Anti-depressant link to suicide unproven, say regulators

1.00pm

New Zealand has decided not to ban a group of anti-depressants that prompted a ban in the UK and warnings in the USA, after a study found potential links to teenage suicide.

The Ministry of Health said today that after reviewing international data, it did not plan to change the way the anti-depressants, known as Selective Serotonin Re-uptake Inhibitors (SSRIs) were prescribed to teenagers here.

Warnings were issued yesterday by the Food and Drug Administration (FDA) in the United States that 10 of the most popular modern anti-depressants should be closely monitored for signs of suicidal behaviour. Such drugs include the popular Prozac and Aropax.

Medical safety agency Medsafe spokesman Dr Stewart Jessamine said while there were concerns, the data linking the anti-depressants to suicide were inconclusive.

"As a result of the small number of studies reported, the limited number of patients included in each study and inconsistencies in how each study defined safety and efficacy, an accurate determination of the risks and benefits of SSRIs as treatments for children under 18 with depression cannot be made at this point," a ministry statement said.

New Zealand -- like the FDA -- was awaiting a fresh analysis of the data before making a definitive statement, said Dr Jessamine, Medsafe's principal technical specialist.

Currently, there were no alternative medications approved for use in children with depression in New Zealand.

"So we're faced with a balance of 'if we say you must never use these medicines' then there is no medicine available for the treatment of depression," he told National Radio.

The UK has banned the drugs, although doctors still have discretion to prescribe them in some cases.

The situation here was similar, Dr Jessamine said. SSRIs were not approved for use in children, but doctors had the discretion to prescribe them.

"We're saying 'you should use these under specialist advice, in limited cases'."

The chair of the Medical Association's GP Council, Peter Foley, said today that a lack of counselling services for teens meant doctors had no options but to prescribe anti-depressants instead.

"The services offered around the country are not as easily sourced as medication is."

He called for better funded alternatives to medication.

"GPs are not well funded for spending time with patients. We would like that to happen and therapeutic services in different DHBs (district health boards) in the way of counselling are very hard to source, so they need to be better funded as well."

Dr Foley said the US results were so far inconclusive, and New Zealand GPs were awaiting more definite conclusions before changing their approach.

Despite the statistics, he said GPs here had a "cautionary" approach to prescribing anti-depressants as a "second line" treatment for teenagers.

He acknowledged the prescribing of antidepressants to under-18s had increased by 60 per cent in the past four years, but said the diagnosis of teenage depression had improved and "the incidence of depression is probably rising in our community".

Dr Jessamine said that talks with child psychiatrists here reflected that medication should not be the first option for children under 14. But there was more debate over whether therapy or medication should be the first approach for older adolescents, he said.

The key finding by the FDA was that patients on SSRI medication -- adults and children -- should be closely monitored.

About 24,500 antidepressant prescriptions are written for New Zealand children and young people each year.

Since 1998, the number of New Zealand children and young people using SSRIs has increased by almost two-thirds.

The ministry today warned parents of children taking anti-depressants not to suddenly stop them taking the medication, but to consult their doctor.

The United States FDA issued a caution on paediatric use of anti-depressants last year, but this week's action goes significantly further.

It follows pleas from dozens of anguished parents citing pre-teens and teenagers who hanged themselves or slashed their wrists shortly after starting the anti-depressants.

Researchers at the Christchurch School of Medicine have been seeking funding for a three-year study of anti-depressant use in up to 400 New Zealand children and adolescents.

An Otago Medical School study released last year linked anti-depressants to 41 deaths in 2001, with anti-depressant overdoses the cause of 23 of the deaths.

The FDA has said it is not yet "clear" that the drugs actually did lead to suicide, but until that was settled, it called for stronger warnings to doctors and parents that the anti-depressants may cause agitation, anxiety and hostility.

The USA has issued a warning that SSRIs shouldn't be used in most circumstances, and Britain has banned their use completely for teenagers following the studies.

Chief executive of the UK National Association for Mental Health Richard Brook said after examining the results, British regulatory authorities decided the drugs were not only ineffective for teens, but unsafe.

"What we have is a series of drugs deemed not to be effective... What we also found in the UK when we put these studies together was there was an increased risk of hostility and suicidal thinking," he told National Radio.

Teens faced different issues than adults, he said.

Cognitive behaviour therapy, counselling, talking and helping young people with their social life and friendships seemed more effective, Dr Brook said.

"These drugs don't seem to be particularly helpful, useful or indeed even safe for under-18s."

Despite fierce lobbying from pharmaceutical companies, licensing arrangements banned the drugs. However, doctors could occasionally use their discretion to prescribe them to teens in some occasions.

- NZPA