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Depression

Question
Posted by: | 2019/10/07

Q.

Flupentixol for depression

Hello, I have a dilemma about the use of flupentixol as an antidepressant. Where I come from (the UK), the British National Formulary states that there is little to choose between the different antidepressants in terms of efficacy, implying that flupentixol is every bit as theraputic as the others, even for very severe depression. However, the manufacturers Lundbeck are quite strict about this and insist it is not for severe depression. Both parties cannot be right. The BNF is a responsible source but Lundbeck are a well-established pharmaceutical company. I was wondering if you could arbitrate for me and tell me who is right and who is wrong?

Expert's Reply

A.

Depression expert
- 2019/10/09

Interesting question.  I'm so old, I can remember when Flupenthixol ( as it was then called ) was introduced in the UK by Lundbeck, and even visited that company's HQ in Denmark, to explore it.   Flupenthixol is an anti-psychotic drug, shown to be effective given as a monthly injection, in treating schizophrenia and similar conditions.  As such, it is approved in the UK, Canada, SA, Australia, etc. 
At that time, it was also launched, called Fluanxol, as I recall, in a small-dose tablet, to treat anxiety, and was noted to have mild antidepressant effects.   It was not considered to be an anti-depressant as such.
At the time I was running a unit in London which dealt with many overdoses, and we were interested in whether the mild antidepressant effects that has been noted in the injectable form, were strong enough to be useful, as it could help people needing help with depression while still at risk of taking an impulsive overdose of antidepressant tablets.
Confusingly, for no good reason I can understand, it was later sold as a combination with Melitracin, an antidepressant of no special benefits,  apparently to add to anti-anxiety effects, though almost all antidepressants are also effective in relieving anxiety symptoms, often more rapidly than they show their antidepressant effects.
This combination is a problem, and is not approved for use in the UK, America, Canada, etc, or even in Denmark itself ! 
There are so many potentially helpful definitely antidepressant drugs available, I see no point in using Melitracin, and as almost all ADs show value in treating anxiety symptoms, I see no point in combining Flupenthixol with Melitracin or any other AD.
I would agree with the BNF that there is no strong evidence of major over-all benefits for any one of the multitude of ADs available, but if it calls Flupenthixol an antidepressant, and suggests it should be used to treat severe depression, I would strongly disagree, and ask to see their strong evidence in favour of this odd point of view.

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