• Mylan's Fluox brand is not currently available due to manufacturing issues
• Teva’s Arrow-Fluoxetine brand remains in the market to maintain continuity of supply. The Arrow-Fluoxetine caps have been on monthly dispensing since November 2019 and the tablets since late February 2020.

Sertraline Sertrona brand has no supply issues with both the supplier and ProPharma confirming availability
Antidepressants in Pregnancy - a friendly reminder from Dr Paul Daborn (Maternal Mental Health Psychiatrist)
Some GPs are still favouring fluoxetine, which was at one stage the preferred choice. There are risks associated with fluoxetine including earlier delivery, smaller for dates baby and, due to longer half-life (t1/2), more neonatal adaptation syndrome and problems.
Sertraline is the SSRI antidepressant of choice for pregnant women and may be used pre-conception through to the postnatal period and when breastfeeding.
There’s good evidence showing that discontinuing antidepressant medication during pregnancy risks a relapse of depression in up to 70% of women.
Try to expose the unborn baby to as few agents as possible by using the lowest effective dose. For sertraline this may be 50-150mg (rarely 200mg is required).
Current thinking is that there is:

• no increased risk of congenital abnormalities with first trimester exposure to sertraline.
• a modest increased risk of pre-term birth and low birth weight.
• a risk of neonatal adaptation syndrome, but sertraline is probably least problematical in this regard.

It's a good choice in breast feeding as less than 3% of maternal dose secreted into milk with metabolites often being undetectable in the baby.
In summary:

• Continue sertraline for pregnant women, do not change to another agent.
• Consider starting sertraline for depression in pregnancy or postnatally if breast feeding.

Nardil (Phenelzine tablets)
Phenelzine is one of two non-reversible monoamine oxidase inhibitor (MAOI) indicated for the treatment of depression.
Link Healthcare, the supplier of phenelzine tablets, has notified PHARMAC that they can no longer supply this medication in New Zealand. Nardil is the only Medsafe registered brand of phenelzine tablets in New Zealand. Link Healthcare expect all remaining stock of Nardil, to be depleted by mid-late May 2020
Implications

• People taking phenelzine will need to be changed to another antidepressant.
• Please ensure no new patients are started on phenelzine
• Please transition patients currently on phenelzine on to alternative treatments as soon as possible. Mental Health Subcommittee of the Pharmacology and Therapeutics Advisory Committee advise that tranylcypromine sulphate would be an appropriate alternative MAOI for patients, however:
  • treatment changes need to be individualised for each patient.
  • general practitioners should consult with a psychiatrist (e.g. Primary Care Psychiatrist) regarding treatment options and transition.
  • Tranylcypromine has a psychostimulant activity that phenelzine lacks - careful cross-titration is required
  • Approximate dose equivalence: phenelzine 15 mg ~ tranylcypromine 10 mg.​

​Dr Andrew Darby
Primary Care Psychiatrist

We are clearing all assessments in the next couple of weeks plus starting to schedule and rebook appointments. We will be extending appointment times out to reduce any potential public contact and will adhere to social distancing rules. We will continue to ask relevant COVID-19 screening questions as we did pre-lockdown and front line staff will be using ‘light’ level PPE in line with infection control advice. We plan to start mobile unit revisits on 11 May and will gauge their usage which will allow us to decide if they are efficient to be operational during level 3. The sites we will visit will be Thames and Coromandel. We envisage returning to Kawerau after those sites should they be attended to a level that’s practical.
As part of the plan, we are keen to hear from you what you are looking to do/ provide by way of Support to Screening Services and what capacity do you have to provide this? This will help us to determine what work we need to keep ‘in-house’ and what level of activity we can send your way.
If you could let Angela Wheadon know, so we can factor in your planned activity with ours, that would be great.
Ngaa mihi
Shona Duxfield

Can you please let me know if you are interested in recruiting a new graduate (or more than one) in the upcoming intake, which opens tomorrow, and is for graduates starting 31st August 2020 by completing the table below, and emailing to  lisette.ingram@waikatodhb.health.nz
Organisation name
Hospital/centre/placement where grad will be based
Confirmed with area and they are cc’d in your response? y/n
Key contact for planning: name and Email.
Direct line manager (if different) name and Email
All those involved are aware of the recruitment dates below*.

*Please be aware that the candidate details will be sent out to you on Tuesday 9th June by close of business.
You must have interviewed candidates of interest to you and fed back your preferences to us for submitting to ACE by Wednesday 24th June Close of business. – please be aware that this is a tighter timeline than usual due to Covid restrictions pushing out the ACE timeline.
Please be aware that due to Covid-19 restrictions the following changes are in place:
It is reccomended that interviews are by phone or video conference to avoid unnecessary travel and spread of candidates moving through organisations.
ACE will accept uncertified copies of applicant documents at the application stage. ACE are implementing this temporary change to enable as many eligible applicants as possible to participate in the application process” .
Please note: Employers will need to obtain certified copies of documents before an offer of employment is made.
ACE is giving candidates a longer time to submit to help manage extensions of placement due to student placement challenges under covid. We have a far tighter interview time than previously now.
Noho ora mai rā, nā
Lisette Ingram
Nurse Educator, Graduate Programmes | Professional Development Unit | 17 Ohaupo Road |
e: lisette.ingram@waikatodhb.health.nz | m: 021 285 1906 |

• We are open for business and are here to support the GPs after hours
  • Fracture clinics are still operational – despite the low volumes
• We are also supporting CBAC clinics using some of our staff Dr’s
• The business has changed – as you are all aware, moving away from FTF visits. We are adapting to this by providing Covid 19 lab result follow-up (specifically for “no-GP listed” patients in addition to our swabbing/assessments)

Like you all, we are concerned about the community’s health and wellbeing and ensuring access to services. When patients do finally come in, they seem to have left it to the “last minute” with their health deteriorating.
Hopefully the situation improves for everyone.
If there is any assistance we can provide you, please let me know.
Kia kaha