Is my doctor treating me fairly?

[Shredder]

I first visited my doctor (doctor A) back in December as I was having trouble sleeping and infrequent bouts of anxiety. He sent me for blood tests and gave me seven 3.5mg zopiclone pills for sleep. He asked me to come back in a week and let him know how i'd got on.

I went back to see him again the next week and found that my blood tests indicated type 2 diabetes. As my blood sugars were only slightly raised (7.9 and 8.1) I was told to lose some weight and avoid sugary foods. I've been doing well and have so far lost 2 stones (still got a few more to go but it's going in the right direction). I told him that the zopiclone were helping me sleep somewhat and he then prescribed me a further 28 pills to take as and when needed. Doctor A asked how the anxiety was and whether I needed anything for it. I declined as I felt it was manageable at that time. He told me to come back in a month for a third check up.

Fast forward to February when I made my follow up appointment. I didn't go back before then as I still had about 7 zopiclones left. This time I was told that Doctor A had gone to work in A&E and was introduced to Doctor B. Over the last few weeks I had noticed that my anxiety attacks were getting more frequent and more unpleasant so I wanted to discuss this with a professional and maybe see whether I could get some medication (as suggested by Dr A back in December). Doctor B immediately told me that I would not be getting any more zopiclone as it is very addictive (despite me only taking 14 tablets in nearly 3 months!) and suggested I take mirtazepine 15mg for both the insomnia and anxiety. I was prescribed 28 tablets.

Having gone home and read about the side effects of Mirtazepine, I decided against it. I am already overweight and weight gain seems very common. I also suffer from RLS and have found that over-the-counter sedating anti-histamines make the symptoms almost unbearable. As Mirtazepine belongs to the same class of drugs, I felt it was probably the wrong drug for me. I also objected to having to take a strong pill every single day to treat something that may only bother me once a fortnight.

I went back to the surgery last week and saw Doctor C (as I didn't feel Doctor B was taking me seriously). I explained my concerns and asked if I could have something to use as and when needed. Doctor C said this was not an option as these drugs are all very addictive. He dismissed my fears about weight gain and RLS and said that Mirtazepine is generally well tolerated. The end result was that I should take the Mirtazepine and see how things go.

Fast forward to today. I've taken the Mirtazepine for seven days and sure enough, I nearly always wake in the night with severe RLS that keeps me awake most of the remainder of the night. I also feel like a zombie and am always craving food. I went back to Doctor C and told him this. Doctor C told me that the symptoms should ease off in a few weeks and to persevere. He said that the only potential alternative was to consider prescribing a Parkinsons drug to combat the RLS. He warned that this has many side effects so was only given to patients who were suffering severely from lack of sleep. His advice was to get out of bed, walk around and take some paracetamol! I said I would have to manage and left with a repeat prescription for a second box of Mirtazepine.

All in all, I feel like I'm banging my head against a brick wall here. My doctor refuses to listen to me and will not take my concerns onboard. I only want something to take when I have an attack and i'm pretty sure that the placebo effect from knowing that I have a "safety net" will help in itself. I have also had a quick look online and have found there are many possible short term treatments for both anxiety and RLS (not just Parkinsons medication!).

Is it worth me changing surgeries or is this advice normal? Help!!

(sorry for the long first post by the way!)

[Serenitie]

Mirtazapine has a proven history of causing food cravings and significant weight gain as side effects, which can last for the duration this medication is taken. I would definitely switch medications given your history and the hard work you have put into losing 2 stones - congratulations!:yesyes:

I would not advise long term use of tranquillisers but would change your current medication for the reasons I stated.

Ring your local pharmacist for advice on alternatives and make an appointment to discuss your options with your GP. This is what I usually do when I have concerns about medication. Pharmacists are very helpful and much more knowledgeable about medication than GP's. Having information from a pharmacist also adds weight to your argument.

Wishing you the very best :)

[kchan]

Personally I haven't had the medication you have but I do know side effects are common with any medication dealing with anxiety or depression but they do pass in time. They are only initial side effects as they alter levels of certain things in your system, it takes a few weeks for your system to get used to this so I would say the advice given is pretty standard. However that isn't the only point here. If you dont feel comfortable with the doctors at your practice switching is an option. After all making you feel at ease and that all your concerns have been addressed is their job. Like I said the advice to stick it out is standard but they could have explained the why of this to put you at ease.

