§ Paul FlynnTo ask the Secretary of State for Health what recent assessment he has made of the side effects of tricyclic antidepressants and selective serotonin reuptake inhibitors; and what evidence he has collated on their impact on suicidal tendencies in their users. [25436]
§ Ms BlearsSelective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are effective medicines in the treatment of depression, features of which may include suicidal behaviour. It is known that776W features of depression, including suicidal behaviour, can worsen after introduction of any antidepressant prior to its beneficial effect being apparent.
As with all medicines the safety of TCAs and selective SSRIs is continually monitored by the Medicines Control Agency (MCA) and the independent expert advisory body, the Committee on Safety of Medicines (CSM). The safety profiles of TCAs and SSRIs are well established and are reflected in the product information for prescribers and patients.
Reports of adverse effects, including suicidal behaviour, suspected to be associated with SSRIs and TCAs are collated by MCA/CSM through the spontaneous reporting scheme, the yellow card scheme. These data are reviewed on a regular basis.
A possible causal association between SSRIs and suicidal behaviour has been reviewed by the CSM on a number of occasions, most recently in 2001. The CSM concluded that the current evidence is insufficient to confirm a causal association between SSRIs and suicidal behaviour and advised that the issue should be kept under review.
777WThe product information and the British National Formulary warn that patients should be closely monitored for suicidal impulses, particularly in the early stages of treatment. An article emphasising this advice was published in the MCA/CSM drug safety bulletin "Current Problems in Pharmacovigilance" in September 2000.