Q:  Help to stop smoking?

I was diagnosed at age 39 in 1987. I am now going through menopause and take 600 mg.of lithium daily. In this time I have gone off meds twice and became manic within 6 months. Fun for me hard on my family and bosses. My question is this why can't I quit smoking? I would not describe myself as stuborn (a good thing if you are trying to quit ) but I am really really persistant which to me should work to give up a habit. I am not suicidel but I can not quit smoking or even imagine being smoke-free. Is there some magic potion nothing else seems to work.  Tara

Dear Tara -- 
It's great that you can see the toll of a manic phase on your family, because that sounds like it's helping you stick to the lithium now.  It might also help you use great caution if you ever try what someone surely must have recommended to you by now, namely "Zyban".  You may have learned that Zyban is actually just an antidepressant, Wellbutrin, under a new name.  And you may also have learned that antidepressants can trigger manic episodes, and Zyban is capable of doing this too.  

So while I can't tell you of a sure-fire magic potion, I can tell you to watch out for a potion that may be offered to you.  Unfortunately, it also works pretty well, statistically much better than the patch, for example.  So ultimately you might try it, if you convince yourself that nothing else can possibly work.  Your family should probably get an opportunity to comment on taking this risk, and be fully aware of what you're doing with a good channel open to your doc' who's prescribing lithium, and full precautions against manic behaviors in place before you start.  You might even plan on having some rapidly acting antimanic medication, such as Zyprexa, on hand; or at least Ativan -- talk about this part of the strategy with your doctor.  

Dr. Phelps

Published March, 2001