Brief Answer:
Three options.

Detailed Answer:
Hi XXXXXXX

Welcome to Healthcare Magic!

Let me first commend you on deciding to quit smoking. Half the battle is won when you take a firm decision to quit. Well done! You are also right in saying that quitting smoking is harder than quitting alcohol. Most other people also feel the same.

Since you have been trying to quit smoking for some time but finding it difficult, I shall not advise quitting abruptly and braving out the withdrawal symptoms. Let us consider the other available options. There are three main strategies you can use to quit.

1) There are medicines available which reduce the craving for nicotine and make it easier to quit. These are started before quitting and after these become effective, a quit-date is set. On the pre-appointed date, you quit. Because of the medicine's effect, it is easier to remain abstinent. After you have been abstinent for a few months, the medicines are stopped. The two medicines that are commonly used are bupropion and varenicline. Bupropion is cheaper than varenicline. Varenicline is somewhat more effective.

2) You can opt to stop smoking and use other forms of nicotine replacement when you are unable to control the craving. Nicotine containing chewing gums are available for this purpose. After a few days, you can reduce the number of chewing gums that you are taking per day and gradually taper it off. These save you from the harmful effects of smoke, but are still not harmless as they contain nicotine.

3) If you do not wish to try either medicines or nicotine replacement, you can try to gradually reduce the number of cigarettes you smoke daily. Also try to reduce the number of puffs you take from each cigarette and throw away after just one or two puffs. Gradually your body will get used to the lower dosage of nicotine and you will be able to taper it off with only mild withdrawal symptoms.

I shall be able to help you better if give me some details about the number of cigarettes you smoke per day and the methods of quitting that you have tried in the past. Also let me know the problems you faced so that we can discuss how to surmount them. Think about the methods I have mentioned here and let me know your preference so that we can discuss that in detail.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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Brief Answer:
As below.

Detailed Answer:
Hi XXXXXXX

There is no medicine in this world which is without any side effects. But bupropion is usually tolerated well. However, it should not be taken by people who have ever had seizures in life. If you are not very keen on doing this with the help of medicines, then I would suggest that you first try reducing the number of puffs you take from each cigarette. Limit your daily intake to as before, say 12 cigarettes per day, spacing them over the entire day, say around one per hour. But force yourself to throw the cigarette after just one puff. This way you do not starve yourself but still are able to cut down. Once you can do this, try reducing the number of cigarettes to 10 per day, increasing the time interval. A few days later, cut down to 8 per day. Carry on in this manner till you are able to quit completely. During this process, avoid being in the company who are smokers. Watching others smoke or smelling smoke are strong cues for inducing craving. Feel your body healing and growing healthy with each passing day and use this thought to motivate yourself further.

If this fails, you always have the option of medicines to control the craving and help you quit.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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