DRUGS OVERLOAD

AN Irish Examiner investigation into prescribing patterns of tranquilising and stimulant drugs shows that pharmaceuticals to help anxiety and depression are being dished out in alarming numbers.

An analysis of the top 100 drugs reveals that, in 2009, the latest year for which data is available, more than €60 million was spent on anti-depressants, while a further €53m was spent on benzodiazepines (tranquilliser drugs), anti-psychotics and sleeping tablets.

The sector watchdog, the Mental Health Commission, says it is worried about the widespread use of benzodiazepine medication among the long-stay and elderly population in mental health services, and about the emphasis on a pharmacological approach in services in general. While just the top 100 drugs are published, overall in the medical card and drug payment scheme, prescriptions for medications which have an effect on mood — either stimulating or tranquillising — were written at a rate of almost 20,000 scripts a day in 2009. The drugs, classified as psycholeptics and psychoanaleptics cost €148m and account for 10% of all pills prescribed through the schemes. Other uses which were excluded for this article, include Alzheimer’s, dementia and narcolepsy.

ANTI-DEPRESSANTS:

Nine anti-depressants, most of which are selective serotonin reuptake inhibitors (SSRIs), were prescribed more than 2.2m times in the medical card and drug payment schemes in 2009.

One of those, escitalopram, cost €15m alone, even though it is simply a newer version of citalopram, the active ingredient in the SSRI anti-depressant, Cipramil. So while the older version costs far less, both are being prescribed.

This is a technique used by pharmaceutical companies to charge more for what is essentially a copycat medication. Several studies have found that second-generation antidepressants, despite differences in drug classification and cost, offer patients very similar benefits and only minimal differences in risks. SSRIs have been the source of much controversy in recent years. Findings of the US drugs watchdog the FDA resulted in a black box warning on SSRI and other antidepressant medications regarding the increased risk of suicidal behaviour in patients younger than 24.

The family of Shane Clancy, who took his own life after stabbing his friend, Sebastian Crean, to death, believe the antidepressant he had been prescribed, citalopram, drove him to do what he did.

In giving expert evidence at his inquest, psychiatrist Professor David Healy said in a small but significant minority of patients using SSRIs can give rise to violent behaviour including self-harm, suicide and violence towards others. Prof Healy said he had had clinical experience of two men with no prior history of violence who became homicidal after a week on citalopram where the problem cleared up once treatment had stopped.

ANTI-PSYCHOTICS:

In relation to anti-psychotics, former mental health inspector Dr Dermot Walsh maintains second-generation anti-psychotics — such as the most commonly prescribed in this country, olanzapine — cause substantial adverse effects compromising life expectancy in psychiatric patients.

“As shown by studies such as CATIE and CUTLASS 1, these second-generation drugs have little therapeutic advantages over their predecessors but cost much more,” he said.

Equally of concern, Dr Walsh said, is emerging evidence that some changes in brain structure, previously thought to be the consequence of the schizophrenic process, may actually be treatment related.

Dr Walsh said while campaigners are vocal on the issue of outlawing electroconvulsive therapy (ECT), no one is shouting about the damage which the use of such drugs, administered to unwilling or incapable patients, could be doing.