If ongoing antidepressant treatment is required and your patient is unable to obtain supplies of their fluoxetine or sertraline, I would recommend changing to another SSRI (citalopram, escitalopram, paroxetine), or a different class of antidepressant such as venlafaxine or mirtazapine especially if they did not adequately respond to an adequate trial of fluoxetine or sertraline.
When switching medications (especially from fluoxetine), please be aware of the impact on Cytochrome P450 metabolism of other medications (e.g. warfarin) that in turn may require further monitoring and dose adjustments.
Please also closely monitor for any variations in mood, anxiety, agitation and suicidal ideation during the change over period.
I would recommend switching according to the NZF Antidepressant Switching Table: https://nzf.org.nz/nzf/resource/Antidepressant_Switching_Table.pdf.

When switching from one serotonergic agent to another, there is a very low risk of inducing serotonergic syndrome. This link provides a good summation of clinical signs and symptoms: https://www.medsafe.govt.nz/profs/PUArticles/SerotoninSyndromeToxicityReminder.htm
This patient brochure is available at: https://www.medsafe.govt.nz/consumers/educational-material/Serotonin%20Syndrome%20December%202015.pdf
Please do not hesitate to contact me should you have any questions.
Click here for printable document
Dr Andrew Darby
Primary Care Consultant Psychiatrist

Our response to date has been to identify how we can support your people in alignment with our Government’s health advice, containment advice, and its guidelines for us all to follow and intended to reduce the chance of widespread community outbreak.  This has included planning and preparation to support the wellbeing of our own people, so they are in the best possible position to cope with the unfolding situation and can continue to care for your people.

As at today, all ongoing appts (ie for those who have already commenced an EAP programme with us for attendance “in-person”) will remain to be attended “in-person”.  However, and as a precursor to if and when we may all be required to self-isolate, any first appts in relation to a ‘new’ EAP programme will be scheduled to commence via Telephone and all ongoing sessions in relation to those ‘new’ programmes will continue to be scheduled for attendance via Telephone.


If and when containment advice requires, we will contact all those with existing “in-person” appointments to transition their EAP to continue as intended but via Telephone sessions.


Physical distancing does not mean social isolation.  As we are coming into the weekend it’s important to remind your staff and colleagues to stay connected to others, e.g. via phone, social media, etc.  Talking to people and checking in on others keeps us all connected and that is more important than ever.


Our Business Continuity Plan under these circumstances includes provisions for appropriately managing the expected increase in phone calls and requests for appointments during times of crisis.  We are constantly monitoring these to ensure we have the right number of people in place to support your people.  In addition to our e-flyers, our Clinical and Marketing personnel continue to produce a growing bank of supporting documentation with tips and information sheets for you and to share with your people.  Please see attached, which are also accessible via our EAPNOW mobile App.

As always, we are here to help support you and your people.


Tips for Parents and Caregivers on media coverage of major events
Coping with stress during infectious disease outbreaks

We appreciate that because of work commitments and restrictions due to coronavirus many people have been unable to participate in the process to date.
The workshops involve developing recommended actions for government, and ranking these actions for importance and achievability.
After the workshops, we will conduct an additional brief survey for those who can’t attend a workshop to rank the actions agreed at the workshop.  Participants can rank their top 10 actions for importance and achievability. This ranking will be considerably shorter than the online rating of implementation. We will send the survey link on Friday 27th March and the survey will close on Tuesday April 7th at 5pm.


Regards
Dr Sally Mackay, Registered Nutritionist