UK Sources on Antidepressant Prescription Durations?

[_Alex_]

Does anyone know any UK sources for guidelines on the prescription duration of antidepressants?

I'm interested in the issue of where prescription durations are deliberately limited because of the risk of people taking an overdose.

Of course if people are actually misusing medications it's kind of understandable that doctors act to limit the risk.

But I'm interested in the more general level, of where perhaps doctors are routinely providing a worse service to patients with mental health problems "just in case" they are inclined to mess about with pills.

I have been refused a particular SSRI before, on the (nonsense) grounds that it was "too dangerous in overdose" for me, and this kind of thing just massively offends me. Firstly, it's not even a dangerous one that I was asking for, but secondly, even if it was, it's kind of my own risk anyway...

Doctor to patient: "Sorry, I can't give you that antidepressant-- you're depressed".

Doctors suck.

[Missy_D]

Try nice.org.uk/guidance

[_Alex_ in reply to Missy_D]

Thank you. I have already read some stuff from NICE, but that search page may turn up something relevant for me.

[chbale]

This is a really tricky issue. I think it's a little unfair for you to say Doctors suck - they are in a very difficult position with things like this.

I'm no expert and have no medical training so please don't take my words as proper advice.

A lot of people with mental health conditions have suicidal tendencies. Medication is needed to control that but these powerful drugs can help them achieve to do so if misused.

From a personal point of view I am on prescription medication. I am given 28 days/4 weeks of pills at a time. I don't misuse (if anything I forget to take them and it's only one pill a day).

My ex is on a mind blowing cocktail of medication, he has misused many times in the past, now his doctor/pharmacy only let him have 7 days of pills and he has been told if he takes them all in one day it won't finish him off. That doesn't prevent stock piling but it could help him in a moment of madness. He has tried to kill himself several times trying to overdose with paracetamol which is probably the most horrendous death anybody could go through.

As I said, I'm no expert and can only talk about my personal experience. But your doctor is an expert and will do what is the best for you. If they don't trust you with medication they are only trying to help.

Sorry for the long winded reply, I really do wish you all the best but please have faith in the medical people - they don't always get it right but they do what they do with the best intentions.

[_Alex_ in reply to chbale]

As I just mentioned, my doctor openly told me she had a selfish reason for refusing the medication.

As for trust... well am I supposed to trust my doctor, when my doctor doesn't even trust me?

In the situation I was in, refusing the particular antidepressant probably made zero difference to my treatment. But in a different situation, if doctors, or some doctors, aren't giving proper access to let patients try different antidepressants for this sort of reason, then they could be doing serious harm to some of them.

I don't see that you can harm patient A, just to try to stop patient B from harming themselves. And a doctor's "good intentions" don't automatically make their behaviour to be moral.

[chbale in reply to _Alex_]

I can't really comment on your personal dealings with your doctor but it seems you've not been given what you want based on the doctor's knowledge. In the same way you feel that they don't trust you maybe you don't trust them.

The medical profession isn't perfect but they're much better at seeing issues than either you or I are. If you are so concerned get a second opinion.

If a second opinion is the same then just think about who is actually right.

I'm struggling a little to understand what the issue is here. Are you demanding medication that your doctor won't give you for very good reasons? Self diagnosing?

[_Alex_ in reply to chbale]

I did get a second opinion on the medication in question. It's not a "dangerous in overdose" one, so my doctor was giving me factually incorrect information. Of course that's really a small point anyway.

The issue that really concerns me:

Should doctors be able to give a worse service to patients over this issue, without having *any real* evidence that a patient is likely to misuse medications?

[chbale in reply to _Alex_]

Doctors quite rightly use caution. It's not a personal attack on you but if they feel the condition/medication could be problematic they will use caution and quite rightly in my opinion

[_Alex_ in reply to chbale]

Ok, but my view on this, is that their "precaution" has real negative consequences for patients. It makes things more inconvenient for patients. It makes medication more expensive for patients. If certain antidepressants are being underused, then very serious harm may be being done to some patients.

[hypercat54 in reply to _Alex_]

Every doctor has a legal duty of care towards their patients. I came across this when I was trying to get more help for a sister with very severe osteoarthritis who suffered her back muscle separating. A doctor had visited but wouldn't prescribe anything stronger like oramorph.

