Adverse side effects of medicines can be underestimated and often not
recognised as such. 110 drugs prescribed on the NHS have been linked to depression,
self-harm and suicidal behaviour in a scientific study of patient Yellow Cards drug
reaction reports sent to the Medicine’s
Regulatory agency, the MHRA.
The paper
published this September 2014 in the journal BMC Pharmacology &
Toxicology is believed to be the first UK
Anti-depressants, acne, smoking cessation and weight-loss drugs were most
frequently linked with serious psychiatric adverse drug reactions (ADRs).
Clozapine, the anti-psychotic drug, had the highest reporting rate of suicide,
with 78 reports between 1998 and 2011 linking the fatality to the drug.
Both nervous system and non-nervous system drugs met the study’s
thresholds of at least 20 reports for depression, 10 for non-fatal suicide and
5 for fatal suicide between 1998 and 2011. Topping the charts with most
frequent reports of depression were smoking cessation medicine, varenicline (Champix
/ Chantix) and bupriopion (Wellbutrin / Zyban), followed by paroxetine (Seroxat
or Paxil), the SSRI antidepressant. Also high on the list of drugs linked to
depression were the acne treatment, isotretinoin (Roaccutane / Accutane), and
rimonabant (Acomplia), a drug for weight loss. For suicidal and self injurious
behaviour, SSRIs, varenicline and clozapine occurred most often.
Figures found in the study are likely to underrepresent the true count
of iatrogenic effects (drug-induced side effects) as the Yellow Card reporting system remains
relatively underused by both patients and healthcare professionals.
The paper recommends the drugs most commonly arising in patient reports
for grave psychiatric conditions need further analysis to understand the
reasons why these drugs might be causing undue harm.
When a drug is licensed for prescription, pre-market trials do
not undergo full powered studies into adverse drug reactions (ADRs) as this
would require larger numbers of participants. Post-marketing pharmacovigilance
using the Yellow Card reporting system and its careful analysis is therefore
one of the main ways we can achieve a fuller picture into the neglected area of
patient experience with medication.
Due to poor
publicity and the underpowered studies of iatrogenic effects, psychiatric drug
reactions and withdrawal effects are neither sufficiently well recognised nor analysed
in the medical community. A
study published in 2004 found that fewer than half of pharmacy programmes
and medical schools provided students with a guide to reporting ADRs. Yet NHS
Education for Scotland (NES), in a
press release published in June 2014, stated that 7% of acute hospital
admissions were due to ADRs. The NES have thus launched six new e-learning
modules to support healthcare professionals identifying and reporting
iatrogenic symptoms. Clinical pharmacologist
Dr Simon Maxwell published an article reporting that undergraduate
study is in urgent need of review to improve the safe and effective use of
drugs in patients. 74% of medical students felt
the amount of teaching in this area of safe prescribing was ‘too little’ or ‘far too little’, and most
disagreed that their assessment ‘thoroughly tested knowledge and skills’.
If we are to reduce the effect of ADRs on the population, and their
economic impact that costs the NHS
an estimated £2 billion each year, healthcare professionals and
pharmaceutical companies need to make best use of new information made
available by patient reporting.
Jacqueline
Bond blogging for APRIL
