Plea for suicide alert on anti-depressants - South Island - The Press
By HELEN MURDOCH - The Press | Saturday, 7 July 2007
New generation anti-depressants used by more than 135,000 New Zealanders should carry a warning alerting users to the possibility of increased suicidal thinking and behaviour, a coroner says.
The call has been made by Nelson coroner Ian Smith.
He is concerned the casual prescription of the drugs, coupled with ineffective mental-health treatment, was related to the suicides of at least four men in Nelson last year.
Pharmac figures show more than 600,000 prescriptions for new generation SSRI (selective serotonin reuptake inhibitors) anti-depressants were issued to New Zealanders last year at a cost of more than $27 million.
This was up from around 50,000 prescriptions in 1993.
Commonly prescribed SSRI medications include Prozac (Fluoxetine), Aropax (Paroxetine), Cipramil (Citalopram), Zoloft (Sertraline) and Luvox (Fluroxamine).
Pharmac medical director Peter Moodie said the increased use of SSRIs was because they had fewer side-effects.
There was also greater awareness of depression, and thus greater use of anti-depressants, he said.
Pharmac had no reason to be concerned at the use of SSRI medication, but the coroner's comments should be taken seriously and all clinicians needed to review how they handled patients with depression, he said.
Dr Stewart Jessamine, of Medsafe, said the Medicines Adverse Reactions Committee recommended new warnings go on antidepressant data sheets in 2004 to indicate possible increased suicide risks and the need to closely monitor patients.
Although there was some increased risk for some adults taking SSRIs the overall benefits outweighed the risks, he said.
The coroner's recommendations came in his finding into the self-inflicted death of David Stringer, 37, who died last January.
He said he was concerned that the theory behind SSRI treatment – that the drugs restore normal mood by allowing neurotransmitters to accumulate in the spaces between brain cells – was too simplistic.
He said he was worried the drugs were too casually prescribed and too widely used.
An article published last year in the Australian and New Zealand Journal of Psychiatry warned those who had been on SSRI medication for less than 10 days were four times as likely to suffer suicidal thoughts as those who had been taking the drugs for more than 90 days, he said.
The coroner said it was evident that patients placed in care and released remained a high suicide risk, and it was imperative follow-up was completed on how patients react to the SSRI treatment.
"David Stringer died within eight to nine days after his release from care and this will be shown to be a common thread in the other findings to come," the coroner said.
"It must be pointed out that it is not only the issue of the prescribing of SSRI drugs that factor in these people who have suicided, but also the background of their mental health care."
The coroner said it was imperative a one-on-one counselling program be available for patients using the medication and health professionals remain in regular physical contact with patients, rather than relying on telephone follow-up.
He recommended that patients who failed to make appointments be physically contacted immediately, and that counsellors develop solid relationships with the patient's next-of-kin.
Mental Health Foundation chief executive Judi Clements said the coroner's comments should be taken on board and highlighted an issue already known to be significant.
"The majority of people who take their own lives have contact with the mental health service and anyone falling into that category is a priority," she said.
Counselling was also an essential part of treatment, but was currently not readily available, she said.
Mental Health Commission chairwoman Ruth Harrison said all psychotic drugs had side-effects and the increase of suicidal thinking, and need for increased follow-up, was recognised with the use of SSRI medication.
Stringer was prescribed Prozac in 1993, 1994 and July 2005, and Cipramil in August 2005, during which time he made several suicide attempts and was seen by the mobile community team.
In January 2006, Stringer was admitted to the Nelson-Marlborough Health Board's mental health unit for four days after another suicide attempt, by which time his prescription had been changed to Aropax.
Smith found the community team's follow-up after Stringer's release was confined to telephone calls, during which he admitted to suicidal thoughts.
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