I'm not surprised mianserin is so expensive, Terry. The market for it must be tiny now so the cost of making it would be high, plus I suspect there may be wastage from meds reaching the use-by date unsold. Unless there is some huge market for it in an obscure part of the world that I don't know about, I really can't see why they bother. There can't be much profit in it even at 400 quid for a year's supply. Just announce production will cease in say 6 months and all patients should be switched to mirtazapine and be done with it.
Yeah, prescribing a drug that costs 29 times as much as its claimed superior analogue isn't going to win her the Nobel prize for economics - though it might put her in the running for exchequer!
The mental machinations of psychiatrists have long baffled and confounded me. I've concluded most have far more screws loose than any of their patients.
BTW-do you have costings for dosulepin/dothiepin and tranylcypromine?