Remember the depressed vegetarian

A recent experience has raised the issue of whether prescribers consider the suitability of medication for their vegetarian patients. A 30-year-old woman was prescribed an antidepressant for a depressive disorder. She later informed us that she could not take them as they contained gelatin, which is not suitable for vegetarians. This experience raises many questions. Which antidepressants contain gelatin, are prescribers aware of this information and do prescribers routinely enquire whether their patients are vegetarians prior to prescribing antidepressant medication?

We researched commonly used antidepressants by contacting the pharmaceutical companies regarding the origin of the excipients in their antidepressants. Those investigated included fluoxetine, citalopram, paroxetine, sertraline, reboxetine, venlafaxine, amitriptyline, dothiepin, imipramine, lofepramine, trazodone and nefazodone. Of these, five antidepressants are definitely suitable for vegetarians. These are sertraline tablets, venlafaxine tablets (but not capsules), fluoxetine liquid (but not capsules or tablets), amitriptyline mixture (but not capsules or tablets) and imipramine mixture (but not tablets).

Assuming the lifetime risk of developing a depressive disorder warranting treatment is 10% and there are about 4 million vegetarians in the UK (The Vegetarian Society, Altrincham, personal communication, 2000), 400 000 vegetarians may need antidepressant medication.

Hence, vegetarians are commonly likely to be prescribed antidepressants by their general practitioners or psychiatrists. It is important that enquiries be made routinely regarding whether an individual is a vegetarian prior to prescribing antidepressants.