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SSRI prescribing up 9.7 percent despite warnings

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SSRI prescribing up 9.7 percent despite safety warnings

Prescribing of new-generation antidepressants continues to grow strongly, figures issued today by government drug funder PHARMAC show.

In 2005 prescribing of SSRIs grew by 9.7 percent, reaching an all-time high of 584,000 prescriptions.

The drugs, such as fluoxetine, paroxetine and citalopram, have been subject to international scrutiny after new data linked them with an increased risk of suicide, particularly among adolescents. Medsafe, the New Zealand drug safety authority, issued advice to prescribers in September 2004, advising them of the increased risks and advising them to monitor patients. In the United States, the Food and Drug Administration went further and required SSRIs to carry “black box” warnings, the highest-level safety warning.

PHARMAC Chief Executive Wayne McNee says a closer examination of the data shows that prescribing for adolescents, the highest-risk group, continues to grow at a similar rate to adults and no significant change was noticed after the new advice from Medsafe.

“Patient numbers are small, which may indicate that prescribing amongst this age group is already done carefully,” Wayne McNee says.

“It’s also worth noting that we have less than one year’s data since the new prescribing advice was given, so it may be too early to see a definitive trend.”

Mental health overall is an area where prescribing continues to grow strongly. In addition to antidepressants, the use of antipsychotics grew 16.8%, with the majority of that growth in the newer agents such as olanzapine, quetiapine and risperidone. During 2005, PHARMAC widened access to both olanzapine and quetiapine to enable them to be subsidised for mood disorders.

Use of hormone replacement therapy continued to decline. In 2005 there was a further 17% following reductions of 32% and 45% in the previous two years. This trend follows international studies that showed there are greater risks than benefits in using HRT long-term.

In other trends noticed during the year

- Prescriptions for cholesterol-lowering statins approached one million – representing some 250,000 patients.

- Prescriptions for benzodiazepines (sleeping pills) rose, reversing a downward trend. This may be due to the impact of low cost PHOs as most patients taking benzodiazepines are elderly.

- Prescribing of methylphenidate for attention deficit disorder is flattening off after steady increases over recent years.

- Spending on test strips for monitoring blood glucose levels is almost on a par with spending on diabetes medicines, such as insulins. Test strips accounted for $19.5 million of expenditure while diabetes medicines were $20.6 million. A new product, pioglitazone, helped raise expenditure on diabetes medicines.


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