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Anti-Depressant Use on the Wane

Posted on: Tuesday, 26 April 2005, 15:00 CDT

WARNINGS over the safety of anti-depressants appear to have turned the rising tide of young people taking pills for depression, new figures show.

Drug-buying agency Pharmac is welcoming the change as evidence patients and doctors have heeded the message, but mental health workers are worried the shortage of other options means more young people may be going untreated.

Anti-depressant use in six-year-olds to 18-year-olds has soared in recent years, increasing by two-thirds from 1998 to 2002. But, since international warnings that the drugs could cause suicidal thoughts, the number of Kiwi kids taking the pills has dropped by almost a fifth.

Safety concerns first emerged in December 2003, but it was not till last October that New Zealand drug regulator Medsafe advised doctors the risks of prescribing the class of newer anti- depressants, called Selective Seratonin Reuptake Inhibitors, generally outweighed the benefits for young people. There was some evidence fluoxetine (Prozac and generics) had a better risk profile.

Figures from Pharmac show the number of young New Zealanders taking SSRIs peaked in August last year, at 1026 prescriptions, but has since steadily declined, falling to 832 prescriptions in December.

Pharmac chief executive Wayne McNee said the drop was good news. The previously steady growth seemed to have plateaued, indicating young people had listened to the warnings and reviewed their treatment, with some coming off the drugs.

But child and adolescent psychiatrist John Gregson said the drop was worrying, given the shortage of alternative treatments. "Potentially it means 200 people out there are not managing their depression. We don't know that, but that is the concern."

He had not had a flood of young people coming in worried about SSRIs and still felt comfortable prescribing them as many of his patients had suicidal tendencies. Giving anti-depressants was still safer than failing to treat a young person at risk, he said. He now prescribes fluoxetine wherever possible.

But fluoxetine prescriptions have also dropped, despite the drug not being included in the warning, suggesting a growing reluctance among GPs to prescribe anti-depressants, Dr Gregson said.

Family doctors were in a more difficult situation as they saw less serious problems and could not monitor patients as closely. The recommendation for GPs to consult a specialist was unrealistic as child psychiatrists were in short supply, he said.

Island Bay GP Helen Rodenburg agreed doctors had become more cautious about prescribing anti-depressants. She tried to use counselling and psychologists where possible, but alternatives were limited. If patients could not afford private treatment, there was a long wait for hospital services, she said.

Source: Dominion Post

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