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Thread: GP won't prescribe me pregabalin.

  1. #81
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    Re: GP won't prescribe me pregabalin.

    Quote Originally Posted by nickw View Post
    It's one of those ones that will vary from Doctor to Doctor.

    Chiefly because it has some relaxing therapeutic effects that can make it desirable recreationally and groups such as heroin addicts will seek it out so there is potential for black market resale.

    Despite the fact that these therapeutic effects are part of what makes it an effective treatment, some Drs simply do not feel comfortable with using anything that has a cold purely medical purpose. Some however are more laid back - my ex for example mentioned anxiety and got Diazepam straight away - something even I thought was a bit irresponsible.

    It's not know exactly how Pregablin works and there are more common alternatives.

    So they will be looking to see if you've asked for it as you think you may enjoy it. They will also be looking at your personality - someone who is a little unstable, prone to mood swings and depression also runs a higher risk of abuse and addiction.

    It is frustrating that there are so many barriers to potentially effective legitimate medicine, when hard rugs are easy enough to get on the black market if you were not going by the book. If something makes you feel good on top of treatment then bonus!
    That would mean no one with mental health problems would get it!

    The actual advice to doctors is not to issue it to patients with a history of substance abuse.

    I have no idea what you mean by doctors be unwilling to issue a med because it has a purely medical purpose - that's the point of all meds!
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    For free Mindfulness resources, please see this thread I have created to compile many sources together http://www.nomorepanic.co.uk/showthread.php?t=168689

  2. #82

    Re: GP won't prescribe me pregabalin.

    Frustrating to read here about others having difficulties in getting this medication through GP's - for me it has been the first thing that has helped my GAD after so many years of struggling to cope. Recently had it prescribed by a psychiatrist, and so far it has helped a significant amount.

    But I have also experienced a problem in getting a repeat prescription from my GP, despite having with me a letter from my psychiatrist, and my medical records clearly showing that I'd been on all the usual SSRI/SNRI and tricyclic options, with zero effect (other than many difficult side effects!) over recent years.

    The GP was extremely antagonistic and misinformed about the medication generally, and tried to tell me things which seemed to be her misinterpretations of some of the recent studies relating to its potential for misuse/dependence in forensic populations and in those who have previously had substance misuse issues. I don't think she was expecting a patient to have read all of the systematic reviews! - and in the end she resorted to some rather unprofessional statements such as 'well, I wouldn't want my son or daughter to take it' - which is not the point.

    The current NHS England guidance for prescribers is that patients should not be refused access to a potentially helpful medication on the grounds of potential for dependence - unless there are particular circumstances suggesting otherwise - and that the patient should be allowed to make an 'informed choice' about it - which I felt she was taking away from me.

    To cut a long story short, I decided to switch GP practice, since I hadn't been particularly impressed with any of the doctors I'd seen from a MH point of view - in the same catchment area - and had no trouble at all. The only question that was asked was 'is it helping?' (yes) - and he said he would just liase with my consultant if needed.

    The first GP, interestingly, said it wasn't a question of cost - which was what I'd been afraid of being told! - but that she just thought it was too 'dangerous' a drug to prescribe..though how she would know, as she said proudly she had never prescribed it for a patient in all her time in practice...I am not sure.

    I am trusting my consultant on this one (and the evidence I've read) - that there is, like with most medications, the possibility for tolerance forming as your body gets used to it - but it's a risk I'm willing to take at this point, and I'm very careful about minimising the dosage of any medication I'm on. Consultant says she has been using it in practice for 10 years now, with generally good effect, and no problems with dependence etc.
    Last edited by Nella131; 02-08-16 at 19:08.

  3. #83
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    Re: GP won't prescribe me pregabalin.

    There is a world of difference between dependence and tolerance and we should be careful not to regard the two as interchangeable - they are not.

    Sadly, a whole lot of people are most certainly 'dependent' on medications - but why we would decry this in MH patients but not, say, diabetics (insulin), high-cholesterolers (statins), or lord knows how many other things I do not know.

    Tolerance is clearly a different animal; it suggests that the drug will require ever larger doses to have an impact and indeed give up being useful entirely over time. Thus it clearly is not a long-term solution, and obviously is problematic from that point of view. There is anecdotal evidence of 'tolerance' about virtually all drugs, including MH ones, but the actual hard evidence is much thinner, including on Pregabalin.

