Will GP prescribe what I ask for?

[Wilburis]

Hi

Im in a really bad place atm, and am waiting to see a psychiatrist.

My ADs are not working despite my GP upping the dose to the max.

Ive got an appointment to see him tomorrow and want to ask for Pregalabin, as Ive seen that lots of people have been helped on it.

Over the years Ive tried many ADs, to no avail.

Im worried my GP will say lets wait to see what the psych says. I could be waiting weeks.

Any ideas?

[.Poppy.]

Has your GP been open to questions/suggestions from you before?

I know that with my GP, whenever we discuss medication it's usually a conversation rather than an out-and-out prescription coming from him. He'll tell me why he thinks X medication would work best, do I remember taking and and what do I think? I know if I had a question about any med he would be very open to discussing pros and cons and deciding the best course of action.

Granted, my GP no longer handles my MH meds, my psych does. But he did before I was able to see a psych, so if you haven't been able to have that appointment yet yourself then I think he definitely should be more open to helping you out until you see a psychiatrist.

I would definitely go in having done some research on it and tell him you are interested in giving Pregabalin a try and ask him what he thinks.

Maybe someone on your side of the pond will have a better answer, too, I never seem to understand exactly how your health care system works. :)

[skymaid]

Seems to vary. Some Gp's don't even seem to think pregablin is used to treat GAD (at my surgery anyway). Some will know about it though and you can always bring a printout of the Nhs Nice guidelines (which lists it).

I had a psychaistric presribe mine along with emergeny diazepam

Im just up to 200mg pregabalin a day from today in fact. I feel like my has improved a fair bit already even though ive only been on a low dose.

Hardly ever need my diazepam now at least.

[Wilburis]

Thanks guys.

I think he feels he's hit a brick wall with me as nothing seems to work.

x

[MyNameIsTerry]

Preg can be tricky. Keep in touch with the guys on the Preg board because they understand this med well and the problems with getting it so they can help you.

NICE do state Preg can be tried in the following condition:

https://www.nice.org.uk/guidance/CG113/chapter/1-Guidance

Drug treatment

1.2.22 If a person with GAD chooses drug treatment, offer a selective serotonin reuptake inhibitor (SSRI). Consider offering sertraline first because it is the most cost-effective drug, but note that at the time of publication (January 2011) sertraline did not have UK marketing authorisation for this indication. Informed consent should be obtained and documented. Monitor the person carefully for adverse reactions. [new 2011]
1.2.23 If sertraline is ineffective, offer an alternative SSRI or a serotonin–noradrenaline reuptake inhibitor (SNRI), taking into account the following factors:
tendency to produce a withdrawal syndrome (especially with paroxetine and venlafaxine)
the side-effect profile and the potential for drug interactions the risk of suicide and likelihood of toxicity in overdose (especially with venlafaxine) the person's prior experience of treatment with individual drugs (particularly adherence, effectiveness, side effects, experience of withdrawal syndrome and the person's preference). [new 2011]

1.2.24 If the person cannot tolerate SSRIs or SNRIs, consider offering pregabalin. [new 2011]

1.2.25 Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises. Follow the advice in the 'British national formulary' on the use of a benzodiazepine in this context. [new 2011]

1.2.26 Do not offer an antipsychotic for the treatment of GAD in primary care. [new 2011]

1.2.27 Before prescribing any medication, discuss the treatment options and any concerns the person with GAD has about taking medication. Explain fully the reasons for prescribing and provide written and verbal information on:
the likely benefits of different treatments the different propensities of each drug for side effects, withdrawal syndromes and drug interactions the risk of activation with SSRIs and SNRIs, with symptoms such as increased anxiety, agitation and problems sleeping the gradual development, over 1 week or more, of the full anxiolytic effect the importance of taking medication as prescribed and the need to continue treatment after remission to avoid relapse. [new 2011]

1.2.28 Take into account the increased risk of bleeding associated with SSRIs, particularly for older people or people taking other drugs that can damage the gastrointestinal mucosa or interfere with clotting (for example, NSAIDS or aspirin). Consider prescribing a gastroprotective drug in these circumstances. [new 2011]

1.2.29 For people aged under 30 who are offered an SSRI or SNRI:
warn them that these drugs are associated with an increased risk of suicidal thinking and self-harm in a minority of people under 30 and see them within 1 week of first prescribing and monitor the risk of suicidal thinking and self-harm weekly for the first month. [new 2011]

1.2.30 For people who develop side effects soon after starting drug treatment, provide information and consider one of the following strategies:
monitoring the person's symptoms closely (if the side effects are mild and acceptable to the person) or reducing the dose of the drug or stopping the drug and, according to the person's preference, offering either an alternative drug (see 1.2.23–1.2.24) or a high-intensity psychological intervention (see 1.2.17–1.2.21). [new 2011]

1.2.31 Review the effectiveness and side effects of the drug every 2–4 weeks during the first 3 months of treatment and every 3 months thereafter. [new 2011]

1.2.32 If the drug is effective, advise the person to continue taking it for at least a year as the likelihood of relapse is high. [new 2011]

Here is the British National Formulary (BNF) showing it's licencing:

https://www.evidence.nhs.uk/formulary/bnf/current/4-central-nervous-system/48-antiepileptic-drugs/481-control-of-the-epilepsies/gabapentin-and-pregabalin/pregabalin

Indications
peripheral and central neuropathic pain (section 4.7.3); adjunctive therapy for focal seizures with or without secondary generalisation; generalised anxiety disorder (section 4.3)

If you are in Buckinghamshire, you've had it - they have blacklisted it for all uses, not just anxiety, just to save money. It's a disgrace, but that's the NHS for you.

If you are in Scotland, it can be tricky and you will need to be pushy to get it.

In terms of prescribing, Preg tends to be "third line". SSRI's are always first line and meds like Mirtazapine & Venlafaxine tend to be second line. That's what I've seen in some local trust's literature.

If you know your local trust, they should have an online prescribing guide for their doctors. I've found many of them very easily via Google.

[Wilburis]

Hi

Thank you for the information.

Im in Kent.

So far Ive tried, Sertraline, Imipramine, Nortriptyline, Prozac, Clomipramine, Mirtazipine, Escitalopram and none of these have worked.

Im going to change my GP surgery.

I took a Phenergan last night before bed. Oh my, I felt so bad, I thought I was going to stop breathing, I felt faint, and couldnt sleep, it felt like I had a constant panic attack and I still dont feel so good this morning.

x