orlamac
commented
3 years ago Thanks for starting this codelist Andrew. I have made the following amendment: I have included Duloxetine - it is included in our local MH trust antidepressant formulary as a third line option and I would say it is used relatively commonly for depression / anxiety as a result. I have not included the 20mg or 40mg strengths, which as you have pointed out are for urinary incontinence.
I have included Mianserin and Trazodone as we had excluded these from our tricyclic codelist.
Meanwhile, I agree with excluding flupenthixol as it is not used exclusively for depression in my experience. Also I agree with excluding Levomilnacripan, Milnacripan and Oxitriptan which are not licensed in the UK according to MHRA products website.
The only other drug I wanted to consider is whether we should include Bupropion - this is not licensed in UK for depression although it is licensed in the US as an antidepressant. It is used off-licence for this indication third line, usually third or fourth line due to poor tolerability or poor efficacy. It is mentioned as an option in key literature about antidepressants (e.g. BAP guidance). I'm happy to exclude but include just wanted to highlight consideration here.
HenryDrysdale
I've produced a codelist for Other Antidepressants.
EXCLUSIONS Duloxetine 30mg & 60mg capsules Are licenced for depression/anxiety and diabetic peripheral neuropathy. Duloxetine wouldn’t be a typical first line treatment either for diabetic peripheral neuropathy or anxiety/depression – so not clear to me that there is a dominant indication for these strengths. As such probably safer to just exclude them? n.b. 20mg and 40mg capsules are used for urinary incontinence, but do not fall within this BNF chapter so are excluded by default.
Flupentixol Licenced for depression but mainly think of this as an antipsychotic. EMC defines as “flupentixol is a neuroleptic of the thioxanthene series.” https://www.medicines.org.uk/emc/product/997/smpc#PHARMACODYNAMIC_PROPS
Levomilnacipran An SRNI used for depression but isn’t in the BNF or EMC. Zero prescribing in the UK.
Milnacipran An SRNI used mainly for fibromyalgia. It isn’t in the BNF or EMC. Zero prescribing in the UK.
Oxitriptan (5-HTP) Precursor to serotonin mainly used for depression, insomnia and appetite control. Also reported to be helpful for fibromyalgia and migraine. It isn’t in the BNF or EMC. We do have a small amount of prescribing in the UK (6 items in last month), but given the diversity of its claimed use cases and lack of direction from licencing I’m inclined to exclude it.
INCLUSIONS Agomelatine - Melatonin receptor agonist
Venlafaxine - SNRI
Mirtazapine – tetracyclic
Nefazodone - an antidepressant with a unique MOA involving both blockade of postsynaptic serotonin 5- HT2A receptors and inhibition of serotonin and noradrenaline reuptake. https://link.springer.com/article/10.2165/00003495-199753040-00006 It isn’t in the BNF or EMC, but have included it as the use case as an antidepressant seems quite clear cut and we do have a small amount of prescribing in the UK (3 items in last month).
Reboxetine – noradrenaline reuptake inhibitor
Tryptophan – precursor to 5-HTP (early precursor to serotonin) licenced for treatment of depression.
Vortioxetine – unique multi-modal MOA.
Let me know if any suggestions for changes.