Saturday, October 10, 2009

So You Want To Quit Smoking?

Well far be it from me to advise you how. Maybe you can benefit from my experience, though. I realize it's different for everyone. Maybe you don't smoke all the time; maybe you don't smoke a lot. I was a two-pack-a-day-er who tried to hold it to a pack and a half, but sometimes blew through three. Since I lit my first Winston Red at 19 until January of 2008, I didn't live a day that wasn't focused in some way either on how to get more nicotine or how to steel myself to keep from ingesting it.

Of course I didn't go from a single Winston to 40 of them a day overnight; that took a few months. And I switched brands quite a few times since that first one, going from Winston Reds to Marlboro Reds to Marlboro Lites and then cheaper brands as prices increased along with my habit. And back when I started (as I recall, it was 1973), cigarettes had a lower nicotine content than the ones coming out of the Tobacco Belt today.*  They were easier to kick, and I did it several times, cold turkey, over the years. Happily, I was able to quit before I became pregnant with my son. But a year after he was born, I started up again.

By 2000, I was so hooked that attempt after attempt to quit failed. I tried patches, gum, wafers, will-power... but the Misty Menthol Lite 120s I was smoking then always weaseled their way back into the spot of number-one priority in my life. My last thought upon going to bed at night was whether I should run up to the nearest Mobil for more smokes. My first thought upon waking was how many cigarettes were left in the pack. And did I have a working lighter? Did this restaurant allow smoking? Could I scrape up enough cash for another carton this week? Yes, I felt guilty about the money I was spending; yes, I was conscious of a worsening cough. I knew all the health risks; what smoker doesn't? But I still loved (not too strong a word; if anything, an understatement) my Mistys. I went nowhere without them.

Sometimes I went a whole day or two without lighting one, but they still occupied my every waking thought. If I passed an overflowing ashtray outside a building, the ever-present low-level anxiety about having or not having a smoke burst into a full-blown craving. If I smelled cigarettes in a bar or saw anybody lighting up, that's pretty much all my brain could focus on. I didn't always give in, but I always wanted to.

Fast-forward to 2007. I saw an ad online for a new smoking-cessation drug called Chantix being introduced in the U.S. by Pfizer. I read up on it; I talked to a doctor about it. By January of 2008, I had cadged a prescription (my doctor had reservations about it, but I was persuasive) and set a quit date.

I didn't quite make it by New Years Day, my target date, as I didn't get the script filled until around the 15th of January. The instructions stated that it was supposed to be taken for three months, but I decided to fill just one month at a time until I knew how it worked.

I took it for two weeks.

By the end of that time, I was bat-shit crazy.

But I wasn't smoking.

It was as if, for me, cigarettes had never existed.

After 35 years of struggling with nicotine-related anxiety of one form or another, I was completely free of it.

I know you don't believe this if you're still smoking. I couldn't have imagined it a year ago, either. But it's absolutely true. Here's the best illustration of this I can give you: I don't know the exact date that I ceased to smoke. One day I simply forgot to. And never thought about doing it again.

Now when I'm among people who happen to be smoking, I am mostly unaware of it. The smell is neither delicious nor offensive to me, nor does it trigger the mental nudge that anything cigarette-related used to give me. Long butts abandoned in ashtrays no longer call to me. Packs of cigarettes stacked on store shelves don't arrest my attention any more. I just don't notice them. For awhile I was worried that if I purposely remembered what it physically felt like to smoke, I might want to do it again. Mercifully, that turned out not to be true. I am writing this piece without a hint of craving. My feeling about smoking now is complete and utter indifference.

Okay; now you know that Chantix made me quit smoking. (Yes, I said "made me"; my own will had nothing to do with it.) However, so you can make your own decision about trying it, I need to tell you what I meant above about bat-shit crazy.

Some of it I expected. The package insert is quite explicit about the fact that anybody taking Chantix can expect vivid dreams, for example. Boy, did I have those: deep, colorful, excruciatingly detailed, highly emotional epics that seemed to last all night and stayed with me for days. But they were not all nightmares; some were vastly entertaining. (Who knew I had that much imagination?) The manufacturers also warn about physical symptoms such as nausea and constipation, and they're not kidding. But certainly these side effects were no worse than those experienced with pregnancy, so I was more than willing to continue taking the drug.