    My personal suspicion is that the anecdotes derive from the abusive takers, who whine that the euphoria they first gleaned from taking (often foolishly large) doses is hard to replicate. But euphoria is not what proper MH takers of Preg are after - they just want some relief from crippling anxiety. And the evidence that it helps many, perhaps, most, takers is very significant.

    Albert

  4. #84

    Re: GP won't prescribe me pregabalin.

    I totally agree, SmilingAlbert - and it seemed to me that the GP was very muddled in her understanding of the difference.

    And re 'euphoria' - I wonder if the recent reports about the medication being abused within certain settings (prisons, mainly, I understand) have been distorted within certain members of the medical profession - as the GP also said that the reason I felt better on the 100mg a day was because of 'euphoria'...

    I told her that at this dosage experiencing euphoria was not a usual experience (and nor was I feeling such) - but sadly she seemed triumphant in her conclusion that it is not a drug that people should be 'allowed'.

    Even if I had been crippled by anxiety for the last few years and was now feeling able to resume studies and work - in her opinion it was better that I come right off it.

    Unfortunately, even though I'm well informed as a patient (and soon to re-start my training as a MH nurse) I felt I had little chance of being heard, in a situation where everything I said was used as evidence of my 'addiction'.

    As you say, SmilingAlbert - dependence on medications for physical health conditions wouldn't be challenged in this way, and I have never encountered a GP who has been unhappy to keep prescribing SSRI's in ever increasing amounts despite their blatant lack of efficacy for me.

    It seems as if, as with benzodiazepines and opioids, there is a risk that the messages about the potential for 'misuse' and dependence are preventing some doctors from prescribing pregabalin even when clinically indicated - which would be a great shame in my opinion.

  5. #85
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    Re: GP won't prescribe me pregabalin.

    The misuse argument is rubbish anyway. Studies in prisons...those places full of naughty boys & girls () aren't relevant to those without a substance misuse problem.

    And some of the studies out are written with a clear intention because they talk generally about Preg and yet when you delve into the study the patients were all mixing them with other illegal substances.

    And I find it a farce they complain about misuse potential and yet there are still GP's happily hooking their patients on Benzo's and the NHS doesn't seem to have any interest. It's quite simple to tell a computer to run a report of all Benzo takers >X months and then the trusts ask for justification but I bet you no one is doing this. That's the NHS dinosaur for you.

    I find it simply laughable that your GP said it should be prescribed to no one when NICE have included into their guidance and lets not forget the drug is not only licenced for GAD but other conditions such as Epilepsy.

    And if they want to talk about damage, how about all those people out there on long term anti psychotics, drugs known to cause Diabetes and change metabolism?

    It's crazy and just smacks of ignorance. Well done for getting informed and challenging this ignorance to get a better treatment for yourself. And good luck in your training, we need more people like you!
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    For free Mindfulness resources, please see this thread I have created to compile many sources together http://www.nomorepanic.co.uk/showthread.php?t=168689

  6. #86

    Re: GP won't prescribe me pregabalin.

    Thank you MyNameIsTerry

    Very much agree with the points you make; I only wish I had known in advance that the doc had been going to come out with all that rubbish so that I'd gone in armed with printed copies of the latest NHS England and NICE guidance to show her that Pregab is very much a licensed 2nd line treatment for GAD...but alas I went in naively expecting her to know that...

    Anyway, all's well that ends well for now - and I just feel lucky that I've had a supportive consultant throughout this who was prepared to get involved if need be. Not always the case for people who only have recourse to treatment through their GP...which can be patchy.

  7. #87
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    Re: GP won't prescribe me pregabalin.

    +1 to all that.

    NHS is indeed a dinosaur, and sadly many people who work in it are also. They just don't bother reading up new drugs etc. as they come up, and get set in their ways. I'm sure many perhaps most GPs are great, and in often trying circumstances, but as with any job, there are lousy ones who don't realise that the days of 'doctor knows best' was killed by Dr Google a long time ago.

    Now as we know Dr Google is often very wrong, but the fact is people can and do know a lot more than before, and the old days are never coming back. Dismissing the thoughts and concerns of patients is just not good enough: they are providers of a service that users have paid for.