I told her she had better get her in hospital then as she couldn't even sit up and hadn't been to the toilet in 16 hours. She got the oramorph. The doctor explained the duty of care as it is a very addictive drug x

[_Alex_ in reply to hypercat54]

I'm aware that doctors are responsible for what they prescribe.

However, in normal cases, they don't need to be responsible for patients deliberately misusing medications. It would actually often be very unfair to hold them responsible for patients misusing things.

I also doubt that it's fair that e.g. patient A doesn't get a painkiller that they genuinely need, because patient B may misuse it.

[hypercat54 in reply to _Alex_]

There are lots ssri's that are much less likely to cause problems if you overdose so unless you have tried with all these first I doubt any doctor would prescribe ones that can be abused. They have guidelines to follow too x

[_Alex_ in reply to hypercat54]

Yes, but they wouldn't typically make you try them all before switching you out of the class.

And I believe the local policy in my area, was that you could switch class after failure with just *one* SSRI. But that wouldn't be to the most dangerous types.

[MAS_Nurse]

Hi _Alex_ and thank you for your post. As Missy_D has suggested, please have a look on the following website--

nice.org.uk/guidance

You can also discuss any concerns about medication with your pharmacist. Please be reassured that your doctor has your best interests at heart.

Thank you and best wishes.

[_Alex_ in reply to MAS_Nurse]

My doctor *openly* told me that she was acting to protect her own backside in case "anything happened".

Also, she didn't originally tell me she was refusing the medication on the grounds of it being dangerous in overdose. She switched from one justification to another after her first reason was pointed out to be false. So I suspect deception / lack of openness from her.

And while my doctor may still have been trying to act for my best interests (as well as worrying about her own backside in case I killed myself on her prescription), I personally don't think that makes her behaviour acceptable. Many things may be done with "good intentions" but may still be acting on bad principles.

[Daen]

NICE also has the BNF Online as a free resource - bnf.nice.org.uk/ . The BNF is the pharmacists' 'bible'.

In respect of your doctor personally I'd change doctor and quite likely also refer any doctor who said that to me to the General Medical Council. This is the link to their guidance on prescribing responsibilities, but it may be worth also looking at other guidance on the site such as Good Medical Practice - gmc-uk.org/ethical-guidance... .

You could always ask the Mind legal advice line or any of the major mental health charities advisory services for their suggestions on how to handle this situation, or involve an advocate. If this happened to me I'd be very interested in hearing the clinical grounds on which both the statement made and the refusal to prescribe were based, but then that's just me. Mind you I do have a certain reputation with my local services!

In fairness it does depend upon the level and type of depression; the evidence used for NICE guidance does say that for mild to moderate depression medication is not generally the most effective treatment option. Again, from a personal point of view I'd be reluctant to take medication for something situational (reactive depression) as by the time antidepressants begin to have a therapeutic effect the worst of the cause is usually over.

[_Alex_ in reply to Daen]

Firstly, thanks for the links. I will check them out.

To be fair, my doctor did use a different form of words. She didn't put it as crudely as I did.

And I did try to get her to source the claim at a later time. She wasn't pleased...

[Daen in reply to _Alex_]

My heart (if I had one) would be bleeding in misplaced sympathy for her - NOT. I'd still change doctors or get a second opinion. If you really want to rub it in there's always the British Association of Psychopharmacology to signpost her towards - if she's unsure what the BNF and NICE guidance says is accurate enough for her to prescribe a particular SSRI to a specific patient safely.... (devil)

[Hidden]

Welcome

Yes it is a problem, I have been on the same medication now for over ten years and it is only now I am going through a review of all my medications to such an extent, I was withdrawn of one drug by a series of telephone calls when I was away on holiday.

Generally You can follow NICE as explained, also you can check on NHS Information on the Internet. There are also various sites regarding medications by manufacturers in your own country or UK.

Generally I understand AD are prescribed and recommended over varying periods of time. Your GP will know what and how He wishes to proceed, so trust your GP, He has your interests at heart, and also what He is trying to achieve from any recommendations he has been given.

You could also read the instruction leaflet in the box your medications came in, they will explain and inform you on the drugs positive and negative affects

BOB