually calm down to be almost gone by the 4th week.
B. Each individual episode of craving for a cigarette typically lasts a few seconds, and rarely longer than a couple of minutes. Keeping yourself busy and actively switching your mind onto other things will help get rid of cravings more quickly.
C. Cravings are stimulated by being around tobacco and other people smoking. If you have any in the house, get rid of it. If you are hanging out in a place where people are smoking, hang out somewhere else!

You have probably put in quite alot of effort by the time you found this web-site. Don't throw it away by having a smoke. Keep going. It is tough but you can succeed.

Labels: Chantix, cigarette smoking, nicotine, patch, quitting, side-effects, symptoms, withdrawal, Zyban

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