New antidepressants 'no riskier'

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Doing good deeds makes endorphins clinical trials have proven. There is a

book on it. I'll try to find it. N

 

New antidepressants 'no riskier'

 

http://news.bbc.co.uk/1/hi/health/3910029.stm

SSRIs posed the same risk of suicidal behaviours as tricyclics

The risk of suicidal behaviour with newer antidepressants like Prozac is

the same as the risk with old-style antidepressants, research shows.

There have been concerns about reports of suicidal thoughts and behaviours

among people, particularly under 18s, taking newer SSRI antidepressants.

 

But Boston University research suggests all antidepressants take time to

work.

 

The findings appear in the Journal of the American Medical Association,

published this week.

 

Prozac (fluoxetine) and Seroxat (paroxetine) both belong to the newer form

of antidepressant drugs called selective serotonin reuptake inhibitors

(SSRIs).

 

I think most doctors would be modestly reassured

 

Dr Simon Wessely, consultant psychiatrist from London's Institute of

Psychiatry

 

 

SSRIs are prescribed as an alternative to older antidepressants called

tricyclics.

 

Tricyclics are thought to be more dangerous in overdose, which makes SSRIs a

good option for patients about whom the doctor is concerned may be suicidal.

 

Back in 2000, researchers questioned the safety of these newer alternatives.

 

They were concerned some SSRIs were addictive and could make people feel

suicidal.

 

In response, the government commissioned a review into the safety of SSRIs

in 2003.

 

The review looked at drug trials and reports of adverse drug reactions made

to the Committee on Safety of Medicines and the Medicines Control Agency

(now the Medicines and Healthcare products Regulatory Agency).

 

Safety concerns

 

The CSM concluded there was no, or insufficient, evidence from clinical

trials that benefits outweigh the risks of side effects for certain SSRIs in

children younger than 18.

 

These were sertraline (trade name Lustral), paroxetine (Seroxat), citalopram

(Cipramil), escitalopram (Cipralex), venlafaxine (Efexor) and fluvoxamine

(Faverin).

 

Prozac (fluoxetine) was the only drug that had clearly demonstrated that the

benefits outweighed the risks, said the CSM.

 

It said doctors could continue prescribe Prozac off licence for people under

18.

 

The CSM is still looking at the evidence on SSRIs in adults.

 

Dr Hershel Jick and colleagues at Boston University conducted their own

research to estimate the risk of non-fatal suicidal behaviour in more than

2,500 people in the UK who had started taking one of four antidepressants.

 

Two were the commonly prescribed SSRIs fluoxetine (Prozac) and paroxetine

(Seroxat) and the other two were tricyclic antidepressants - amitriptyline

and dothiepin.

 

Overall, the patients had an increased risk of suicidal thoughts and

behaviours during the first month of taking their antidepressant, especially

during the first nine days.

 

Equal risk

 

But this increased risk was the same for each of the drugs.

 

Dr Jick said: " The most likely explanation for this finding is that

antidepressant treatment may not be immediately effective, so there is a

higher risk of suicidal behaviour in patients newly diagnosed and treated

than in those who have been treated for a long time. "

 

" It is also possible that this observation reflects patients starting to

take an antidepressant drug when their depression, which naturally

fluctuates over time, is at its worst, " he said.

 

Dr Jick said it was less likely that SSRIs worsen depression, leading to

suicidal thoughts and behaviour, but could not exclude it.

 

Dr Simon Wessely from the Institute of Psychiatry in London said the results

contradicted the concern that SSRIs posed a higher risk of suicidal thoughts

and behaviours than tricyclic antidepressants.

 

" Most doctors would be modestly reassured by that, " he said.

 

" What it also shows, which is a worry, is that when people start treatment

on antidepressants they are at particular risk of suicidal behaviour. We

already knew that.

 

" It reinforces the need for patients to be monitored at the early stages of

treatment irrespective of the drug that they are being given.

 

Advice

 

" Doctors need to remember that that is a dangerous period. But it doesn't

suggest that anything specific has to be done for people taking for example

Seroxat as opposed to an older drug, " he said.

 

He said most psychiatrists still thought SSRIs were safer to use than

tricyclic antidepressants in people who might be suicidal.

 

" They are much safer in overdose and most patients prefer them and I think

most psychiatrists will continue to use them, " he said.

 

A spokeswoman from the Department of Health said: " The results of this study

are in line with existing advice from the CSM that the risk of suicidal

behaviour may increase in the early stages of treatment with any

antidepressant, including SSRIs.

 

" The study will also be looked at by the CSM's Expert Working group on the

Safety of SSRIs as part of their assessment of all available evidence. "

 

The National Institute for Clinical Excellence is due to produce guidelines

on the treatment of depression and anxiety in adults in October of this year

and will consider the evidence from the CSM.

 

It will also produce guidelines on the treatment of childhood depression in

April 2005.