Critical anti-depressant study: Don't panic, says Pharmac

Pharmac is warning New Zealanders taking anti-depressants not to stop taking their medication as new research suggests they might as well be taking sugar pills.

The study by British and American researchers, published in the journal Public Library of Science Medicine, examined results - including unpublished data - from 47 clinical trials on Prozac and other selective serotonin reuptake inhibitors. It found only a small group of patients with extreme depression showed any benefit.

Lead researcher Professor Irving Kirsh, from the University of Hull, said most of the 5000 patients taking the drugs improved - but so did those on placebos. "Given these results, there seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients, unless alternative treatments have failed to provide a benefit," he told The Times.

More than $30 million of the health budget was spent on 1.1 million prescriptions for anti-depressants  last year. Hundreds of thousands of New Zealanders are prescribed anti-depressant medications.

Dr Peter Moodie, the medical director  of Government drug-buying agency Pharmac, said the study would be discussed but Pharmac would not rush a decision.

"When we're looking at questions about the efficacy of drugs, we should use a measured approach."

"In New Zealand we write something like 720,000 scripts for anti-depressants every year, and we spend something like $27 million on them, so we really want to make sure we are getting the best value for money from those scripts," he told Radio New Zealand.

He said that in the meantime people on anti-depressants should continue taking them.

Pharmac says New Zealand doctors prescribed anti-depressants worth $30.7 million in the year to June, mostly ($27.7 million) on new-generation SSRI drugs. Of the 1.1 million prescriptions issued for anti-depressants, 721,550 were for SSRI-type drugs, mainly fluoxetine (was Prozac, now Fluox), paroxetine (was Aropax, now Loxamine), and citalopram (Celapram).

Clinicians are defending their prescribing rates, saying medication plays a vital role in treating moderate to severe depression.

Mental health advocate Mary O'Hagan, a former mental health commissioner, said depression was a serious issue but popping a pill might not always be the answer.

"There is a danger that we're medicalising ordinary unhappiness. We have this idea we should be riotously happy all the time and, if we're not, we must be depressed.

"But sometimes unhappiness is telling us there are things we need to change in our lives."

She said family doctors tended to overprescribe anti-depressants because there were no publicly funded alternatives.

However, Auckland psychiatrist David Codyre, head of ProCare Primary Mental Health Programme, said he believed GPs were judicious in prescribing anti-depressants. He agreed there should be more funded access to alternative therapies.

"Clinical evidence shows that self-help strategies - exercise, relaxation, stress management etc - are effective in treating mild depression. But when it comes to moderate depression you need psychological intervention or medication and, at the severe end of the spectrum, you need both."

He said the cost of untreated depression in New Zealand would run to millions in lost productivity with people forced on to benefits, putting the cost of drugs into perspective.

Allen Fraser, of the New Zealand College of Psychiatrists, said symptoms of mild depression should be treated in the same way as early diabetes or heart disease.

"That is to say seriously, with medication if necessary, but in the first instance we should look at lifestyle changes."

The Health Ministry declined to comment, saying officials had yet to consider the study. Meanwhile, drug manufacturers criticised the study for taking only a small subset of data into account.

DRUG COMPANY DEFENDS MEDICATION

A spokesman for Eli Lilly, which makes Prozac, said: "Extensive scientific and medical experience has demonstrated that fluoxetine is an effective antidepressant.

"Since its discovery in 1972, fluoxetine has become one of the world's most-studied medicines.

"More than 40 million people suffering from depression have been treated with fluoxetine in over 100 countries around the world.

"Lilly is proud of the difference fluoxetine has made to millions of people living with depression."

- with NZPA