How to Quit Smoking

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I started Zyban [an antidepressant shown to help people quit smoking] plus the patch plus one of the other replacement therapies,” says Foulds. “We figure it’s a lifesaving intervention, so why do it halfheartedly? These medicines are not very dangerous in themselves, so there’s no reason to hold back.”

It’s perfectly all right to be on nicotine replacement for as long as necessary to quit smoking. Nicotine has some obvious benefits — it makes you more alert and seems to decrease the risk of Parkinson’s and Alzheimer’s disease. And although it may increase blood pressure, its negative effects are trivial compared to the thousands of other poisons in cigarette “tar,” which is responsible for cancer, heart disease, and most other ill effects of smoking. “If it’s a question of smoking or spending your life on nicotine replacement, I choose the latter,” says Klesges.

Zyban, the brand name for bupropion, apparently works by activating reward centers in your brain similar to the way nicotine does. A new drug, varenicline, marketed as Chantix, blocks the receptors that get turned on when you smoke, making smoking less pleasurable.

Studies seem to show varenicline is more effective than Zyban, but with a cost. About a third of those who stayed on varenicline reported . “A colleague of mine who did one of the early trials said he could tell which patients were getting the drug [and not the placebo] because they were turning green,” says Klesges. Still, varenicline may be an option for some people.

The “never borrow a cigarette” rule

Once you’ve stopped, obviously, it’s essential to stay stopped. Relapses are common, but Klesges has a system for keeping them to a minimum. The rule is never relapse on a borrowed cigarette. If you need a cigarette desperately, leave wherever you are and buy a pack at a store. Smoking is a sudden urge, one that can fade on the way to the 7-Eleven. If it doesn’t, throw away the 19 left in the pack that you don’t smoke.

“I’ve never had anybody follow these rules and relapse,” Klesges says. “But a lot of people don’t follow the rules.”

A footnote: Three days after I submitted this story, on my 48th birthday, I stuck a 14 mg nicotine transdermal patch on my arm. I’m on my second day. Wish me luck.