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  • 1-2 antidepressants

    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?
    MUR

    Major Underestimation of Resources

  • #2
    Re: 1-2 antidepressants

    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?
    Don't Stop Believing

    http://youtube.com/watch?v=rnT7nYbCSvM

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    • #3
      Re: 1-2 antidepressants

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

      Major Underestimation of Resources

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      • #4
        Re: 1-2 antidepressants

        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

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        • #5
          Re: 1-2 antidepressants

          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!
          Don't Stop Believing

          http://youtube.com/watch?v=rnT7nYbCSvM

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          • #6
            Re: 1-2 antidepressants

            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.

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            • #7
              Re: 1-2 antidepressants

              Originally posted by Shwampa View Post
              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?
              Don't Stop Believing

              http://youtube.com/watch?v=rnT7nYbCSvM

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              • #8
                Re: 1-2 antidepressants

                Originally posted by Jen the 3rd View Post
                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

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                • #9
                  Re: 1-2 antidepressants

                  Originally posted by Fleegle View Post
                  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.

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                  • #10
                    Re: 1-2 antidepressants

                    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.
                    We are the music makers, We are the dreamers of dreams and God damn we are that good

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                    • #11
                      Re: 1-2 antidepressants

                      Originally posted by SolomonQ View Post
                      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?
                      Solly and Schwampa, who do you think is going to know the most about a drug made by a specific company? Us sat in our dispensary or the medicines info dept at the company that makes the damned stuff? Most drug companies hire pharmacists or other HCPs to work in the medicines info dept for this specific reason - they are there to know all the ins and outs of the drugs made by that company. Granted they may not know everything off the top of their heads and may need to go and find things out for you, but then I'm sure there are plenty of us who have to refer to our books some of the time - after all we aren't expected to know everything.

                      The medicines info depts of drug companies don't just sit there twiddling their thumbs all day waiting for us to ring - they are actively working with hospitals, trusts and other info depts by combining ongoing research with trust guidelines and off-label prescribing all the time. Even the generic manufacturers. In the past i've found Teva's dept to be incredibly helpful, for example.

                      Granted, they probably will be biased when telling you to use their product over someone elses but that's not the issue at hand - you're already wanting to use their product - you're just finding out if you're going to be doing it right!

                      And i'm sorry but if ringing a manufacturer to find out if an off-licence dose is safe or acceptable constitutes losing my scientific or ethical integrity then I should hand in my certificate now. I've (to paraphrase someone i respect) never heard such bollox.

                      How easy is it for your average community pharmacist to access pubmed or use the athens database to find peer-reviewed studies on specific drug doses. I'd love to trawl through obscure publications looking for relevent info to practice more EBM but quite frankly myself and others simply do not have time to do this and provide a full service to the 20 other patients waiting for prescriptions, advice, murs, pct schemes etc.
                      “It's not worth doing something unless you were doing something that someone, somewhere, would much rather you weren't doing.”

                      Terry Pratchett

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                      • #12
                        Re: 1-2 antidepressants

                        just one word..vioxx

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                        • #13
                          Re: 1-2 antidepressants

                          Originally posted by Shwampa View Post
                          just one word..vioxx

                          That's a copout and you know it! Had you been given advice at the time regarding vioxx the meds info dept would have supplied you with everything they had. To suggest that every single person in the company knew of the dodgy dealings and cover-up regarding it is nothing short of ludicrous. Besides, had you acted on that info it would have been in good faith under the assumption that the data supplied to you is correct - after all it is the drug company themselves who are responsible for submitting the safety and efficacy data to the MRHA.

                          Or are you saying that we should never trust any drug manufacturer about anything, never take any tablets or develop any new drugs ever again?

                          Try to have a think about what you say before making sweeping statements that are unworkable in everyday practical situations.

                          oh, and a quick look online has found a total of ZERO evidence based medicine courses available for pharmacists in my area. A different story if i was a doctor, of course.
                          “It's not worth doing something unless you were doing something that someone, somewhere, would much rather you weren't doing.”

                          Terry Pratchett

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                          • #14
                            Re: 1-2 antidepressants

                            Originally posted by Sir_Dispensalot View Post
                            oh, and a quick look online has found a total of ZERO evidence based medicine courses available for pharmacists in my area. A different story if i was a doctor, of course.
                            NPCi or Bandolier ('nowt wrong with teaching yourself)

                            But I agree about phoning the manufacturers - they know what trials have been carried out with unusual doses and which are in progress.

                            Jeff

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                            • #15
                              Re: 1-2 antidepressants

                              Trip Database - For Evidence Based Medicine (EBM)- TRIP Database
                              We are the music makers, We are the dreamers of dreams and God damn we are that good

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