[Tessar]

Hi Shredder, you have made brilliant inroads towards recovery, not least losing all that weight. It demonstrates you have strength of will which is really good.
Also I feel you are right to stick to your guns about the medication, you know yourself and your body best.I feel that Serenitie is right about what to do, it is very sound advice.

[Shredder]

Thanks for the replies. My local Lloyds pharmacy has a consultancy service so I will pop in and have a chat with the pharmacist. What treatment options are others given for insomnia and anxiety? Most of the information online is aimed at US citizens (oxycodone and methadone for RLS in the UK? Not likely!) so it's difficult to know what options are available in the UK.

[Edie]

I think there's been some kind of crackdown on zoplicone recently, but doctors seem to be going really over the top. I've been taking 3.75mg (very low dose) for 4 years, once a week, and a couple of months ago my GP told me I was craving it and wanted to take higher doses more and more often. I am not having those thoughts at all, but my GP was adamant I was.

I tried amytriptiline and mirtazipine and didn't get on with them at all. Amytriptiline may be worth asking about though, it's quite widely used and you might get on with it better. Mirtazapine really doesn't seem a sensible choice for someone who already has a weight problem.

There are also some over-the-counter meds you can buy. I find Sominex and Nytol-One-A-Night (not ordinary Nytol) helpful. So may also be worth asking your pharmacist what they have.

[Shredder]

Thanks. The over the counter sedating antihistamines are what set off my RLS so I can't take them. I've tried the herbal ones too but these give me a nasty pressure in my chest and make it hard to breathe (I'm asthmatic btw).

[JaneC]

I agree with Edie, Shredder, it seems to put you on mirtazapine when you have done so well in losing weight, and it is so important that you have done so. I had to have a fasting glucose test a couple of weeks ago and was dreading a Type 2 diagnosis because I knew I'd have to make major lifestyle changes. I dodged a bullet this time but really admire what you've done.

I'd be a bit careful about amitryptiline as it's a tricyclic AD and they can also cause weight gain. Your zopiclone use sounds perfectly responsible to me - it's a shame when doctors go over the top as Edie says.

Once a week on a low dose Edie - that's so ridiculous. Your doctor should know from your records that you aren't increasing your dose or using it excessively.

I use temazepam for insomnia - again not all the time and again I've never had to increase the dose (I've certainly never craved it either) - but I dread the day my doctor retires, as she probably will soon - because I bet some of the others at the practice wouldn't give it to me.

I hope the pharmacist has helpful advice for you Shredder.

[Bosslady]

Zopiclone is for short term use only for insomina. There are other drigs such as lorazepam that is given to patients with anxiety and allowing them to fall into a natural sleep. However evidence suggests that these drugs benzodiazepines can be addictive and with long term use be more detrimental.Doctors are guided by cost, Nice guidlines, evidence, personal opinions. However someting called "person centered care" was intorduced to encourage doctors to communicate with pateints and involve them in their care.

Holistic medications to enable sleep may be a better option but not sure if this is appropriate whist on your an anti depressent. I wonder why your doctor choose this drug and not citalopram considering you have Diabetes?

Yes its true you have to give medications a few weeks to start working but i feel its very important to work on why your unable to sleep and where this intermittent anxiety is stemming from. Perhaps some counselling alongside meditation classes, yoga.

I wish you luck. Oh.... whats RSL?

[Oatcake]

Oh.... whats RSL?

Restless Leg Syndrome, I think?

Shredder, I feel for you. I shall be watching your thread with interest, as I've got a GP practice with a similar mentality. I've seen a different GP every time. Doctor 1 gave me Mirtazapine too, and after I read about the side effect of weight gain, I went straight back, saw Doctor 2 and told them I wasn't taking it. I was desperate to try Buspirone or Pregablin, but they won't even consider it. I have no idea how to change their mind :huh:

Given how I've gone through the usual SSRIs with little effect, they've put me on Amitryptaline instead, but I don't feel any effect from that either. I don't feel any hungrier than usual, but to put it politely, I'm getting through rather a lot of Andrex. I will be asking to change meds at my next appointment.

I saw an Occupational Health doctor yesterday. Unlike my GP, he had time to listen, and said he'd put me on a strong antidepressant and Zopiclone. GPs are so rushed that I'm fairly sure a lot of them make up their mind about how to treat you within ten seconds of your arrival.

Good luck to you - keep us informed please! :hugs: