To expect a consultant psychiatrist to know about new medications?

[dontrunwithscissors]

Background: I have bipolar 2--98% of my problems are with low mood. I'm taking a combination of 3 meds, which generally work well. However, the antipsychotic (Quetiapine) causes awful joint pain and muscle weakness. I take 3 different painkillers, but I am still in pain every day. At its worst, I have to crawl up the stairs and struggle to walk. I've tried switching to other medications, but they all caused even worse side effects and/or weren't effective. My psychiatrist has said there aren't any other medications that are likely to work as well as the Quetiapine. So I'm stuck between being depressed or being in pain. It's because of these problems that I've been keeping an eye out for new medications. It seems like the only hope.

So, I'm aware that there's a new antipsychtoic called Latuda. It's licensed in the USA for schizophrenia and bipolar depression. It's licensed in the UK for schizophrenia. It sounds very promising in terms of relatively few side effects. I saw my pdoc last week and asked her what she thought about Latuda and if there are any plans to apply for a license for bipolar depression in this country.

She'd never heard it. She had to ask me how to spell it and then looked it up online. She's a big consultant in the Trust. AIBU to expect a consultant psychiatrist to at least be aware of new medications available? I appreciate that services are under incredible pressure, but surely there should be up-to-date information on medication?

[Cookie500]

If it's not licensed here yet for your condition, then drug reps won't have been round doing the promo... this remains the main way doctors hear about new drugs on the market. Not ideal, but that's the reality. That said, they often appreciate info from patients so they can then seek out further info. Good luck in your search for better treatment, it sounds like you're having a really difficult time at the moment.

[dontrunwithscissors]

It is registered in the UK for schizophrenia--since August 2014!

[dontrunwithscissors]

Sorry--the point in my last post was that, even if it's not licensed here for bipolar, the fact it is licensed for schizophrenia means I would have expected a pdoc to at least have recognised the name.

[SparkleSoiree]

YANBU. I would expect a specialist medic to know about medications that could be used for the conditions they diagnose and treat. Saying that, I've even had to tell a consultant psychologist about a condition she hadn't even heard of which was common knowledge in the field of her specialist interest.

[VoldysGoneMouldy]

YABU but totally understand how frustrating it is. New drugs (and this would count as that, if it only started use here in August 2014) take a long time to get into the system, and a longer time to be regularly prescribed. Also the meds often go by different names in different countries, and that combined with how long they take to come over can make it a bit of a minefield.

She should, however, have been willing to help you find an alternative medication.

Have you tried respiridone?

[cosamangiare]

I recently (December?) started Latuda for bipolar, I'm quite surprised a consultant psych hasn't even heard of it but still having problems getting my GP to prescribe it.

[BillSykesDog]

Does she treat people with schizophrenia as a consultant though? She may well not.

There are hundreds of new drugs every week, so to be effective they have to concentrate on the ones which are relevant to them, eg for conditions they treat and also licensed and prescribable.

They may well pick up info from General reading etc, but it's not something they'll be cribbing up on until it's licenced for the conditions they treat.

[cosamangiare]

apart from lithium any drugs used to treat bipolar were developed originally for other conditions (usually epilepsy or schizophrenia) so I would expect any psychiatrist to be aware of any promising new treatments especially for schizophrenia

there are no drugs specifically for bipolar, and certainly not hundreds of new ones every week!

[cosamangiare]

anyway can confirm that it is my prescribable in my trust, it wasn't until recently and there are only two of us taking it here so far

[dontrunwithscissors]

Yes, she's the top consultant on the psych ward so certainly treats schizophrenia and the more serious end of mental illness.

It's called Latuda in this country (& elsewhere). Hmm, so almost 18 months after it is first licensed, it's OK to not even be aware of its significance? I know of people who are prescribed it so some pdocs are certainly using it. It is very expensive, of course. Even so, to have no idea . And after looking it up online, she said she hadn't heard of it so it wasn't a case of having the wrong name. I'm truly shocked if that is considered acceptable practice in the medical profession.

[Summertime1]

I think natural remedies can sometimes help if you are feeling low or not yourself. They have certainly helped a member of my family in the past when the only other recourse was the stronger stuff.

They found the best one contained 5-htp which naturally boosts the neuro-tranmitter Serotonin in the brain, helped them deal with life better: www.365vitamins.co.uk/5-htp

There are so many views out there it can be confusing but if you are insomniac and stressing it or something similar may help.

