Study: Despite Black Box Warning, Chantix Okay for Smokers With Depression

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Fotografias de Rodolfo Velasco / Getty Images/Flickr RF

Kicking the habit can be hard enough, but smokers with depression face a steeper challenge. Now there’s evidence that the drug varenincline (Chantix) can help.

About half of smokers who try to quit have a history of depression, and depression can make the process not just more difficult but shorter lived. While varenincline, which was approved by the Food and Drug Administration in 2006 and helps 44% of smokers give up cigarettes after nine to 12 weeks, the drug also carries a warning that it can trigger suicidal thoughts and behaviors, making it unsafe for patients with psychiatric disorders.

But in a clinical trial involving 525 smokers who had either current or past diagnoses of depression and were treated for the condition, those assigned to take 1 mg of varenicline twice daily were able to quit smoking after 12 weeks without worsening symptoms of depression or anxiety. At the end of the study, 20% of the participants taking varenicline were able to give up their cigarettes compared to 10% of the people in the placebo group.

Recent studies also showed that the smoking cessation drug, which works by activating the same brain receptors as nicotine, may help wean people from other addictions, such as to cocaine and alcohol. Two investigations last year found that the drug helped to dampen the power of cocaine and alcohol-related cues for the participants by activating receptors for the brain chemical acetylcholine, which regulates arousal and attention. Researchers believe that this activity competes with the activation of other reward-based receptors, making the cues for addictive substances like nicotine, cocaine or alcohol less intense and therefore less appealing.

(MORE: Can the Quit-Smoking Drug Chantix Help People Kick Alcohol, Cocaine?)

But the drug comes with some significant side effects. After its release, reports and studies found that people taking varenicline were eight times more likely to engage in suicidal or self-injurious behavior than those using nicotine-replacement therapies like the nicotine patch. Studies have also linked the drug to a higher risk of heart problems in people who were already at greater risk of heart problems (the current study excluded people with a history of heart-related disease). So in 2009, the FDA mandated the black box warning, and many physicians decided not to use Chantix as a first line treatment for smoking cessation.

The latest findings, however, suggest that varenincline may not make symptoms of depression worse in people with a history of the disease who want to quit smoking. “Depression and smoking are among the leading causes of disability and death in the world, yet studies testing smoking cessation drugs generally exclude participants who are taking antidepressants, and relapse rates are high among those who do manage to quit,” said study author Dr. Robert Anthenelli, an associate chief of staff for mental health at VA San Diego Healthcare System and professor of psychiatry at University of California San Diego School of Medicine in a statement.

Smokers with depression should still discuss with their doctors whether varenincline is the best way for them to kick the habit, however, since each person’s history of depression, and his symptoms, may determine how he responds to the drug.

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