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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

Original poster

To expect a consultant psychiatrist to know about new medications?

88 replies

dontrunwithscissors · 05/02/2016 13:17

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?

OP posts:
Original poster
dontrunwithscissors · 05/02/2016 20:36

OK! To repeat myself--she definitely does treat people schizophrenia. I've been on the ward with a fair few of them! (As far as I know, all consultants working in adult psychiatry will be experienced in treating the most commonly diagnosed mental illnesses).

seasidesally. I've had the joint pain for 4 years and have had loads of tests, been seen by rheumatology etc . At first my pdoc didn't think that it was being caused by the medication. However, I've kept a log of mood/sleep/pain/meds for the last few years. (I use an app that lets me print off charts etc). The pain is very clearly related to quetiapine dose & it's now accepted that it's a side effect. It took a long while to get that established.

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Original poster
dontrunwithscissors · 05/02/2016 20:40

With refer to the question of generic v trade name--well, she typed 'Latuda' onto the computer and certainly didn't go 'ahhhh, it's lurasidone.' She read for a couple of minutes and then 'oh, ok, it looks like.....' and explained what she'd read. Certainly appeared that she didn't know of it at all.

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Marynary · 05/02/2016 20:46

DownWithTitchenor If a NICE TA recommends a drug as an option then CCGs can't refuse to fund it if a doctor wants to prescribe it. All NICE-approved drugs must be included in local formularies.

Marynary · 05/02/2016 20:48

With refer to the question of generic v trade name--well, she typed 'Latuda' onto the computer and certainly didn't go 'ahhhh, it's lurasidone.'

That's a bit crap then....

CantChoose · 05/02/2016 20:52

I'm not in the least bit surprised by a fourth year student never having heard of joint hyper mobility syndrome. In my experience a lot of fully qualified doctors have fairly low knowledge of this condition, it's notoriously underdiagnosed and poorly understood... Hopefully having met you they will be better informed and able to help patients in the future - that's why they're still a student :) thanks for letting him examine you, it really helps!

hopelesslydevotedtoGu · 05/02/2016 20:54

If it isn't on your ccg formulary list then she won't be able to prescribe it, so there are probably more relevant topics for her to study, than a drug she can't prescribe.

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,
I wouldn't change your opinion based on this one incident.

CantChoose · 05/02/2016 20:55

FWIW I would also be very surprised if you had any psych doc who treated bipolar but not schizophrenia...

Marynary · 05/02/2016 21:00

If it isn't on your ccg formulary list then she won't be able to prescribe it, so there are probably more relevant topics for her to study, than a drug she can't prescribe.

You would expect her to have at least heard of the generic name if it was her speciality though.

AliceInUnderpants · 05/02/2016 21:04

I'm not in the least bit surprised by a fourth year student never having heard of joint hyper mobility syndrome. In my experience a lot of fully qualified doctors have fairly low knowledge of this condition, it's notoriously underdiagnosed and poorly understood... Hopefully having met you they will be better informed and able to help patients in the future - that's why they're still a student smile thanks for letting him examine you, it really helps!

I am placing all my hope in one student that they are going to be the one that works out wth is wrong with me, happy to let him examine me. It's a teaching hospital and I'm always more than happy to speak to students. Though the FY2 who I swear was trying to kill me can FRO Wink

lougle · 05/02/2016 21:37

Have you ever tried Respiradone?This summary compares the two

Original poster
dontrunwithscissors · 05/02/2016 21:40

No, I haven't, but it's been discounted by my pdoc because she doesn't think it will suit my needs--apparently it doesn't have as strong an antidepressant effect as quetiapine. Amilsulpride has been discounted due to the risks of increased prolactin levels.

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doleritedinosaur · 05/02/2016 21:50

Consultants/doctors can be bad about medications, pharmacists are way more trained in drugs & side effects however they just deal the drugs not prescribe.

There's a way to prescribe it unlicensed but it doesn't seem like she's comfortable but you could ask.

lougle · 05/02/2016 21:56

That's what I wondered. Lurasidone is similar to Respiradone.

LondonTizz · 05/02/2016 22:00

I'm sure a consultant psychiatrist would have known it but you used the brand name- if you'd referred to it as lurasidone which is what it's known as in the UK she wouldn't have needed to look it up. Doctors aren't always aware of all drugs brand names.

Original poster
dontrunwithscissors · 05/02/2016 22:03

As upthread.....she didnt know it as Latuda or lurasidone.

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rainingsleepingbags · 06/02/2016 06:14

That's shit OP. I saw a shrink like that for a while; he was atrocious. Just had no idea what he was on about. At one point he decided I wasn't bipolar after all and almost had me convinced too. Except he was very, very wrong ConfusedHmm

I really have no knowledge about interactions with pain medications, but I did want to mention asenapine (Safris/Zafris? Something like that) in case you weren't familiar with it. I tried for a while but didn't get along with it, precisely because it apparently acts very similarly to quetiapine which is also no good for me, but I could be something to think about for you.

It's such a bitch that with illnesses like bipolar you as the patient has to often do as much reading and studying as the doctor who is getting paid to do it just to ensure you get good treatment. We don't get to just walk in, do exactly as the doctor says and resultingly get better Sad

lougle · 06/02/2016 08:58

Fair enough, but if Respiradone is no good for you, it's unlikely that lurasidone will be.

milkysmum · 06/02/2016 09:06

I'm an experienced mental health nurse, I have never heard of it I am a afraid. I am off to look it up. It can very much depend on what drugs are used within your own trust.

cosamangiare · 06/02/2016 10:38

evidence so far is that lurasidone has a lot going for it that risperidone doesn't, not only in the adverse events department but it has some antidepressant action whereas risperdal is probably a better antimanic isn't it

Original poster
dontrunwithscissors · 06/02/2016 11:33

cosaman, that's my understanding of Latuda. As far as I know, risperidone hasn't been licensed for bipolar depression anywhere. It also seems to bring a lower chance of raised prolactin levels. Also fewer incidents of cardiac side effects. (I have a family history of long QT syndrome so that's s big deal.)

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cosamangiare · 06/02/2016 11:47

Yeah don't understand how that confusion arose but they definitely very different!

Good luck with everything, will keep an eye out for your posts. I'm feeling hopeful about it so far although v early days obviously Flowers

lougle · 06/02/2016 13:22

Lurasidone was only licenced for bipolar type 1 though.

Marynary · 06/02/2016 14:43

I'm an experienced mental health nurse, I have never heard of it I am a afraid. I am off to look it up. It can very much depend on what drugs are used within your own trust.

Whether or not it is on the trust formulary, a consultant psychiatrist who treats people with schizophrenia should have at least heard of it.

UnusualPolarBear · 06/02/2016 15:29

Hey OP,

I've not yet read the thread, but I also take quetiapine for bipolar and used to get terrible knee pain. My psych prescribed me procyclidine which is actually a Parkinson's medication to combat that, and now I have no joint pain at all. Might be worth trying? I only take 5mg once a day but can take it up to three times a day if I need to. X

Original poster
dontrunwithscissors · 06/02/2016 16:04

lougle, it's licenses for bipolar depression in the USA. I'm hoping they get a license for it in the uk.

unusualpolarbear I tried procyclidine. It helped a bit, but turned me into a walking zombie. Really sedating for me.

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