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Stick to the script: doctors warn on anti-depressants

Local psychiatrists have urged people with depression to be vigilant when following prescribed drug regimens in light of a US public-health advisory warning of increased suicide risk for some who use anti-depressants.

"Of the 90,000 psychiatric patients in Taiwan, only about 30 percent return for follow-up appointments with a doctor," said Lee Ming-been (李明濱), superintendent of the Taipei City Psychiatric Center and head of the Taiwan Association Against Depression.

Lee said that patients had recently begun to express reservations about anti-depressants following a US Food and Drug Administration (FDA) health advisory on March 22.

The advisory asked manufacturers of some anti-depressants to include warnings that depression and suicidal tendencies may worsen after patients begin their prescriptions.

"Medication is necessary for serious cases of depression," said Liao Shih-chen (廖士程), a National Taiwan University hospital psychiatrist.

"While drugs can treat symptoms such as the inability to sleep and a loss of appetite, changing a patient's evaluation of his personal situation usually comes last," Liao said.

Lee said that although anti-depressants were effective in treating depression, it was important to be particularly vigilant in observing the emergence of suicidal feelings at the start of a drug program.

"Depression is not like a cold. You cannot take the medication until you feel better and then quit," Lee said.

He said that at no point in the course of a patient's drug regimen should the patient discontinue the prescription without consulting a doctor.

"In Taiwan, patients tend to think that doctors can work miracles. If the drugs that doctors prescribe do not work at first, they go around shopping for other doctors to prescribe different medication," Lee said.

"Changing a patient's drug regimen is a technique and skill in and of itself," Lee said.

"It's important that patients bring records of their previous drug regimens when seeing a new doctor," said Winston Shen (沈武典), head of the psychiatry department at Wanfang Hospital in Taipei.

According to a Taiwan Association Against Depression press release, selective serotonin reuptake inhibitors (SSRIs), including Prozac, Paxil and Zoloft, are presently the most commonly prescribed anti-depressants in Taiwan.

"Despite the FDA's warning, there is so far no scientific evidence showing that SSRIs and other anti-depressants are a direct cause of suicide," Shen said.

Shen added that studies of the causes underlying increased suicidal tendencies among users of anti-depressants were currently being conducted around the world.

Meanwhile, Tsai Hsiang-ping (蔡香蘋), chief of the Life Improving and Loving Association (中華民國生活調適愛心會), said that the association's suicide prevention and crisis hotline often received calls from patients who refused to take medication to treat depression.

"People do not want to take anti-depressants because it is admitting that they are sick and that they have a disease," Tsai said.

Tsai also said that after important events such as the presidential election, the association's hotline receives calls from a new group of people seeking help.

"Judging from the calls that we've been getting, I don't think that the election has had much of an influence on those who have already been diagnosed with a depressive illness," Tsai said.

"However, I predict that in a month or so, new callers will begin calling with election-related problems," Tsai said.
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