[The dilemma of court expertise--commentary on the SSRI-tapering verdict by the Saxonian social court].
We comment on a Social Court verdict that sentenced a German health insurance carrier to pay for the tapering of fluoxetine in a case of adolescent depression but not to payment for ongoing SSRI treatment in view of their off-label status. Evidence presented to the competent court, including a statement by the German Association for Child and Adolescent Psychiatry (DGKJP), was inadequately interpreted or else misunderstood. The court abstained from substantiating its own competence, e.g. by means of an external expertise. Even though an earlier verdict by the Federal Social Court was taken into account, there were shortcomings with regard to its realisation. The physician in charge of such a case is confronted with therapeutical and ethical dilemmata, as well as with problems of liability, as the court-ordered discontinuation of pharmacological treatment could conceivably compromise the well-being of the patient. Due to the recent marketing authorisation by the EMEA for the use of fluoxetine in the treatment of depressed children above the age of eight years in Europe, the case may be settled. Yet the implications of juridical intrusions into medical practice and therapy regimes must still be addressed.
Schepker
Renate
R
Zentrum für Psychiatrie Die Weissenau (ZfP), Ravensburg, Abteilung für Kinder- und Jugendpsychiatrie und Psychotherapie, Ravensburg. renate.schepker@zfp-weissenau.de
Lippert
Hans-Dieter
HD
Kölch
Michael
M
Fegert
Jörg M
JM
D000293:Adolescent; D003866:Depressive Disorder / Q000188:drug therapy* / Q000191:economics; D017277:Drug Approval / Q000331:legislation & jurisprudence; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D005260:Female; D005473:Fluoxetine / Q000191:economics / Q000627:therapeutic use*; D005858:Germany; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence*; D007356:Insurance, Pharmaceutical Services / Q000331:legislation & jurisprudence*; D009313:National Health Programs / Q000331:legislation & jurisprudence*; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage* / Q000191:economics
D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors