As the novel coronavirus infection continues, it is predicted that the number of depressed patients in Korea will continue to increase. Courtesy of Getty Image Bank
Selective serotonin reuptake inhibitors (SSRIs), one of the antidepressants, are considered to have relatively few side effects and high safety among antidepressant drugs. Currently, a 60-day supply can be prescribed in other departments such as psychiatry, internal medicine, pediatrics, and family medicine.
However, recently, when the Health Insurance Review and Assessment Service (HIRA) came up with an agreement to allow non-psychiatric departments to prescribe this drug for more than 60 days, controversy grew. Non-psychiatrists argue that the treatment of depression, which is gaining weight in modern people, will be more active, while psychiatrists are fighting by emphasizing negative effects such as drug side effects and limitations in drug prescription in the early stages of depression.
As it is predicted that the number of depressed patients will continue to increase in Korea due to the novel coronavirus infection (COVID-19) pandemic, internal conflicts within the medical community over the treatment strategy for depression are deepening.
According to the medical community on the 4th, the HIRA held a meeting on the 17th of last month to collect opinions from various fields on the agreement to allow repeated prescription of SSRIs. The agreement would allow non-psychiatrists to prescribe the drug for patients with depressive symptoms, repeatedly for 60 days. After review by the Ministry of Health and Welfare, the HIRA can be implemented in the form of an interpretation by the HIRA or a notice by the Ministry of Health and Welfare.
SSRIs first appeared in the 1980s as a drug called Prozac. It relieves depression by increasing the amount by inhibiting the reuptake of serotonin, a neurotransmitter that has an antidepressant effect. Compared to tricyclic antidepressants (TCAs), which inhibit the reuptake of other neurotransmitters, it is considered to have fewer side effects and higher safety.
Non-psychiatrists say that SSRIs should be prescribed repeatedly in various departments, citing the safety of SSRIs. Hong Seung-bong, president of the Korean Society for Depression and Suicide Prevention, which consists of doctors from neurologists, internal medicine, family medicine, and pediatrics, said in a national audit last year, “There is no prescription restriction for tricyclic antidepressants, which have a higher risk of side effects than SSRIs.” The restriction is a regulation that lacks a medical basis to the extent that it cannot be found in countries other than Korea.” He noted that if the ’60-day prescription limit’ is removed, access to early-stage depression treatment will be several times higher than it is now.
● Psychiatrists “Some of the side effects of SSRIs include an increase in adolescent suicidal behavior, requiring professional prescription”
Psychiatrists have different views on SSRI safety. Kim Dong-wook, president of the Korean Psychiatric Medicine Association, said, “SSRI can be used relatively safely, including patients with cardiac conduction disorders, but it is necessary to accurately point out the side effects.”
According to Chairman Kim, in addition to the well-known side effects such as vomiting and nausea, SSRIs can cause side effects such as excessive sedation, weakness, antidiuretic hormone inappropriate secretion syndrome, and serotonin withdrawal syndrome.
Several overseas studies have also reported that it may increase suicidal behavior in children and adolescents. “As a result of analyzing the results of 77 studies, SSRI reported 16 suicides, 172 self-harm, and 177 suicide attempts,” said Chairman Kim.
He also emphasized the high risk of SSRIs incorrectly prescribed to non-depressive patients. Chairman Kim emphasized, “The initial symptom of bipolar disorder (manic depression) is depression, and taking antidepressants can promote the induction of bipolar disorder.
He expressed concern that reliance on medication for early depression treatment is also dangerous. Although drug treatment has the advantage of being inexpensive and effective, it is not enough to expect a therapeutic effect that takes into account the recurrence of the disease.
Chairman Kim said, “In many clinical studies, only regarding 30% of symptoms were completely improved through drug treatment, and 60 to 70% of patients experienced recurrence. In addition, dynamic psychotherapy and cognitive behavioral therapy approaches are recommended in parallel.”
Chairman Kim said, “Korea has a higher ratio of specialists compared to overseas countries. “Regulation of drug prescription cannot be the right strategy for depression treatment,” he said.
