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?

Do you have long QT syndrome? I know you said you have a family history - can you not be tested? Then either be put on appropriate meds or know that you are able to take meds that potentially have cardiac interactions. :)

Don't...have you tried all of the other licensed mood stabilisers instead of QT like Abilify?

I'm also bipolar 2. My major issues have always been with depression....I do get hypomania but since I made some major lifestyle changes the hypomania has almost gone even though I'm on 225mg of Venlafaxine (which I would expect to be sky high on)...

Omega 3 sends me off the planet too, I thought that was just me! What a weird thing.

You can have more than 2 anti convulsants depending on risk factors and reasons. Some compliment each other some don't, some are used in different doses and therefore giving a different effect.
A lot comes down to having an experienced consultant who is willing to trial and error. Everyone also responds slightly different to drugs, which is where someone who has experience is fantastic, as you kind of need a lot of guts and conviction to prescribe combinations of drugs which aren't always classed as standard approaches.

mamadoc
Where can people find doctors like you? So many have been sucked in by the drug companies and seem to want to push aripiprazole or quetiapine for depression before trying older (IMO safer) drugs like clomipramine.

OP I think YAB slightly U. New drugs take a while to come into the system and the benefits of new drugs are always over hyped anyway.

I work in mental health - heard of lurasidone as a recently developed atypical antipsychotic. Not aware of trade names for almost all drugs so i wouldn't have recognised it under latuda. Certainly here at present I would need to discuss with pharmacy re availability and potentially medicines review board if non formulary and expensive. Also, I use off license meds sometimes but only drugs i am familiar with using for licensed conditions. I would certainly exhaust other atypicals / mood stabilizers i know well and have lots of high grade non-pharmaceutical sponsored evidence of efficacy and safety for bipolar 2 before something new. I do investigate drugs patients bring up in consultations if they are unfamiliar.
Good luck with finding something more suited to you!

oh and in my experience psychiatrists are the absolute worst for not listening to patient wishes or input on medication at all. chances are if if they have heard of it and it is an appropriate indication they still wont let you try a medication simply because you asked for it.

I can't comment on psychiatrists in general but I am always open to a patient's ideas.
I actually think a psychiatrist is going to be more open to a patient's ideas than say a general surgeon just that less people have their own ideas about surgery.
I think OP psychiatrist does sound like a good one because she was willing to admit she didn't know and look it up rather than pretend to be omnipotent.

Occasionally the patients idea is genuinely something I haven't thought of.
More often it's something I have thought of but don't think is a good idea. However it's their life so if we have a fully informed discussion and I point out why I think it's a bad idea and they still want to go ahead I would likely be willing to do it unless it was dangerous or unethical.
I can't be forced to prescribe something I think is a really bad idea (most common request a lot of benzos) but equally I can't force anyone to take something they think is a really bad idea (MHA situations aside and even then I really try not to.) It's a joint decision.

You would be most likely to find a good psychiatrist at an academic centre I think. Not at all saying that good psychiatrists don't exist outside of those obviously they do but the chances are higher of a bad apple. Basically it's a shortage specialty which results in not much competition for jobs especially in 'undesirable' locations which results in sometimes less good Drs. It pains me to admit that but it is true. I love my job and think it is one of the most interesting in medicine but that's not a popular viewpoint and most med students and young Drs I come across won't touch it with a bargepole.

I did have one pdoc like that longtime. He actually had the nerve to tell me that he'd "chosen me" as "his project" to make me better.

My current pdoc, however, is open, honest, and always listens. I really can't fault her.

The problem is, I think, that my pdoc/CPN are very jittery about changing medications due to what's happened in the past. The message at the moment is to put up with the pain until (at least) I have a longer spell of stability. In fairness, I'm very scared of making any changes, too. Previous attempts have been horrendous & nothing else has worked. Even if pdoc wanted to prescribe Lurasidone, I'm not sure whether I would want to try it.

It's such a big gamble. I can't afford any more time off work. (DH is a SAHP). I just get so fed up of being in pain.

That sentence should have read: "When it came down to it, even if my pdoc wanted to prescribe Lurasidone, I'm not sure I would have the guts to actually go through with another change."

Just in case anyone's about why I was bothering asking about it in that situation. I'm stuck between a rock and a hard place. I'm not expecting to be side-effect free, but it's awful telling DC's that I can't go to the playground with them.

OP, are you sure that it is the quetiapine that is causing the pain? You said that you are also taking lamotrigine and this can cause joint pain...

I think that if it has been licensed for as long as that, then she probably should know about it. But tbh, the way she behaved when you mentioned it, comforts me. She didnt belittle you and was willing to look it up and consider it.
Someone else earlier said about side effects, totally agree, it takes time and people using them before we know what they are.

marynary, yes, I've tracked my mood/sleep/pain/med doses for avout 2.5 years and there's a very clear relationship between the joint pain and quetiapine dose. On the last time I tried to switch from Q to a different AP, the pain just about completely went. I never managed to get off the Q--I think I got down to 100mg. There was a big difference. Then it came back as soon as the dose went up.

I've had tests, X-Ray's and seen a rheumatologist & the consensus is that it's the Q.