Ministry rethink on anti-depressants

By MARTIN JOHNSTON health reporter

Doctors have been warned against using several modern anti-depressant drugs in youngsters because of links to suicidal thoughts or attempts.

The Health Ministry is considering whether warnings should be further strengthened.

Among the medicines which British health authorities say should not be given to people under 18 are three sold in New Zealand as Aropax, Cipramil and Efexor.

Britain's Committee on Safety of Medicines raised concerns about Aropax in June. It and a medicines regulatory agency have now added other drugs to the list, saying their risks outweigh their benefits in young people.

According to New Zealand Government records, the volume of all anti-depressants given to people aged 6 to 18 increased by 64 per cent in the four years to 2002.

Modern anti-depressants and cognitive behaviour therapy are considered the most promising treatments for depression.

Anti-depressants are used mainly for depression, but also for other conditions including anxiety disorders.

The British agencies say reviews of clinical trials on depression in under-18s found that, compared with taking inert placebo pills, Cipramil was associated with an increased rate of self-harm, and that Aropax and Efexor were linked with higher rates of self- harm and suicidal thoughts. One trial reported three suicide attempts on Efexor, compared with none in the placebo group.

There was insufficient or no evidence that the drugs were effective against major depression.

But Prozac-type pills - also sold in New Zealand as Fluox - were effective and were not linked to suicidal thoughts or self-harm.

None of the four drugs is specifically licensed for use by under-18s, but doctors are still allowed to prescribe them "off label".

The new information has already led the ministry to approve warnings against prescribing Aropax and Efexor to under-18s for depression.

"As a result of the British advice and other information we will be considering whether stronger advice is necessary for other related medicines," said the manager of its Medsafe division, Clare van der Lem.

"It is most important that patients do not suddenly stop taking their anti-depressants. Patients should discuss any concerns with their doctor."

Dr Ian Griffiths, the medical director in New Zealand for GlaxoSmithKline, which makes Aropax, estimated that about 500 New Zealanders under 18 took the medicine.

He said Aropax was the leading anti-depressant prescribed to under-18s in New Zealand. "We've never promoted it for use under 18. It's always been up to the prescribers' judgment."