Health: Smoking gun?

Giving up cigarettes is hard enough, but with reports of nicotine withdrawal being linked to depression and suicide, could a drug designed to help be causing more problems than it set out to solve?

SMOKING kills around 120,000 people in the UK every year. Take your pick from cancer or the slow, agonising deaths that result from lung disease and emphysema. It's not pretty.

Add to that the cost – a 30-a-day habit will set you back around £2,600 a year – and the UK-wide smoking ban, and it isn't surprising so many of us are trying to give up.

But at what cost? Omer Jama, a video editor with Sky Sports, was prescribed the drug Champix as he tried to quit his 20-cigarettes-a-day habit. Two months later he had taken a knife to his wrists and killed himself. Was the drug to blame?

Jama is not the first person to die after taking Champix. The Medicines and Healthcare Products Regulatory Agency, which has been monitoring the drug's reported side-effects, says there have been four cases of suicide and five attempted suicides by users since it was launched in the UK in December 2006. Since that time, 300,000 have been prescribed the drug.

One of these statistics, Karen McGhee, has no recollection of attempting to hang herself from the banister at her home in Greenock. Remarkably, she survived, but she is convinced the drug she took to help her stop smoking caused her to attempt to take her own life. Although she had experienced mild depression on and off for 20 years, she says Champix made her feel worse than ever.

Paul Robinson, 46, a co-owner of delicatessens in Castle Douglas and Dumfries, had been smoking all his adult life before he was prescribed Champix. "I was smoking up to 30 cigarettes a day but I wanted to give up, for health reasons and because of my age.

"I'd given up once before for nine months when I was on the patches, then I started again and probably smoked even more."

A friend told him about Champix and it seemed a miracle cure. He was prescribed the drug and, after just a few days, went to have a cigarette. "The taste was absolutely disgusting," he says. "I thought, 'That must be me, I'll try again.' I gave it three or four chances to make sure. Then I just stopped."

After the first few days the dosage is increased, however, and that's when Robinson says the side-effects began to kick in. "I started getting really moody, really quite down. I felt dizzy and depressed and very low. I'm always full-on and quite chatty with the customers but I just couldn't be bothered. I was very depressed. In the end I thought, 'I can't do this any more, these are not making me feel right.'"

He gave up immediately, going cold turkey. "It was really bad. I had sweats at night and I was feeling pretty down for two or three days. But then I felt as though I'd got over it and I've not had a cigarette since."

Robinson says he would advise anyone to think carefully before trying Champix. "I wouldn't want to put anyone through that. I know I've given up smoking, but who knows how it's going to affect other people?"

Champix works by blocking the attachment of nicotine to certain receptors in the brain. This prevents the reward smokers get when they inhale. Pfizer, the drug's manufacturer, insists there are no proven links between Champix and depression, and claims nicotine withdrawal can also lead to mood swings.

A Pfizer spokesperson said: "No causal link has been established between the drug and depression. Depression, rarely including suicidal thoughts, has been reported in patients undergoing a smoking cessation attempt. These symptoms have also been reported while quitting with varenicline (Champix's generic name]. A relationship between varenicline and the reported symptoms hasn't been established but in some reports a link couldn't be excluded. If patients are concerned they should consult their doctor."

Following a review by the European Medicines Agency, which licenses the drug for UK use, labels were updated last month so clinicians and patients are aware of possible depressive symptoms in people attempting to stop smoking. The firm recommends that patients discuss this fully before treatment.

Putting things in perspective, Sheila Duffy, chief executive of ASH Scotland, says: "Tobacco is a deadly drug. It is highly addictive and lethal, killing one in two of its regular long-term users. This is a preventable epidemic, and smoking cessation should be a top priority for anyone concerned with improving Scotland's public health.

"Drug treatments such as Champix or Zyban are generally considered as options when a smoker has not been able to quit using other treatments. They remain prescription-only because there are some contraindications and because any adverse reactions need to be monitored carefully. Your doctor will be able to discuss the possible risks with you, and advise you if you are taking these medications and experience any unusual or distressing symptoms."

But she adds, "The risks of continuing to smoke are certainly far greater than the risks from using any of the stop-smoking treatments."

• Champix – how it works

Invented by an ex-smoker whose father died from a smoking-related illness, Champix reduces the craving for nicotine by binding to the nicotine receptors in the brain, thereby cutting down the symptoms of withdrawal. It also reduces the satisfaction the smoker gets from smoking.

In trials conducted by Pfizer, it has been very successful: 44% of those treated with the drug stopped smoking after 12 weeks, compared with 11% taking a placebo. Over the same period, it was shown to be twice as effective as other anti-smoking drug treatments. and has been available on prescription in Scotland since January 2007.

• Stub it out

Half a million Scots want to stop smoking. If you are one of them, the NHS provides free help and advice, from advising which drugs are appropriate, to running group and one-to-one sessions. For more advice on the best way to quit, speak to your GP, contact Smokeline (0800 84 84 84, open daily 12pm-12am) or visit www.canstopsmoking.com.