2009 FDA ACTION UPDATE: Since the below article's original publication on April 2, 2008 the U.S. Food & Drug Administration (FDA) announced on July 1, 2009 that Chantix must carry a black box warning, the FDA's highest warning level. This FDA site link discusses the new warning and allows viewing of September 2009 FDA video on the black box warning update.
WARNING: As advised by the FDA and Pfizer, "If either you, your family or caregiver notice agitation, depressed mood, or changes in behavior that are not typical for you, or if you develop suicidal thoughts or actions, stop taking CHANTIX and call your doctor right away."
WARNING: Do not rely upon any information in this article, including comments made by other Chantix users, to replace individual consultations with your doctor, pharmacist or other qualified health care provider.
WARNING: If you or your loved one is using or considering using Chantix or Champix be sure to read the new patient Medication Guide released on May 16, 2008. Also watch the safety warning video clip released by the FDA on April 1, 2008 (FDA website clip in various formats or WhyQuit link in Windows Media format only). If unable to watch the clips you can read warnings discussed in the clip at the FDA website.
While some smokers commit suicide there is no evidence that those attempting to quit without using pharmacology products are at increased risk of suicide. Yes, millions with depression or other serious mental health issues smoke cigarettes. But how many smokers on the brink of committing suicide will endure full-blown nicotine withdrawal in hopes of extending life?
PubMed may be the world's largest free searchable database of summaries (abstracts) of articles, studies and editorials appearing in the world's medical journals. It indexes 15,096 smoking cessation articles and 45,860 suicide articles. But a simple search of "smoking cessation" + "suicide" will not produce a single medical journal report of suicide by any non-pharmacology quitter. None. But why?
Again, there is no debate but that there is often a normal sense of emotional loss associated with nicotine cessation. There is also no debate but that some unknown percentage of smokers have both untreated and undiagnosed organic depression, that can become pronounced and beg treatment once nicotine's contribution to brain dopamine pathway stimulation ends.
But should any cold turkey quitter experience either a temporary sense of emotional loss or the onset of a once hidden and masked organic depressive condition, some degree of relief via a powerful brain dopamine "aaah" reward explosion was always just 8-10 seconds away.
A 2006 study found that just 1 puff of nicotine can result in up to 50% occupancy of a4b2 type acetylcholine receptors, the receptors known to be responsible for triggering dopamine production.
Not so among Chantix users where varenicline's blocking effects have a 24 hour elimination half-life. Page two of Pfizer's varenicline prescribing sheet [link to current sheet - email for copy of 05/07] asserts that, "varenicline binds with high affinity and selectivity at a4b2 neuronal nicotinic acetylcholine receptors." It asserts that, studies show that varenicline "stimulates receptor-mediated activity, but at a significantly lower level than nicotine. Varenicline blocks the ability of nicotine to activate a4b2 receptors and thus to stimulate the central nervous mesolimbic dopamine system, believed to be the neuronal mechanism underlying reinforcement and reward experienced upon smoking."
What Pfizer is not telling smokers is that using varenicline to block nicotine from activating brain dopamine pathways, also blocks life and arriving acetylcholine molecules from activating them. Could it be that the "significantly lower level" of dopamine stimulation produced by varenicline is insufficient to allow some taking the drug to avoid serious mental health, behavioral and depression concerns?
Could it be that the reason there are no news stories or medical journal articles about cold turkey quitters killing themselves is that non-pharmacology quitters always have an immediate escape route, a route blocked by varenicline's nicotine blocking effects and 24 hour elimination half-life? Could it be that as varenicline's captive prisoner to escalating depression, that the minds and thinking of far too many varenicline users saw only one way to make it end?
We don't yet know. What we do know is that when any health care provider or quit smoking counselor learn of depressive type symptoms in any quitter, they do not encourage relapse or emotional suffering but immediately refer them to physicians for treatment. Given proper treatment relief from depression, freedom from nicotine is within their grasp too.
Whether or not Pfizer is able to convince the media that it is normal and expected to see cold turkey quitters attempt suicide, both common sense and a massive body of historical evidence scream otherwise.
Part of that evidence are the millions of archived quit smoking support group message board threads and posts across the Internet, where prior to the arrival of Chantix and Champix, suicide in quitters was probably never a discussion topic. Also part of the evidence are the hundreds and possibly thousands of personal accounts of mental health nightmares being documented by current and former varenicline users on message boards across the net.
Pfizer may spend millions on the absurd comparison that using Chantix is safer than smoking. But it must do so against a growing chorus of victim and survivor voices bellowing a far more sensible message, the advice to pick another quitting method. Below is a small sampling of varenicline mental health messages found on the Internet and presented pursuant to the fair use doctrine, in the interest of public health. Although their accuracy and truthfulness cannot be verified, their numbers are far too many to ignore. They stand in stark contrast to Pfizer's assurance that Chantix use is safe, even among smokers with a history of mental illness.
