A shortage of New Zealand's most common anti-depressant and a switch in the drug's supplier has sparked fears Kiwi lives will be put at risk.
Since Monday, all pharmacists have been told by New Zealand's drug buying agency, Pharmac, to only give patients one month supply of anti-depressant Fluoxetine, instead of the usual three months.
Pharmacists are also being told to add a note to the prescription, which is prescribed to hundreds of thousands of Kiwis, saying it is "out of stock".
• Premium - Pharmac funding: How it works - and the changes its critics want
• Opposition turns its sights on Pharmac funding
• Pharmac changes funding processes for greater transparency
• Patient advocacy group demands doubling of Pharmac budget to fund life-saving treatments
The Herald can reveal the shortage comes as Pharmac is changing its funded brand of fluoxetine from Arrow-Fluoxetine to Fluox, which has now been delayed until later this year due to manufacturing problems.
While Pharmac says more stock of Arrow-Fluoxetine will be available in two weeks, Auckland pharmacist Lyn Goddard said there's no guarantee how much will be available.
She fears some patients battling serious depression could be left without their medication and even if it was just for a week the consequence could be deadly.
Goddard has spoken out in "disgust", saying the shortage of the depression pill was because Pharmac had not managed to get the new variant registered in time.
"They [Pharmac] are playing with people's lives and I'm sick of it," Goddard said.
"It's all about money and they [Pharmac] have no feeling for the patients who are suffering, and we [pharmacists] are the ones who take the brunt of it."
She was also worried about the impact the brand switch could have on patients, given the epilepsy deaths shortly after Pharmac changed its generic brand in October last year.
The deaths were referred to the Coroner and Pharmac backed down on the brand switch.
National Party's health leader Michael Woodhouse has come down hard on Health Minister David Clark, saying he should seek assurance that no one would miss out on their anti-depressants due to this reduction.
"I hope David Clark has learnt from his mistakes with the attempted brand change of Lamotrigine that led to three deaths.
"The minister needs to make sure these changes don't come at the expense of Kiwis' health."
A spokesman for Clark said the minister wasn't available for comment but was aware of the shortage.
"I can confirm he was made aware of the brand change and a stock issue in early January."
Fluoxetine is an anti-depressant used to treat depression, obsessive–compulsive disorder, bulimia nervosa, panic disorder and premenstrual dysphoric disorder.
Figures obtained by the Herald show more than 300,000 Kiwis were prescribed anti-depressants, with at least 95,000 people taking Fluoxetine, last year.
New Zealand Association of Counsellors (NZAC) president Christine Macfarlane said it was the first medication given to adults who suffer depression.
"Though Pharmac will say the brand change won't have any effect on patients, we know that it does, especially when patients aren't made aware of the switch, which has happened in the past."
She said this issue will put a lot of pressure on the people who are prescribing the drugs, which are the GPs, psychologists and pharmacists.
"Public insecurity will also grow, which is a major concern for people who are already battling anxiety."
Pharmac's director of operations Lisa Williams said cost was behind the brand change.
"Pharmac has a fixed budget, which means we need to make careful and considered funding choices. Every dollar in the budget is used to fund pharmaceuticals – any savings we make are used to fund more medicines for more New Zealanders."
• Just Listen podcast: Mental health - Let's get comfortable with uncomfortable conversations
• Surprise findings: Is social media really hurting your mental health?
• New mental health service
• Thousands more people to get mental health training, Government announces
Goddard said Pharmac had been far from transparent when it came to telling patients about the brand change, not to mention the potential risks involved in switching brands.
"Of course there will be a variance in the different brand. Everyone responds differently to medication and can get different side effects," Goddard said.
She said drug shortages, which often lead to patients being without their medication for up to three months, were happening every month. Other recent cases, along with Lamotrigine, included changes for people with cancer and Parkinson's disease.
Williams said Fluox had the same active ingredient (fluoxetine) as Arrow-Fluoxetine and it had been assessed and approved by Medsafe.
"This means it is just as safe and works the same as the currently funded brand. Patients shouldn't notice any difference in how it affects them.
Auckland father D'Arcy Waldegrave says his daily dose of fluoxetine anti-depressants has been "life-changing".
"I'd tried a number of different drugs and then fluoxetine came up and it didn't give me any of the nasty side effects I had experienced with other drugs.
"It didn't make me dull, a lot of the other medication I've tried takes the top off so I don't experience those highs and I just can't live like that," the 50-year-old radio broadcaster told the Herald.
Before speaking to the Herald, Waldegrave had heard nothing about the shortage of his medication or that there would be a brand switch, neither had his psychologist.
"It's pretty alarming, especially because I know I haven't responded well to other drugs."
The Newstalk ZB and Radio Sport broadcaster has battled depression his whole life but it wasn't until he turned 32 that he was officially diagnosed. Years later he was also diagnosed with ADHD.
"I just thought it was just standard, that this was how people lived. I didn't have any idea that this wasn't right. My brother finally dragged me to a doctor after I wouldn't get out of bed for two days.
"I talked to my doctor and he said wow, and asked me about the ups and downs.
"I was working a great job in radio, I was young and healthy, smart and not ugly, I had good friends but I still just couldn't get out of bed, I'd stand in the shower and cry all day thinking this is f**ked."
Waldegrave said knowing that everything was right but he felt was wrong, was really hard to come to terms with.
The message Waldegrave wanted to share with people who were battling depression was to talk, "It's the simplest thing in the world."
"A lot of people have depression but they are too proud to say anything. If you get a room full of people and ask 'who's depressed?' not many people would say anything, but if you have a room full of people and you say 'if you had a friend who was depressed, would you help them?' they would all put their hands up because that's human nature.
"We are no longer ashamed to speak out and the more people we can help, the better."
WHERE TO GET HELP:
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
OR IF YOU NEED TO TALK TO SOMEONE ELSE:
• LIFELINE: 0800 543 354 or 09 5222 999 within Auckland (available 24/7)
• SUICIDE CRISIS HELPLINE: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• YOUTHLINE: 0800 376 633 ,free text 234 or email email@example.com or online chat.
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757
• SAMARITANS – 0800 726 666.