|
Nurse prescribing
Antidepressants
CPD
Dispensing
ETP
The Profession
The Society
Letters to the Editor
|
Antidepressants
Newer type of antidepressants play a vital role
From Mr S. R. Bazire, MRPharmS
I am writing in response to the article
"MeReC focuses on antidepressants" (PJ, 18 May, p677).
Although The Journal's coverage of the MeReC
Briefing report is correct, both reports may perhaps underplay the
vital role some of the newer antidepressants have in the treatment of
depression. MeReC states that the role of newer antidepressants in primary
care would seem limited and that they have no clear advantages, but one
should consider that:
- Although efficacy between different antidepressants
using defined improvements in specific rating scales is similar, it
is dependent on reaching therapeutic doses for an adequate duration.
Recent data indicate that up to three quarters of all tricyclic antidepressant
prescriptions for depression are at subtherapeutic doses and only 6
per cent complete an adequate course of a tricyclic.1
- The role of the newer drugs may be limited to
those people who experience treatment failure with a first antidepressant,
but market data indicate that 45 per cent of people who start an antidepressant
will need to switch to a second antidepressant, eg, due to lack of efficacy
or side effects. So, the role may be limited, but it is significant.
- Switching from one antidepressant to another
is not an easy task because there can be many problems with, eg, serotonin
syndrome, discontinuation effects from the first antidepressant, drug-drug
interactions, cholinergic rebound, etc. Antidepressants that are easy
to switch to and from will have a major role, eg, reboxetine and mirtazapine.
- Although venlafaxine at doses of up to about
150mg/day may be broadly similar to the selective serotonin reuptake
inhibitors, MeReC notes that there may be a dose-response relationship.
Venlafaxine may be particularly effective in producing remission (as
opposed to just a statistical improvement) in resistant depression in
higher doses, eg, above 200mg/day, when reuptake inhibition includes
noradrenaline and dopamine in addition to serotonin.
I eagerly await the day when tricyclic antidepressants
become third or fourth line therapy as a result of their difficulty of
use, dose-limiting side effects, toxicity in overdose and subtle effects
on cognition and driving skills.
|
Reference
1. Donoghue J. Antidepressant use patterns in
clinical practices: comparisons among tricyclic antidepressants
and selective serotonin reuptake inhibitors. Acta Psychiatr Scand
2000;403(Suppl): 57–61.
|
Stephen Bazire
Pharmacy Services Director,
Norfolk Mental Health Care NHS Trust
|