Many of the below comments have been shortened in order to share as many as possible. This article was originally written in 2008. To see the original link to any comment simply right click on the page and click "View Page Source." There you'll see a hidden comment sharing the original link, which is very likely no longer functional. Each author's name and comment date is from the original full-text post. Please note that posts may be protected by a copyright notice appearing at the original posting site.
My husband who has never had ANY mental health problems, tried to take his own life after being on Chantix for 13 days. He has no recollection of the day it happened, but I was around him alot that day and he was a little more tired than he usually is. But he was normal in every other way. He is home now and doing much better, but maintains that he would never had done this and is really still in a state of shock that he did. I know that it states that in rare cases suicide ideation can occur, but what is rare?? Pfizer never states what the statistics are. Since this happened, I have numerous people say that, yes it helped them with the stopping smoking, but that they felt funny, depressed, agitated, and one lady said she thought about taking her life. It scares me that this drug is even available.
Deanna - June 24, 2007
Omar Jama was a 39 year-old 20 cigarette per day smoker and television editor found dead in his home with his wrists slashed 4 weeks after starting Champix. He had booked a vacation to celebrate his 40th birthday. "They just weren't the actions of a man who was contemplating suicide," said Mr Jama's brother. "He's got no history of depression and was never the sort of person you would see feeling sorry for himself."
The Daily Telegraph - June 12, 2007
My brother in law committed suicide Aug 19. He had taken Chantix and went off it in the spring, then we found out he had started retaking it 7 days before his suicide. He had NEVER shown suicidal ideation before this medication, and shot himself before anyone could stop him or get him to his doctor. I hold Pfizer responsible for his death, since the psychiatric effects are very well hidden in the prescribing info, and if my brother in law had known this beforehand he would have never taken it.
Zezrie - August 29, 2007
My son, age 30, also experienced psychotic behavior while taking Chantix. It was sever enough that his wife feared for her safety. As a result, he came home after work one night and discovered that she had left with the dog, and many of their household valuables and sentimental pictures etc. Thinking the love of his life had gone forever, he hung himself. I was the last person to talk to him. He was clearly not himself. His wife has blamed Chantix for his death since the beginning. (He died on June 6, 2007)
Kathie Jones - September 23, 2007
I took Chantix for about a month. I was nauseous, but it wasn't that bad. Then I started feeling extremely depressed. I was angry, sad, disgusted and somewhat suicidal. I don't recommend Chantix at all. I'm still smoking, but at least I'm alive.
CM - September 28, 2007
My boyfriend was depressed for 2 years but came out of it around 18 months ago. He had since been happy and healthy UNTIL he took Chantix, and by the second week began feeling depressed. Of course it terrified him to return to those dark days. It escalated, and we weaned him off of it on Labor Day weekend. The depression did not ease, and he became more and more unfocused and anxious.
Two weeks ago, he took an overdose of Paxil and Wellbutrin in an effort to end his life. Thank God he survived, and I know the Chantix triggered this depression and incident. I urge anyone with a history of depression to avoid this drug. I was shocked that his psychiatrist had no idea of this side effect, and feel it needs to be known and publicized.
Lynne - October 5, 2007
I have suffered from intermittent depression for years, usually stress related. I started Chantix and by day three I was experiencing emotional outbursts, suicidal ideation, and lethargy. Were any studies done on patients with a history of depression? I have started back on Lexapro as a result... total loss of control for me.
Staci - October 8, 2007
I too have been taking Chantix. I took it last fall and had severe depression and thoughts of suicide. I could stand being sick to my stomach but not the extreme feelings of loss and sadness as I had never felt this way before. I stopped it after 3 weeks and went back to smoking. I have subsequently started taking Chantix again last week, I am now in severe depression and have taken my last dose.
Kathie - October 11, 2007
Our dear friend committed suicide. He also took Chantix. It was completely out of character for him to be depressed. He was a loving father, grandfather and an ex-Marine. Many of us felt it was caused by this drug.
Lynn Rapkiewicz - October 16, 2007
We just buried my brother-in-law two weeks ago. Shot through the heart. An apparent suicide. He had been taking Chantix in the weeks leading up to it. I am concerned that Chantix might have contributed. This was completely unexpected. He was not suicidal, but I know that in days leading up, he was depressed, un-motivated, confused. If you're depressed and thinking bad thoughts...please bail off the drug...think of your family. They love you, tobacco breath and all.
JSC - October 16, 2007
My father in law committed suicide in April, 2007 after having taken Chantix for 2 1/2 months. he was also drinking when he committed suicide. to say our family was in complete and utter disbelief is an understatement. he was not one i or the rest of our family would have ever thought would to something like this. his wife reports very odd behavior prior to and even after his death (belongings she found in very strange, out of place places unbeknownst to her) ... if those that have had similar side effects do not say anything to help get this drug off the market, then we are no better than these enormous drug companies making a "killing", literally.
