Original article n o longer available
The Nelson Mail
Saturday, 7 July 2007
Health professionals have been warned to take greater care advising patients and their families of the risks of taking certain antidepressants found to be a factor in several suicides in Nelson.
Nelson coroner Ian Smith last year began investigating a possible link between SSRIs – selective seratonin reuptake inhibitor medication – and the effects on people suffering mental illness.
Mr Smith issued some of his findings yesterday as part of an inquest into the suicide of David John Stringer, 37, on January 23, 2006.
The coroner said it was not just the prescribing of SSRIs that was a factor in the deaths he investigated, but also the background of the patient’s mental health care.
Mr Smith has recommended that New Zealand’s warnings be strengthened to the level of those adopted by the United States, which requires a strong black-box warning on prescription information.
Those warnings state that in trials, antidepressants “increased the risk of suicidal thinking and behaviour” in children and adolescents with depression and other psychiatric disorders.
Mr Smith said there was a worry that SSRIs – which include Prozac, Aropax, Cipramil, Zoloft and Luvox – were too casually prescribed and therefore too widely used. He stressed in the report that the finding was not a direct attack on SSRIs but “simply a word of caution”.
Mr Smith recommended that GPs and mental health professionals made sure patients and their families were “appraised very fully” of the risks of the use of SSRIs and other antidepressant medication.
He also wanted an “absolute requirement” for a counselling, psychologist or psychiatrist programme to be developed and said patients with depression should receive one-on-one counselling regularly.
“While this may be costly, it is, in my view, imperative.”
Mr Smith said mental health professionals should follow up immediately with a face-to-face appointment if a patient did not attend an appointment.
Nelson GPs spokesman Dr Graham Loveridge warned of being careful not to “throw the baby out with the bathwater”.
“Using SSRIs combined with talk-therapy is the best we can do at present for depression,” he said.
Doctors were dealing with a high-risk group for suicide, and SSRIs were an improvement on old antidepressant drugs, which had worse side effects and were easier to overdose on, he said.
Unsuccessful suicide attempts were more common with SSRIs, suggesting they could be a cry for help rather than a genuine attempt, he said.
Informed consent of side effects was always crucial when prescribing them, but “specifically with suicide risk, you don’t want to be engendering thoughts of suicide”.
Black-box warnings on SSRI medication could be going too far, he said.
According to Ministry of Health data, the Nelson Marlborough region has the fifth-highest rate of antidepressants prescribed among the country’s 21 district health board regions.
But Dr Loveridge said the statistics were hard to put into context because they could mean more people were either getting more help or doctors were over-prescribing.
He supported the idea of regular face-to-face contact with patients, but said it was impossible under present health funding.
Nelson Marlborough District Health Board mental health clinical director Heather McPherson agreed some of the recommendations went too far.
“I think he has rather overstated the connection between SSRIs and suicide,” she said.
She believed monitoring and face-to-face contact with patients was viable and was already being done. The only problem came when patients did not want to make contact.
In extreme conditions, they could be committed to mental health care, she said.
* Help available: DHB Mental Health Crisis Services (03) 546 1800; Victim Support (03) 546 3847; Youthline 0800 376 633, text 027 4YOUTHS or cellphone (call free) 0800 211 211; Lifeline (03) 546 8899 or 0800 423 743.