A review of the evidence in Expert Opinion on Drug Safety has concluded that although the risk of potential neuropsychiatric events is evident through voluntary reporting systems and reported cases in the literature, multiple studies and case reports support the use of varenicline in the mental health population.The referenced study supporting the paragraph says (abstract): 'Cautious treatment initiation, patient education, and close follow-up, monitoring for mood and behavior changes during therapy are recommended, especially in the psychiatric setting'. It also says:
Although the risk of potential neuropsychiatric events is evident through voluntary reporting systems and reported cases in the literature, multiple studies and case reports support the use of varenicline in the mental health population.I have no idea of the rate of successful outcomes compared with adverse events. It is clear however that not only those with a history of mental illness or psychological problems suffer from the side-effects of taking Champix – a fact clearly acknowledged by ASH Scotland in its page featuring Champix:
However depression, suicidal thoughts, suicide attempts and completed suicides have been reported in patients taking varenicline who have no known pre-existing psychiatric conditions, and in patients who continue to smoke.This page gives a clear message in bold type that anyone experiencing side-effects should stop using the drug and get medical help without delay. The confusing part is how this squares with the idea that Champix is 'safe and effective for people with mental health problems'. It would have taken very little to add 'on the understanding that the patient is carefully monitored, and it is not recommended as a treatment of first resort'.
Plaintiffs in court cases on Champix claim that Pfizer 'neglected to test Chantix adequately before its release, deliberately hid evidence of serious side effects and failed to sufficiently warn consumers about its risks'. There was no thorough testing of the drug on people with psychiatric problems, and this incomplete testing has become an issue as more reports of adverse reactions emerged over the years. (Neither of the users of Champix featured in this link had a history of serious mental health problems. One user took her life and the other experienced psychological disturbance following a twelve-week course, that led to a suicide attempt.)
The sheer bloody unpleasantness of taking something that completely unbalances you can't be stated too strongly: even without leading to suicide, it is not easy to put such an experience behind you. (I had an averse reaction to myself to a natural thyroid hormone: after three days on a minute dose I was ready to throw heavy things out of windows. I have been angry before but this was well beyond any previous experience. And the doctor who prescribed it for me found it hard to believe.) There are more stories here from people who wanted to make their stories public.
I can't help but think that ASH Scotland views people who experience such effects as unfortunate statistics – collateral damage in the war on smoking. They've made the warning clear on their website, but still find it easy to call the drug 'safe' for users of mental health services.