Jules in Arkansas - October 23, 2007
Chantix started out to be the best thing I could imagine for quitting cigarettes ... I, too, started losing interest in things but frankly never attributed it to the Chantix.... until 36 hours after my last dose. I flipped between rage and suicidal depression so often and so rapidly, I was looking back at menopause as no big deal! I even had some difficulties keeping clear thought patterns and some word-finding difficulties (as though I had had a small stroke--which I did not).
It is now 1 week after stopping the Chantix. The major swings and degree of the depression have lessened, but I still fight bouts of depression several times a day. I had been ready to quit my job and give up on everything. Fortunately, I seem to be holding things together. I do not have a history of either depression or suicidal thinking. I just have to hope that these mental effects resolve soon. This is no way to live!!!
MC - October 24, 2007
My ex-wife committed suicide on June 5th. We found Chantix in her nightstand with 4 doses gone. She had been diagnosed with bipolar and was taking anti-depressants. Are there any warnings from Pfizer on mixing Chantix with anti-depressants or people with bipolar? I thought her bipolar had been under control for the past 5 years....now this.
Purple Sage - October 25, 2007
My daughter is one of the Casualties of taking Chantix for 12 weeks. In early September she ended up being hospitalized for observation and every since has experienced all of the things that are not listed on the medication.....only on the 17 page report on Chantix by Pfizer. How about an acute psychotic episode that has left her possible permanent damage. Attention span altered anxiety, depression, emotional disorder, irritability, restlessness, aggression, disorientation, libido decreased, mood swings, thinking abnormally, euphoric moods, and more. My daughter has never had any of these types of problems before starting to take the Chantix and now even after nearly 2 months off the medication our entire family has been living in "hell"...
katsrkool1 - October 26, 2007
After viciously pulling my daughter's hair in a rage of anger, I took to my bed planning the best mode for committing suicide. I had an old bottle of Ambien with one tablet left and called the auto refill line.
While suicidal ideation has been my friend in the past during some major depressive episodes, this latest round is different. In the past suicidal thoughts "helped" me cope, somehow soothing the crushing heartache of depression. For the uninitiated, a near constant feeling I can most liken to the first moments after hearing of my beloved father's sudden death. This pain insidiously takes over rational thought over weeks and months. This Chantix suicidal ideation is different. It is meaner. More evil ...
andrew 04103 - November 4, 2007
I am on day 10 of using Chantix. Severe depression, crying, yelling, lots of sleeping, not wanting to do anything started around day 5. The suicidal thoughts started about 3 days ago. I have had depression in the past, but haven't had to use antidepressants for years.
MN - November 14, 2007
I started taking Chantix 12 days ago. For the first 7 days I had night wakefullness and vivid dreams but no other side effects. I was taking .5 a day. On the 8th day I doubled dosage and on day 9 and day 10 I had a constant awful metal taste in mouth and exhaustion and nausea. Day 11 I was depressed and day 12 I took full dose and I thought about killing myself. I'm 49 years old and have never taken any drugs,or had any type of mental illness ever. The not wanting to smoke part works.
JH - November 20, 2007
My son started taking Chantix in late September. He has had a severe change in mood swings, depression, violence and suicidal expressions. Tonight he went on a rage and had to be removed from my house. Another son took Chantix for two days and just informed me of his experience (nightmares and thoughts of suicide) which has prompted me to do an internet search of this poison. Please help with any info related to adverse reactions. He has also had rashes and horrible pus producing bumps under his armpit and on one side of his face.
deb orne - November 23, 2007
Thank you all for posting because I thought I was alone in how Chantix has emotionally brutalized me. I even ruined Thanksgiving by going into an utter rage on my daughter. I have had horrible thoughts of killing myself, alienated most of my friends and sleep 10 or more hrs a day. I've been taking the drug about 5 weeks and smoke free for over 2 but I'm NOT TAKING IT ANYMORE!! It is evil.
Nancy - November 25, 2007
My 25 year old son died Nov 10. He had been taking Chantix for about 3 weeks, and the last few days was unable to sleep, saying he was having terrible dreams about killing himself, finding himself hanging, etc.He was an alcoholic and drug addict who was trying to clean up his life and stop the smoking before the birth of a son due in January. I now wonder if the Chantix had anything to do with his sudden death.
Connie Schlabach - November 25, 2007
I was on Chantix and after two weeks I began to be the most moody person,did not like my self and all I could think of was I didn't want to live, it was not just a few thoughts it was all the time, I stopped taking it but the thoughts were still there, I went to my Dr. and had to go on anti-depressant drugs. It has been two weeks and I am fighting it everyday. This is a very bad drug and should be pulled off the market. Please help pull it.If you take Chantix be very careful.
Kathy - November 25, 2007