    I have said it before and I'll say it again: a GP friend says that a full 50% of her appointments are directly or indirectly (e.g. psychosomatic physical problems) MH related - which suggests that 50% of all GPs should be MH experts. But the figure is much lower. This needs to change. I respect the NHS and think it does enormous good, but it needs to change.

    Far too many people are left withering on the vine, given pills with little warning about often drastic side effects (yes I'm looking at you Mr SSRI 'first line'), or told to get in a very long line for CBT or psych appointments. In the meantime, erm, just manage yourself please, and if you can't, clog up A&E where treating you is vastly more expensive.

    In a world that sees to create ever more MH disorders, for whatever reason, it's just not good enough.

    Albert

  8. #88

    Re: GP won't prescribe me pregabalin.

    Quote Originally Posted by hanshan View Post
    An interesting article on the cost of pregabalin and effect on prescribing -

    http://www.pulsetoday.co.uk/nice-ret...e#.VLMK2yuUeSo

    Any doctor can write a private prescription. They just don't use their NHS prescription forms, or cross out the NHS bit.

    I found a price of around 80 GBP for 56 x 300 mg Lyrica, If you took one per day (single dose per day not recommended, but would save money), it would cost about 1.43 GBP per day. (The following is for information purposes only - not to be taken as a recommendation or endorsement).

    http://www.assetchemist.co.uk/search..._300MG_56_Caps

    Nevertheless, since pregabalin is NHS licensed for anxiety, your doctor would almost certainly be duty-bound to write out an NHS prescription.
    So I had an appointment with a psychiatrist who agreed with me that pregabalin would be a good medication to try so he wrote a recommendation to my gp to prescribe it. I speak to my gp and he tells me he has to get approval to prescibe it because pregabalin is not licensed for anxiety in scotland. I say ok and he tells me he will get back to me. Three weeks later after calling every week he finally speaks to me and falt out refuses to prescribe it being very rude in the process he told me it has a high street value as a reason not to prescribe it, I was shocked he didnt let me say anything then said i will increase your mirtazapine dose (i have been on 3 different anti depressants with no positive effect).

    Basically I dont know what to do I feel this medication could really change my life. I just dont know what to do has anyone been through a similar situation?

    Ps. My psychologist who I do CBT with doesnt know what to do either, I've hit a brick wall and need to be medicated properly before I can start improving in any way.

  9. #89
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    Re: GP won't prescribe me pregabalin.

    Sorry to hear this Scorm. Suggest you read this thread from the start in detail as most of the key themes are here. What has changed is that druggies seem to have sadly taken Preg under their wing in recent years, and that has resulted in Preg changing its legal status and GPs have become more aware of the risks - e.g. that patients will either take dangerous amounts to get high, or take the pills and sell them and use the money for hard drugs etc.

    My advice is the same as 4 years ago - change doctors, try and find a good one in the locality a friend can recommend, and take your pysch's letter to them, and maybe even encourage them to discuss between themselves on the phone or in person.

    It seems you can get Preg in Scotland for GAD and I think there are examples on this thread. But it's a question of jumping through more hoops than in E&W, sad to say. Good luck - you will get there.

    Albert

  10. #90
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    Re: GP won't prescribe me pregabalin.

    My pregablin comes with a little yellow class C warning sticker now - that's the only difference I've noticed.
    Tolerance is a strange thing since it doesn't appear to be consistent. I've been on pregablin with diazepam "as needed" (which in my case is use to stretch my boundries for agoraphobia exposure) and i've never felt the need to adjust my doses of any of it.

    I guess the problem is since these problem are, after all, mostly in in our minds (well mine is - I won't speak for everyone) the placebo effect is very effective too. Maybe my Diazepam and Pregabalin do nothing at all now but since I believe they do - they do.

    Who knows.. as long as I'm continuing to get better I just don't care.

    I had to get my Pregabalin initially as a recommendation letter to to my GP from a Priory Psychiatrist and Psychologist assessment session - before that I was just offered sertraline and citopram - nethier of which I was going to touch with a barge pole since I had pretty bad emotophobia (vomit phobia) at the time and those both have nausea/vomiting listed as a common side effect.
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