Anti-depressant use up 27.9 per cent

The number of people taking anti-depressant drugs in the Waikato has grown by 27.9 per cent over the past six years - the second-highest increase in New Zealand.

But are Waikato GPs and other doctors over-prescribing the pills that pick you up, or is it more an appropriate recognition of a long-unmet need?

It's probably a little bit of both says academic psychiatrist David Menkes, who analysed figures on anti-depressants supplied to the Waikato Times by Government drugs purchaser Pharmac.

And at least one Waikato GP agrees, revealing he and many of his colleagues are erring on the side of caution when treating depressed people who could be inclined to harm or even kill themselves.

According to the Pharmac statistics, 38,900 people were prescribed with anti-depressants last year, well up from 30,400 in 2008.

The biggest increase in antidepressant use was in the Nelson/Marlborough region, which recorded a 28.1 per cent increase. Waikato came second, with Counties-Manukau the third-highest.

Dr Menkes - an associate professor of psychiatry at the Waikato Clinical School, part of Auckland University - said it was difficult to say whether GPs were dishing out too many of the drugs, or if they were now prescribing at a level they should have been at for years.

"Possibly it's a bit of both," he said. "You can also apply the same arguments to ADHD drugs and anti-psychotics.

"It's a big, important and complex area. There will be no simple explanation for the increase and a lot of devil in the detail.

"There are social factors that influence these patterns, perhaps including the drought last year, or unemployment. There will be all sorts of things in the mix and it is very easy to speculate."

And just because people were being prescribed anti-depressant drugs did not necessarily mean they had been diagnosed with depression.

"Anti-depressants are useful drugs and can appropriately be used to treat a whole range of conditions including depression, anxiety disorders, neuropathic pain, post-traumatic stress disorder, agitated dementia, irritable bowel syndrome, [and] premenstrual syndrome.

"[However] they also have a variety of unintended side effects, some of them serious, and these are not always recognised or managed appropriately, especially with the newer drugs."

GPs and other prescribers should always take into account the likely or potential effects and each patient's preferences, he said.

"Anti-depressant prescriptions should always be tailored to the individual, followed up carefully, and withdrawn if the benefit does not clearly exceed harm.

"This doesn't always happen and, accordingly, there is evidence of overprescription and overuse of anti-depressants in Waikato and elsewhere," he said.

"However, there is also evidence that many who could benefit do not receive or take anti-depressants, so it isn't possible to say whether the volumes are excessive overall.

"There are many alternatives to anti-depressants, including 'watchful waiting', since many 'depressions' resolve spontaneously; psychological treatments, and lifestyle changes. These are generally as effective as drugs in mild to moderate depression, but not in moderate to severe illnesses."

Mike Slatter, a GP at the Ngaruawahia Marae Clinic, said there was a lot of fear among doctors that if they did not prescribe anti-depressants to depressed patients, those people could commit suicide - for which the GPs could be blamed.

"There are a lot of factors. It is up to doctors to inform patients of what else is available to treat their depression. There are also expectations from many patients that they will get a pill. If the patient has any potential to commit suicide the doctor will err on the side of caution," he said.

"Depression is a greatly varying thing, from a mild feeling of the blues, which we all get from time to time, to over whelming despair. The challenge for us doctors is to spend more time with our patients and figure out what is best for them."

Waikato Times