Antipsychotic drugs not best option for depression

We were somewhat surprised about the timing of the psychiatrists who expressed concerns regarding the Therapeutics Initiative in the The Province on March 10 and March 14. They wrote about Therapeutics Letter #95, which discussed the use of antipsychotics in the treatment of non-psychotic depression.

We published that letter on our website in August 2015. If Dr. Diane McIntosh or others had comments, they could have submitted them for posting on our website. The Therapeutics Initiative welcomes and posts all comments as long as the authors are willing to declare their potential conflicts of interest. We encourage McIntosh to submit comments along with our standard conflict of interest declaration. If she identifies any errors or inaccuracies, we’ll correct the posted version of the letter.

We stand by the rigorous review we did to arrive at the conclusions published in Letter #95. Every patient has unique needs, so physicians must use their knowledge and judgment to prescribe accordingly. However, when we examined trials of antipsychotic drugs for depression, we could find no evidence that it improves overall function or clinically important outcomes in patients who have unresponsive major depressive disorder.

Antipsychotics cause a range of harms. Health Canada approved quetiapine and aripiprazole for major depression when other drug treatments have failed. However, its standard for approval is relatively low, aimed largely at increasing therapeutic choices rather than protecting patient safety. The product monographs warn that antipsychotics should be used for the shortest possible time to minimize longer-term harms from such drugs.

A draft of all our letters is sent to up to 65 professionals for feedback. These include researchers, family physicians, pharmacists and specialists. For Letter #95 this included several psychiatrists, both local and international.

For 24 years, the University of B.C. Therapeutics Initiative has been a trusted and independent source of advice about prescription drugs for health professionals, the public and the Health Ministry. Over those years, we have contributed to getting things right. We were among the first to identify problems with drugs like Avandia and Vioxx. These and many other drugs, intensively marketed and widely prescribed across Canada, were used less intensively in B.C., partly because of cautionary advice we gave to doctors and the ministry.

Since our creation in 1994, we have published more than 100 newsletters covering the whole range of drug topics. They are freely available on our website at www.ti.ubc.ca. In addition, we have delivered hundreds of seminars and educational sessions to students, residents, physicians and pharmacists across the province. We continue to work hard to improve prescribing and de-prescribing in B.C.

We are pleased to see that Health Minister Adrian Dix recently announced a renewed pledge for our province to build on its strong history of evidence-based health policies.

Among measures the minister has taken is a recommitment to the Therapeutics Initiative.

All B.C. citizens depend on independent evidence of drug effects to ensure that drugs are used optimally for the patients most likely to benefit and least likely to be harmed.

B.C.’s public drug plan now costs more than $1.5 billion a year. It’s essential to reduce wasteful or harmful prescription drug use so that money can be better spent in other parts of our health system.

Dr. James Wright is a specialist in internal medicine and clinical pharmacology. He’s also co-managing director of the Therapeutics Initiative and editor-in-chief of the Therapeutics Letter.