A few more oddities cropped up. For one thing, stuff I used to love (e.g., coffee) suddenly seemed disgusting; stuff I used to hate (e.g., bell peppers) I suddenly adored. This part, at least, felt somewhat familiar... a little bit like the cravings/aversions people often have with pregnancy. Also, I lost my appetite. By that I mean I no longer seemed to have that internal thermostat (not the right word... appestat?) that lets people know when they are hungry, no matter how long it had been since I'd eaten. Perversely, when I did have a meal, about half an hour later I would feel as if I were starving and simply had to eat something or die. Oh, and I suddenly had an acute sense of smell, and most smells nauseated me. (Again, not that different than what some people experience during pregnancy.) Perhaps a bit weirder, though, my own skin seemed to take on a strange scent, like toasted almonds, that I just couldn't shower off. I also felt somewhat more irritable than usual, but I expected that with any smoking-cessation attempt. 

About two weeks into the prescription, though, something just... tilted. Out of nowhere, with no provocation, I'd feel anger building into a blind, unreasoning rage. Seconds later, a random line on TV or in a book would strike me as so funny I literally couldn't stop laughing. People I'd known and liked for years suddenly seemed like loathsome, hateful creatures, full of vicious intent. Every painful or unpleasant situation from my past swam up out of memory and replayed in my mind. Inanimate objects (in one case, cans of corn on a grocery shelf) seemed like the saddest things in the world, and I didn't know how to comfort them. Once, in the act of clicking a couple of unneeded computer files with the intention of deleting them, I was overwhelmed with pity for the poor little documents and simply couldn't bring myself to "kill" them. Out to lunch with my husband one day, talking with him about plans we had for the evening, I burst suddenly into uncontrollable tears. But without any feeling of sadness. It was like somebody else was in charge of my brain, running gleefully up and down its passages and flipping switches at random.

Somewhere in there I stopped taking Chantix (DUH, you say), but without tapering off. That just made things worse. I broke out in a fierce case of hives, for one thing. But above all, I began to feel like a person I simply didn't recognize. I started taking half a pill a day, increasing slowly to the dosage I'd been at when I stopped, and then backed off slowly again. That caused less physical discomfort, but all day, every day, I fought thoughts of paranoia (family, friends, clients were all working secretly against me; soon I would have no work at all and my family would starve; I'd be homeless, etc.). Bad as I felt emotionally, however, I knew I was merely  reacting to the drug.

Finally, even after being off Chantix entirely for months, the depressive episodes intensified and I began to think of suicide. I knew better than to give free rein to those thoughts, but all the same, I made an appointment with a psychologist, just to have someone help monitor me through the situation. I also enrolled myself in a clinical drug trial for antidepressants (because without medical insurance, I couldn't afford the $250 per hour an initial office visit to a psychiatrist would have cost, let alone the medication). I'm not sure the pills helped, but at least I felt I was doing something other than succumbing to misery. And I knew it was all temporary. Or at least, so I hoped.

"Temporary" turned out to be a little longer than I thought it would. Say a little more than a year and a half.

It's been a year and nine months, give or take a week, since I last swallowed a Chantix tablet. I no longer have thoughts of suicide, paranoia, or depression. Life is good again. I still love some foods I used to hate, and hate some foods I used to love. I still cannot tell whether or not I'm hungry. I still never think about cigarettes, and I do not miss them. For real; it's as if I'd never so much as seen one.

Now you know the best and the worst Chantix has to offer.

Good luck. 

*The web site reports that independent analysis, based on data submitted to the Massachusetts Department of Public Health (MDPH) by the manufacturers, found that increases in smoke nicotine yield per cigarette averaged 1.6 percent each year, or about 11 percent over a seven-year period (1998-2005).


Anonymous said...

Great post, Margie! I am so glad you are now a non-smoker, but pity you so for your travails. I count myself lucky that I was able to quit by just doing so; I know how rare that is!

I hope your experiences will prepare anyone who reads this and decides to go 'head on with the Chantix. It sounds dreadful.

Margie said...

Thanks, Linda... I was outraged when I realized it's so hard to quit now because the tobacco keeps increasing the addictive properties of cigs by adding more nicotine. I also realized I probably could never quit cold turkey on my own again, so I was willing to try anything. I still don't know if I think Chantix was "worth it" or not; I simply can't say either way. I worry that a young person with less life experience might succumb to the suicidal urges it can cause. Yet I can't tell you how wonderful it is to just have cigarettes be a total non-entity in my life. I don't even think about being "smoke-free"... it's as if they never existed.

Diane (Canids) said...

Margie Dear, thank you for saving your life so that the rest of us can enjoy basking in the shear glow of your infectious personality for a long, long time.

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