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However, to date, a causal relationship has not been demonstrated between the use of varenicline and these symptoms, particularly because nicotine dependence and withdrawal syndrome are known to be linked to suicidal ideation, negative affectivity, and depressive symptoms (Jimnez-Ruiz, Berlin, & Hering, 2009

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[76] The reinforcing effects of nicotine play a significant role in the beginning and continuing use of the drug

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