Good luck

[dontrunwithscissors]

cosaman, do you mind me asking how you find Latuda?

As you say, there certainly aren't hundreds of new psych meds coming on the market. I think Latuda is the first new antipsychotic to be licensed in the UK since Ariripiprazole--at least a couple of years.

It's left me a bit perplexed. I know she keeps up to date with new research as we've discussed recent publications on mental illness and genetics. I have a lot of respect for her, but wonder how this has not been picked up on.

[x2boys]

Yes your psychiatrist should have heard of it but you will find many psychiatrists have their favourite medications that they use a lot ,I, m an RMN , Quetiapine didn't used to to.be a popular medication in the trust I used to work for about 10,15 yrs ago although I, m aware it's more popular now .

[cosamangiare]

well she's heard of it now so you are a bit further forward!

I find the taking it with plenty of food thing a bit annoying, and it doesn't work without real food, but no horrible side effects yet - I started on 18.6 and am now on 74 (odd doses because they take the sodium out in uk) and starting to get some sleep and am evening out a bit in general

I was on lithium and olanzapine, had been on lithium for ages, it feels like quite a tough act for lurasidone to follow but I can theoretically go back on lithium if necessary

[Marynary]

She would (I hope) have heard of it as lurasidone. It's not prescribed much for schizophrenia so she may not know the brand name.

[lostinmiddlemarch]

If it's not licensed here yet for your condition, then drug reps won't have been round doing the promo... this remains the main way doctors hear about new drugs on the market. Not ideal, but that's the reality.

So there are no medical journals detailing the performance of new medications? Or is it just that there's no formal requirement to read them...

[seasidesally]

hi op,i could of wrote your post,i also have BP an am on Quetiapine slow release 400mg,im at my wits end with terrible joint pain (also crawl up the stairs)

my psychiatrist says it's not the drug causing the pain what does your's say

i cant kneel down and walk with real difficulty

hope you get some answers regarding the new medication

[Wolpertinger]

I wouldn't have heard of anything by its brand name - we just don't call meds by those names in the UK. I'm not a psychiatrist but a different specialty doc and it would always be called lurasidone not Latuda.

And while it may have a UK licence it doesn't mean it's NICE approved - and if it's not NICE approved you can't prescribe it.

And even if it's NICE approved if your CCG prescribing group hasn't approved it, you still can't prescribe it.

And none of them have side effects when they are new, give it a few years for more people to use them and then we learn what the side effects REALLY are. Happens over and over again with new meds.

[thecitydoc]

YABU - even though she is at the top of her field she cannot possible know of every new drug that comes on the market. You say it has been licensed for schizophrenia in the UK so if this is not an area that she specialises in then there is no reason for her to know about it. I am sure that if/when it is licensed for bipolar she will be up to speed. Medics are not the fountain of all knowledge about every drug out there and they increasingly tend to specialise in in a narrow field. So for example an orthopaedic surgeon will specialise in the hand, or the knee. We expect too much of our Drs.

[CantChoose]

I half think they should know about it as they are a specialist and half understand how hard it is to keep up and the many barriers in the way of that.

There are also often local issues as a PP said. I moved trusts and a new (ish - a couple of years on the market) drug that I'd previously used freely was strictly forbidden as not approved because of the cost. My colleagues in the new trust knew hardly anything about it as they weren't allowed to use it so no point really...

[ToastDemon]

Summertime the OP has a condition that requires anti-psychotics - no a 5-htp supplement is not going to help.
That is for people feeling a wee bit down or anxious not for anything serious enough to be under the care of a psychiatrist.

[Marynary]

So there are no medical journals detailing the performance of new medications? Or is it just that there's no formal requirement to read them..

The medical journals will use the generic name (lurasidone) rather than the brand name (Latuda). The reps will use the brand name.

[AliceInUnderpants]

I had an examination Monday from a 4th year medical student (neuro, if relevant) who has never heard of Joint Hypermobility Syndrome. It did make me a bit

[Marynary]

And even if it's NICE approved if your CCG prescribing group hasn't approved it, you still can't prescribe it.

That's not correct Wolpertinger. If NICE approve it, it the CCGs have to fund it if doctors want to prescribe it.

[DownWithTitchenor]

No Marynary they don't.