A coroner has reiterated strong recommendations about the treatment of depressed patients but they have found little traction with GPs.
The latest recommendations from Coroner Ian Smith come after the death of Appleby man Jeremy Reece Fortune who walked into the path of an oncoming heavy truck while in a state of severe depression on May 14 last year.
Mr Smith did not rule Mr Fortune's death "self-inflicted" but his latest recommendations follow ones made in July last year, after inquests into self-inflicted deaths. His findings included making sure patients on anti-depressants known as SSRIs selective seratonin reuptake inhibitor medication are made aware of their risks in line with "black-box" warnings on the drugs, which included Prozac, Aropax, Cipramil, Zoloft and Luvox.
Those warnings state that in trials antidepressants "increased the risk of suicidal thinking and behaviour" in children and adolescents with depression and other psychiatric disorders.
Then and now, Mr Smith said there was an "absolute requirement" for a counselling, psychologist or psychiatrist programme to be developed and said patients with depression should receive one-on-one counselling regularly.
He has also now recommended that patients with depression be warned of the increased chance of suicide, and that patients should be screened to check if they were taking any mind-altering substances.
Nelson GPs' spokesman Graham Loveridge said anti-depressants were, by their nature, prescribed to people who already had some suicidal tendencies and for every study that showed SSRIs increased suicide, there was one showing the opposite.
Given that, a black-box warning could be akin to crying wolf, he said.
Anti-depressants were almost always prescribed alongside counselling but while high risk patients were able to be seen immediately in Nelson there was a wait of about six weeks for patients not in the high-risk suicide category but still significantly depressed.
However, the Nelson Bays Primary Health Organisation was the first in the country to roll out a scheme where GPs were funded to spend more time with depressed patients, and some private centres were funded to provide mental health care.
Patients were usually asked if they were taking any mind-altering substances, Dr Loveridge said.
It was important that patients did not take Mr Smith's recommendations as a sign to stop taking their medication, without first talking to their GP.
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