Another round of drug disputes

Professor John Werry of the Auckland-based Werry Centre for Child and Adolescent Mental Health. Photo / Supplied

Psychiatrist Professor John Werry, who specialises in children and adolescents, has clashed before with Medsafe on the issue of the use of Prozac-type antidepressants for adolescents.

In 2007 he complained Medsafe's restrictions on the use of antidepressants was depriving patients of choice.

The medicines regulator rejected the claim saying studies, though supportive of the use of fluoxetine, "do not resolve the issue of the safety or efficacy" of Prozac-type antidepressants in the treatment of depression in children and adolescents.

Werry continues to disagree with Medsafe's position. "I take comfort in the fact that despite the Medsafe warnings New Zealand doctors have ignored their advice and the prescribing of antidepressants to youth has continued to increase," he told the Herald.

In its February update Medsafe points out: "No antidepressant has ministerial consent for the indication of treating major depressive disorder in children and adolescents." Medsafe explains this means informed consent must be obtained from the patient or parent prior to initiating Prozac-type treatment.

Werry says concerns - as outlined in American Food and Drug Administration black box warning for Prozac - that the use of antidepressants increase the risk of suicidal thinking and behaviour in children, adolescents and young adults need to be balanced against whether that results in actual completed suicide.

He says suicidal thinking is not the chief concern with regard to the effects of Prozac-type drugs.

"It can stir the kid up in general and they can get stroppy. That's much more clinically significant than any increase in suicidal thinking as far as I'm concerned," he says. "It tends to make them a little bit more excited and, yes, it can make them more aggressive, but it's all part of responsible monitoring of medication when you give it. I always warn the parents about this."

If such symptoms do occur, Werry says it's important to discuss it with the prescribing doctor and then make a decision about whether the benefits outweigh the cost. "It's a matter of having a good relationship between the patient and the doctor."

Herald: If a kid does get angry would that be an indication to you that they should perhaps come off the medication?

Werry: It might be, but there are many causes for anger. I think I know what you're getting at - that boy that you're alluding to was provoked, so you can't actually say it had the slightest thing to do with the SSRIs [Prozac-type antidepressants]. You see there are many causes. It's very complicated thing and you have to have a good relationship between the patient and the doctor. You're not the guy who has been waging this vendetta against Marinoto are you?

I'm not waging any vendetta.

Well that is the perception, if it's you. Why don't you report some of the things that the mother has been doing?

Such as?

Look, if you don't know what your job is, then there is no point in my talking to you. Bye.