Sunday, February 3, 2008

Chantix and Suicide

Anti-smoking pill joins the list—but is the risk real?

The U.S. Food and Drug Administration fired both barrels last week, announcing that a variety of anti-seizure medications—as well as the anti-smoking pill, Chantix—may increase the risk of suicidal thoughts in patients who take them. The FDA will require new label warnings for a total of 11 drugs used for epilepsy.

New label warnings are also in the works for Chantix, the nicotine cessation aid being widely used by people attempting to quit smoking cigarettes. In a public health advisory issued last Friday, the FDA declared it “increasing likely” that Chantix may be associated with psychiatric problems. A month earlier, the FDA had advised that Chantix users should be monitored for the onset of suicidal urges, but backed off from making a strict cause-and-effect connection.

The FDA reviewed clinical data on anti-epileptic medications, including Pfizer’s Neurontin and Ortho-MacNeil’s Topamax, and concluded that “patients who are currently taking or starting on any anti-epileptic drug should be closely monitored for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression.” Topamax has shown additional promise as an anti-craving medication for alcoholism.

This follows on the heels of earlier warnings about increased suicide risk in adolescents taking SSRI antidepressants.

In the case of Chantix, the FDA’s Bob Rappaport, in a conference call with reporters, said the agency had “no definitive evidence there is a causal relationship here, they are just strongly appearing to be related.” Rappaport, quoted at, also said that “Chantix has proven to be effective in smokers motivated to quit,” and that the new warnings would help doctors and patients “make an informed decision regarding whether or not to use this product.”

A spokesman for Pfizer, quoted at, said that “no causal relationship has been established. There are some post-marketing reports and you cannot exclude those. We go by our scientific data, and from our clinical trial data we have not seen this.”

Discussions about a possible link between Chantix and suicide were fueled by the death last year of New Bohemians lead singer Carter Albrecht, who was shot while attempting to break into a house in Dallas. His girlfriend told authorities that his behavior had been erratic since he began taking Chantix in an effort to stop smoking.

In no case are the numbers of suicides linked to any of the drugs alarmingly high. The FDA study of epilepsy medications appears to demonstrate, as summed up by the San Francisco Chronicle’s Bernadette Tansey, “2.1 more people for every 1,000 on the medications exhibited suicidal thoughts or behavior, compared with every 1,000 on placebo.”

Note that the FDA is not discussing an increased risk of suicide, but rather an increased risk of suicidal thoughts or feelings. This is called “suicidal ideation.” The FDA usually refers to it as “suicidality.” Unlike an actual suicide attempt, suicidal ideation is the act of contemplating the act—a sort of “what if.” It is the difference, as a mental patient once put it, between buying the rope, and contemplating buying the rope

Persistent suicidal ideation is obviously not a desirable state of mind. But it does not downplay this behavior to note that it is, by nature, often fleeting and difficult to quantify. Moreover, the act of going cold turkey itself can cause heavily addicted people to feel temporarily suicidal—to ideate about killing themselves without killing themselves. These and other factors make it difficult to reach firm statistical conclusions about such risks.

For a Chantix user's point of view on the debate, visit

Photo Credit: eNews 2.0


Anonymous said...

I began taking Chantix to quit smoking at the end of February. I read the warnings, which included a range of side-effects, but none being increased depression or suicidal ideation. The drug worked miracles, smoking was horribe, and I successfully quit after about 1 1/2 weeks. The directions are to contine taking it for 12 weeks to be sure you've kicked the habit.

I started getting extermely irritable and "down". I've always suffered from exterme PMS symptoms (and here in Minnesota many of us get the end-of-winter-blues, awaiting more daylight and nice weather.) I chalked the blues as those two reasons. I began having bad nightmares, and this began to concern me. I was having dreams of things I would never even think about, things that have never crossed my mind. For example: I dreamt of shadows coming out of my legs that were some sort of deamon or devilish thing. I knew that the only way to get rid of these shadows was to cut my legs off. I woke up the next morning panicked, thinking what if I wasn't in a deep enough sleep and I actually went into the garage and fired up the chainsaw. This was my final straw, I thought it must be the Chantix. At this point I stopped taking it and began hearing people talk about their crazy dreams while taking it too.

A few days went by and my craving for cigarettes returned. I thought, well I'll give it another try, maybe it was a fluke. Five days later I got into an argument with my mother, which for us is no surprise. But this time I just snapped.

I decided to take a drive to clear my head. I ended up driving about 70 miles from my home. I was frustrated that I had gotten lost (at this time it was 4am). I pulled off the road after passing the same farmer's field 5 times. At this point it's like I completely gave up. I took a pocket knife from my car, went into the woods and slit my wrists. I was in a remote location on an unmarked road in a field not very visible from the dirt road. I severed the main artery, 3 tendons and 2 nerves in my left hand and 1 tendon in my right. By the grace of God someone saw my car in the field and called 911. A police officer got to me at 1pm, I had been unconscious for approx. 9 hours. It is a miracle I am alive.

I've never been one who wanted to hurt myself. I have the most amazing and supportive friends and family, whom are all baffled. I have psych. doctors telling me they have no idea, I seem to be "normal" and had a random, intense impulse. I'm a very strong and have never considered suicide an option. This leads me to believe one thing...the Chantix.

I apologize if the story got long...but I'm just now realizing I should really share my story. I will be the first to say it did it's job, I quit smoking. BUT I remind every person I talk with to watch your friends and loved ones who are taking it. Be aware of strange behavior! Please send me a message if I can be of any help to anyone with questions. Today it was 3 weeks ago I tried to end my life. I will never understand it.

Anonymous said...

I had taken Chantix for 6 months and had been an ex-smoker after taking chantix for 5 months and that lasted till 2 weeks after I finished taking the chantix. During that time I was diagnosed w/Type II Diabetes and I litterally flipped out. My anger and depression (which I've battled most my life w/anxiety) increased till I stopped the chantix. I got bad news about a family member 1 week after was able to stay free then apparently I suffered withdrawl symptoms w/night terrors and anxiety attacks (which I hadn't had for years). I unfortunately started smoking again. My Dr. wants me to go on it again but after reading this I'm afraid to even try it.

breathing free said...

I've been on chantix for 7 weeks, the nausea is reduced and the dreams are vivid, but they are usually about something I experienedthat day or what i watched on TV that day...I have always had dream, but I tend to remember my dreams now. I will reduce my chantix dose, per my doctor okay.

hope this help someone.

Anonymous said...

I am a recovering alcoholic who took chantix for 1 year. I did quit smoking. Dreams were a side effect of this drug. I had to eat a meal before I could take the medicine because of nause This medicie worked for me. I did not want a cigarette when I was taking it but when I tried to get off of it I would start smoking again. I am no longer taking it because I had a severe seizure last week. I have a normal MRI and chantix was the only medicine I was taking at the time. No doctor will say it was the chantix and some at LSU swear it is not the chantix.

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