1-2 antidepressants

[Jen the 3rd]

I'm beginning to see more and more Rx's where antidepressants, mainly SSRI's, are prescribed 1-2 tablets od. WHen I contacted the GP the first time I saw it he said that he'd told the patient to try one and if he still feels depressed, to try 2. Surely it takes at least a week to see if one is working and it could lead to the patient fluctuating their dose and not getting the full effects? Have any of my fellow pharmacists see this?

[Fleegle]

Short answer from me is no..never seen it..doses always fixed. Agree that one or two "depending on mood" doesn't make sense at all. Is there some new research we are unaware of?

[Jen the 3rd]

My friend said she'd seen it aswell. What would you do if you got a prescription like that?

[pharmatron]

I've seen it loads of times especially for SSRIs but also for other items including antipsychotics etc. When queried, the prescriber usually gives either a response that the dose was one to start but then increased to two over time and the direction has never been amended to "TWO daily" or that the dosing allows the patient to titrate the dose according to response/symptoms.

In one surgery I was told that flexibility in the wording of directions on the prescription allowed the patient's dose to be amended verbally when the patient was reviewed by the nurse without them having to amend the prescription or consult with the prescribing doctor --- sometimes I give up

[Fleegle]

I think I would contact the manufacturing company's helpline to find out if the drug is licenced for this type of dosage regimen..If it isn't, get back to prescriber and take it from there...Personally, I would not be at all happy with a "prn" option on an SSRI...LITIGATION!

[Shwampa]

SSRIs are sometimes prescribed for GAD as well and I wonder whether your GP was helping an anxious person rather than someone with clinical depression. There's consensus that it takes 4 to 6 weeks before judging that a regimen has failed or succeeded. Giving AD on prn basis will only complicate for the prescriber to find the right combination.

In the meantime, 4 to 6 weeks is a long time for a depressed person and IMHO a benzo should be given as well for a short time before the SSRIs start working.

Another point, forget about calling a pharmaceutical company for any advice for the sake of keeping your scientific and ethical integrity. There're more other ways of getting an honest and unbiaised information.

[Fleegle]

Another point, forget about calling a pharmaceutical company for any advice for the sake of keeping your scientific and ethical integrity. There're more other ways of getting an honest and unbiaised information.

What are the more other ways by which I can obtain this "unbiaised" information?

[Jeff]

My friend said she'd seen it aswell. What would you do if you got a prescription like that?

Initially - talk to the patient.

Jeff

[Shwampa]

What are the more other ways by which I can obtain this "unbiaised" information?

I'll start by something you call the BNF! or take a class in Evidence Based Medicine.

Sorry, i'm not trying to single you out. it's a problem we all as pharmacist endure with SOME doctors. They're so busy, juggling between seeing their patients and their game of golf that they just do fine with some education from a pharmaceutical rep. I'm not even talking about willful pushing of some drugs because of some kind of kickbacks.

[SolomonQ]

some people on this forum seem to jump at any and every chance to ring a manufacturing company, maybe its 'cos they think they might get a few free pens etc... btw who would you ring to check on fluoxetine? the generic manufacturer? are the people on the other side healthcare professionals or how can you know they know what they are talking about?

back to the point, the above case I woudnt really bother callin the contacting the GP, as someone already said they might be too busy planning their golf games, and alot of the time it's so hard to get through to the suregry anyway, the best thing to do is talk to the patient and make sure they know what they are doing with it.

Regarding 1-2t od, well although a funny dose it is not dangerous or above max, and it could be alternating dose, to make it e.g. 30mg od on average for fluoxetine, but like pointed out patient was told to increase dose if they think it's required, maybe the GP is utilising the "placebo effect". GPs are funny with anti-depressants, I once spent something like 5 minutes trying to convince a GP that a single dose of fluoxetine is sufficient because of it's long half-life, but the GP insisted on 1c bd. normally i woudnt have queried it anyway, but I was speaking to the GP about something abit more important and thought I discuss this also while I was at it.