New advice on prescribing anti-depressants

New Zealands's Medsafe has sent a letter to all prescribers informing them about new advice relating to the known risks and benefits associated with prescribing medications to treat depression in young people and in adults.

The Medicines Adverse Reactions Committee (MARC), an expert advisory committee to the Ministry of Health, has reviewed this issue and have made several recommendations that apply to all antidepressants including Selective Seretonin Reuptake Inhibitors (SSRI), Tricyclic Antidepressants (TCAs), and Monoamine Oxidase Inhibitors (MAOIs).

Ministry of Health spokesman, Dr Stewart Jessamine says "There is a need for new warnings to go on all antidepressant medicine datasheets to indicate possible increased suicide risk and the need to closely monitor patients with depression."

In addition to this, the MARC have advised that when treating children and adolescents with depression the risk of suicidal thoughts and behaviour with SSRIs generally outweigh the possible benefits from the medication. "However we need to make the point that there is no clinical evidence of increased completedsuicides in any age group using SSRIs," says Dr Jessamine. "The most important thing for people taking these medications is that they keep taking them as prescribed. You can discuss any concerns with your doctor at the next scheduled visit, or if you're very worried call to see your doctor sooner."

"There are some Tricyclic Antidepressants that are currently approved for use in treating depression in children and adolescents, but we will be requiring that the datasheets about this be updated. They will say these medicines are NOT recommended for use in patients under 18 years of age unless upon the advice of an appropriate specialist. This is because the risks of heart problems with tricyclics generally outweigh the benefits for children and adolescents."

Dr Jessamine says "In some instances, a clinician may decide that these medications are the most appropriate way to treat a child or adolescent with Major Depressive Disorder. If that is the case, then the prescriber must discuss the risks and benefits with the patient / parent and obtain informed consent."

For adults, the risk / benefit ratio with all antidepressants is still favourable. "Although there is some evidence that there is a possible increased risk of suicidal thoughts and behaviours in some adults taking SSRIs, the overall proven benefits outweighs the possible risks," says Dr Jessamine.

"All patients with Major Depressive Disorder should be regularly monitored for suicide risk regardless of whether they are taking anti-depressants or not. And it is especially important that specialist advice is sought before starting, stopping or changing any antidepressant treatment in children or adolescents."

Dr Jessamine says "Prescribers will always face dilemmas when treating severely depressed young people because options are limited and there are questions around the effectiveness and safety of the medicines available for treatment. The dilemma comes when weighing up the risk of NOT prescribing one of these medicines, that is why we are telling doctors to get advice from an appropriate specialist."