Antidepressants in the class known as selective serotonin reuptake inhibitors (SSRIs), which debuted more than 20 years ago, have also been associated with adverse events such as suicidal thinking. The first generation of such drugs, which included Prozac, was notorious, too, for lesser side effects, including stomach upset and sexual dysfunction. Subsequent generations of SSRIs addressed some of those issues by building in blockers of certain serotonin receptor subtypes to eliminate unwanted drug actions. 

“As with serotonin, people discovered there are subtypes of [receptor] subtypes. I think as time goes on there will be more sophisticated [nicotinic] drugs coming out,” says Edward D. Levin, a behavioral pharmacologist at Duke University, who has consulted for Targacept and for the National Institutes of Health.

“It’s just like the SSRIs,” Role agrees. “I think refining the compounds in terms of the balance of their activities is really key, but that’s not to say that’s trivial. It’ll take time.” Targeting nicotinic receptors “has enormous therapeutic potential,” she says, adding that the biggest joke on the tobacco industry may be that they missed seeing it.

Note: This story was originally printed with the title, "First in Class".

6 Comments

1. 1. Virginia Lee 08:25 AM 8/27/08

   Why wasn't this drug tested on people of color? Is it because Pfizer knows it effects the melanin which is the dark pigment in skin and the brain regions where the dark grey matter is located. Why not use the cheap and tested for 50 year base for this drug which is cytisine? Silly me, I know why because it wouldn't make Pfizer the millions this one has on the blood of the unwarned initial users of this highest reported side effect drug ever.

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2. 2. panamabob 09:41 AM 8/27/08

   Part of the problem is that the drug trials were sanitized. Those with any history of mental symptoms, drug use, and alcohol abuse were eliminated. The remaining smokers have a much higher rate of these concerns. Also, the dosage is one size fit all unlike comparable drugs in this class.
   I took this drug a year ago and after 6 weeks I was living a nightmare for the next couple of months.

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3. 3. dsr8time 11:43 AM 8/27/08

   Chantix is a very dangerous drug, some of it's severe side effects could be permanent, we just do not know yet. There is a 50/50 shot that patients will experience severe side effects; that means that you might be ok or you might want to claw your face off. There are millions of people that are taking Chantix right now in different countries.There are plans to use Chantix for other medical issues, but no plans to perform more much-needed trials. Pfizer needs to stop this madness as soon as possible.

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4. 4. ImAReader 01:37 PM 8/27/08

   My mother took Chantix successfully in two rounds and quit smoking after 30 some years. I decided to try it, having failed to quit smoking on numerous attempts. It did cut cravings. It also gave me extreme nausea as the doctor warned. However, after 2 weeks on the drug I began to have night terrors and panic attacks from triggers I had long overcome. Some history- I was brutally attacked about 10 years ago. At that time I had what was called PTSD, took celexa for about 4 years for anxiety, and with strong will power and cognitive therapy overcame the fears. I have lived a normal life for a long time. Now, since taking the drug, I feel like I am starting over. Literally, the 'terrors' came back (flashbacks of event in extreme vividness). Perhaps the drug is good for restoring memories, but that's not something I needed or anticipated. My doctor thinks it was a rare side-effect, but after reading your article I wonder. He knew my medical history and should have not recommended the drug. In my view, a life of persistent feelings of terror mixed with intrusive suicidal ideation and depression (being unable to close my eyes without seeing the attack) is worse than smoking and its health effects for me.

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5. 5. raspberry 04:23 PM 8/27/08

   I took Chantix for almost three months. I thought it was a wonder drug! After being a smoker for over 20 years,I just didn't want a cigarette any more. I was so happy.I felt physically great. When my third month was up I began to get progressively angrier. I have gone through withdrawl before, this was not the same. I hated everyone around me including my sweet children. I could not rationalize my feelings I thought I was litterally going insane. I have never had trouble with anxiety, depression or anger before. Two weeks after quiting Chantix I became the happy optimist once again.

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6. 6. JimK 12:49 AM 8/29/08

   If little is known about the mechanism of the receptors that varenicline affects then why was this drug introduced and approved in the first place. I would say it's all about Big Pharma's pursuit of the almighty dolllar but it goes further then that; this drug was approved and endorsed by the Government and the National Institute of Health based upon dubious test results. The NIH in its endorsement of pharmaceuticals, particularly veranicline was based on a 6 month end point and it was not much more effective then buproprian. Any study on addiction should have at least one years as an end point and as one scientist pointed out; if smoking in and off itself is a chronic illness then the end point should be 5 years.
   Almost any television advertisement for any other drug lists all the potential deadly effects that may result from the use of the advertised drug; however I do not recall any serious adverse events described in the original Tortoise and Hare Commercial.
   In addition I am tired of hearing about nicotine withdrawal causing suicidal thoughts. If it is indeed the nicotine withdrawal then they are admitting that their drug does not work as it is supposed to replace the dopamine agonist effect of nicotine. They can't have it both ways; it reduces your craving for nicotine because you are receiving the dopamine blast from our product; but because you committed suicide it was withdrawal from nicotine.
   Please do me a favor and stop trying to save me from myself by introducing more poison. The arrogance of the medical and scientific community and the government's complicity in the introduction of a drug that effects a part of the brain that they do not fully understand borders on criminal negligence. It's one thing to introduce a drug that benefits truly ill people; it's another thing to introduce an unproven drug to eliminate a habit that annoys the Nanny Nation.

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