I was agog at the news last week that US doctors had accepted Madonna concert tickets, among other gifts, as incentive to prescribe GlaxoSmith-Kline’s medicines.
The UK-based manufacturer was given a $3 billion penalty after admitting to what’s being called the ‘biggest healthcare fraud in history’.
One antidepressant involved is Paxil. Known here as Seroxat, or paroxetine, it has been linked to a higher risk of suicide in some patients.
Links: Antidepressant Seroxat is used in Britain. Manufacturer GlaxoSmith-Kline was given a $3billion penalty after admitting to what's being called the 'biggest healthcare fraud in history'In one case in 2003, an 18-year-old Londoner, Jamie Hoole, hanged himself after being put on it for two months. An inquest concluded his death may have been ‘wholly or in part’ linked to his use of the drug.
The new scandal adds to the worry for the millions of Britons on antidepressants, including Seroxat. As a GP who has written many prescriptions for these types of drugs, my first message is: don’t panic.
Might my GP have been pressured to prescribe me a certain antidepressant?It is highly unlikely. In Britain, all doctors have to be very careful about accepting gifts or anything that may appear to be a financial incentive from pharmaceutical companies (or patients for that matter).
Every year we have to carry out a detailed appraisal, overseen by the local Primary Care Trust (PCT), in which we declare all gifts. If we do accept any, we run the risk of being disciplined for a conflict of interests.
All PCTs have a medicines management team who monitor all prescriptions from every GP practice. If a doctor was seen to favour one drug over others, it would be picked up on quickly.
So how do doctors decide on which drugs to prescribe for depression?The most prescribed antidepressants are those that increase levels of the mood-balancing hormone serotonin in the brain. These are known as SSRIs (selective serotonin re-uptake inhibitors). First-line treatments include the drugs fluoxetine (Prozac), sertraline and citalopram.
This is in line with the recommendations of the National Institute of Clinical Excellence, which sets prescribing guidelines based on large amounts of research. From experience we know these work well, and cause least side effects.
Other choices for those with more complex problems or in whom previous treatment has failed include amitriptyline, lithium or venlafaxine. Drugs such as lithium would normally be started by a psychiatrist after assessment, rather than a GP.
What if I’m on Seroxat? Should I stop taking it?Seroxat isn’t so commonly prescribed: though these drugs all work the same way in theory, in practice some seem more effective that others. But if you are on it and have no problems, you should carry on.
How quickly can you tell if an anti-depressant is working?
These drugs are only prescribed after clear symptoms of depression such as poor appetite, early-morning waking, loss of enjoyment of life or marked loss in concentration. The symptoms will wane when an antidepressant works but it can take up to four weeks for it to happen.
People can feel worse in these first few weeks: close supervision by family and a GP is essential. Antidepressants are not a quick-fix and require a long-term commitment.
What options do I have if the antidepressant doesn’t work?SSRIs are usually started at a low dose and altered according to the response. An alternative SSRI can be tried – this is not uncommon before finding the one that works best. Finally, it may be appropriate for a review either with a psychiatrist or a psychotherapist. Good access to therapy may avoid the need for a prescription.
I feel fine now, so can I stop taking my pills?This is a joint decision between you and your doctor. Patients may feel ready when symptoms have improved greatly – but it’s a mistake to stop as soon as you feel better. This is a sign that the drugs are working but a relapse can happen if you suddenly stop. Antidepressants should usually be slowly reduced over a few weeks.
I always recommend that patients wait until exacerbating stresses – such as financial or family worries – have passed.