Red flags raised over prescription meds

While Gesy has been hailed for its public benefits, experts have raised red flags over the way medication is “freely” prescribed, even over the phone without any face-to-face prescription. A case in point is the ease with which antidepressants are prescribed.

Under current rules, GPs can prescribe mental health related medication, including anti-depressants and anxiety medication.

“This is done way too easily in Cyprus and it shouldn’t be like this. This medication has side effects and a patient might not even need it to begin with,” said general secretary of the psychiatric association Louiza Veresie.

As a result of the Covid-19 pandemic, reports of depression and anxiety have spiked across the globe, with Cyprus being no exception.

“There needs to be far more control over what is prescribed. A pathologist cannot prescribe depression medication. Psychiatry works with some very fine lines and a misdiagnosis can quickly exacerbate something else,” Veresie added.

For instance, a patient could go to their GP reporting they are feeling melancholic. Because a GP may not think in the same lines as a psychiatrist, they may miss indicators showing the patient may be bipolar, she explained.

Consequently, “the GP may misinterpret the symptoms, prescribe antidepressants and then cause drug-induced mania.”

Currently GPs and pathologists can prescribe some mental health related medication such as Xanax, diazepam, Librax (chlordiazepoxide), Lorivan (lorazepam) and Zoloft (sertraline).

Patients association head Marios Kouloumas said abuse of the system is rampant. “The medical system is in complete anarchy.”

He said unnecessary medication is prescribed left, right and centre, in a manner akin to candy.

“There are no protocols from the Health Insurance Organisation (HIO). There needs to be far more stringent control and audit over doctors.”

Kouloumas argues in favour of having stringent protocols of how GPs and pathologists prescribe medications and under which conditions should refer patients to specialists. “This does not apply just to mental health medication, it’s a widespread problem.”

He recognises that patients also have a degree of responsibility in the manner they make requests to GPs for medication, rather than leaving it up to the professional discretion of the expert in the situation.

“We don’t have a proper health culture and this needs to change.”

But one pathologist, who spoke to the Sunday Mail on condition of anonymity to avoid conflict with colleagues, said the problem isn’t just that non-psychiatric medical professionals can prescribe medication.

“The problem is that 90 per cent of prescriptions happen over the phone. GPs need to sit and talk to their patients face-to-face”.

He said that the mental health medication GPs and pathologists can prescribe are mild and generally given in small doses, making the risk of negative consequences very slim. But he did warn that “every doctor should know where their limit is. If a patient comes to me and they’ve suffered a loss in their life and need something to calm them down, it shouldn’t be an issue if I prescribe some anxiety medication.”

It becomes a problem if a doctor starts observing something over time but does not refer the patient to a specialist, he added, bringing him back to his original point: “it comes down to paying attention to our patients.”

Kouloumas said the fault for the current problem is threefold: it’s the responsibility of professionals, patients and the state.

“Professionals should see patients as people and not money sources. Patients keep making requests and demands and the state just observes and does nothing.”

Giorgos Nicolaou said he visited his pathologist complaining of chest pains. The doctor did not find anything physically wrong with him and put them down to stress, prescribed him Cipralex and sent him on his way.

“I had no idea what this was for, he didn’t explain anything to me. He just told me that if I don’t stop stressing I’ll feel worse.”

Four years later, Nicolaou decided to turn to a mental health professional. “Back then I didn’t think I had anxiety, I thought my symptoms were pathological. I didn’t really understand why he prescribed Cipralex to me so I stopped taking them eventually.

“I think I would have preferred if he had referred me to a psychologist or psychiatrist. That way I could have understood what was going on and started getting to the root of the problem. Or at least explained things a little”.

Like many others, Nicolaou admits to stress but he didn’t feel there was any discussion of this from the doctor, or suggestion to turn to a mental health professional if the symptoms persisted.

One source close to the medical community said waiting lists are terrible and milder cases may be treated with “simple” prescriptions, meaning not every negative feeling warrants a psychiatrist.

Veresie however maintains that “doctors should just stick to their specialisation.”

“Every doctor goes through medical training but just as a psychiatrist cannot prescribe cardiology medicine, a pathologist also shouldn’t prescribe anti-depressants.”

HIO senior official Monica Kyriacou said the organisation is always open to discuss such matters with the respective professional associations but they have yet to receive any information or been alerted to any problems that would prompt the need to re-evaluate.

The Cyprus Medical Association was not immediately available for comment.