Me or the pharmacy

[RainbowCottonCandy]

My 17 yr old dd has been on anti depressants for a few months now. She's also awaiting a formal diagnosis of adhd/asd. She has very low mood and is prone to anger outbursts.
Her prescription review is done over the phone by the GP then it gets sent to the pharmacy. Last month the GP booked the review for a month later after giving her a month's supply of medication. Now I assumed this would mean the review date would tie in correctly to ensure the meds don't run out but that wasn't the case. I realised on Tuesday she had the review Friday (yesterday) but would take her last dose on Thursday. I called the GP and they said there were no more appointments but as soon as the GP called it would immediately get sent over for collection. It likely meant dd would only be a few hours later than usual taking it so I had to accept that as there were no other options given.
So yesterday dd was agitated by late morning. She had the GP call about 2.15 and he asked her how she felt etc. She said really really angry and I haven't had a tablet yet. He said he would immediately send it over and mark it as urgent. At the time dd was about to go into her therapy appointment so it was nearly 2 hours later we got to the pharmacy because the traffic was so bad.
Arrived and they said they had it but it was in a queuing system and be at least an hour. Dd was visibly distressed by this point. Pacing and fidgeting with things in the shop. A clear sign to me she was going to have a big meltdown soon. I discreetly explained the whole situation and said she's run out, needs it asap and is now so late taking it etc but they refused to do anything. There was no one else waiting btw. They text you when prescriptions are ready to collect.
I then walked out as I saw no further point of discussion but unfortunately dd had had enough. She was shouting and crying and then this carried on for about an hour. I then had to go back and get it whilst battling awful traffic again as thee is roadworks next to it.
I think they could have hurried up things on this occasion. When there isn't a physical queue with people waiting, they could see she was distressed. It could have been avoided. The meds only needed signing off. Aibu?

YABU. Who’s to say that other people in front of you also did not see their meds urgently. The title of your post makes it sounds like a battle and if you went in there with that approach not surprised that the chemist stuck to process.

That sounds like an issue with your GP rather than 'the system' though. I started ADs in January 2021 and had a review two weeks after and then three months after - and I've heard nothing since, just been getting my repeats approved every month for over a year now.

Then you should realise that not all teenagers are the same. My 18 year old has Asperger's. She couldn't handle sorting out a prescription, at all.

Op, you need to support your daughter to check when her tablets will last her until. GPs will often give you an appointment for a month's time but then the tablets come in packs of 28. The pharmacy has to follow protocol and can't just hurry something up because you've failed to check when you needed more tablets for. Your daughter's irritation was due to not having the physical tablets in the house, not because her medication had worn off. It doesn't have that effect.

I have taken antidepressants for years. They will not ' wear off" an hour later so that doesn't explain your daughter's meltdown
You and your daughter should request repeat prescription one week before they run out.
Just because there was no one in the queue, doesn't mean they're not busy
Try to keep calm as your frustration rubbed off on your DD

I'm wondering if the meltdown was because of the change in routine rater than the medication withdrawal. As pp have said, anti depressants don't work like that. Does your DD have any coping strategies for change of routine? Maybe help her with those next time something like this happens. I don't think the pharmacy were BU but I can understand your frustration, especially if you thought she was experiencing withdrawal symptoms.

This completely hits the nail on the end.

I work in community pharmacy, we always dispense urgent prescriptions as quickly as possible. Even though it isn’t our fault the prescription has been delayed/the doctor was running late/the patient didn’t order in time. People don’t see a queue and assume we just stand around doing nothing! At any given time there are dozens of tasks being carried out by the members of staff, the absence of a queue means nothing.

YABU. You have no idea what was in the queue for checks, and it doesn’t just need ‘signing off’

Pharmacists have a duty to fully check every prescription against your DD’s medical record to make sure it’s the suitable dose and won’t counteract with any other medications. GP’s are notorious for just prescription something without fully checking the ins and outs of the medication.

As others have said it’s obvious the medication is just playing a placebo role for her. Unless she missed 2/3 days it would have still been in her system and being a few hours late wouldn’t have made a difference.

Perhaps the agitation was psychological? It's still very real and a consequence of the delay but not physical. Sorry you and your DD went through this. Does she like any particular exercise or something to distract from a build up like this. For me, yoga has been a godsend. But any physical activity that she likes might be worth encouraging?

YABU I'm afraid. You knew you had one months supply, and wouldn't receive meds until the GP review. It was up to you to make sure that review was booked before the meds ran out.

If there is no actual queue in the pharmacy is doesn't mean there aren't urgent prescriptions to fill. End of Life medication for hospice and nursing homes must always jump to the top of the list for obvious reasons.

I think the OP is saying DD’s agitation is because of her ASD where the GP mix up & delay with her tablets only added to her stress & meltdown.

Some AD’s do have a much shorter half life 3-7hours & on mine if I was later than an hour I started feeling withdrawal fix. Plus everyone reacts differently to them.

However agree that wasn’t pharmacist’s fault.

I think you and your DD need to research how anti-depressants work. Being late by a few hours really isn’t going to have any effect. I can understand why she got upset and agitated if she likely has ASD and/ or ADHD, I can feel the same if I feel out of control and am waiting for somebody else to fulfill a request, the panic becomes very real.

But I also think this sort of feeling will be exacerbated by her misunderstanding how anti-depressants work, their effect builds up over time and then they stay in your system so that accidentally taking a dose late or skipping a dose entirely isn’t going to have any noticeable effect on mood. The feelings your DD had would have been psychodynamic rather than linked to the missed dose if that makes sense, because she’s expected to feel bad she has but actually there won’t have been a physiological effect going just a few hours over the usual time. If you supported her to understand her medication better and to understand that it’s okay if she’s a bit late taking them, it won’t matter or make her feel anything noticeable, then if this happens again hopefully she would be able to cope. I do understand that if she has ASD rules might become very rigid for her and do if she thinks she’s broken the ‘take at the same time each day’ rule she has probably catastrophised and become anxious and then assumed that’s the effect of not taking the medication and gone into a spiral. A better understanding of her medication and how it works would hopefully reduce the likelihood of this happening again if there were ever another situation where she couldn’t take her medication exactly on time.

YABU and if she is on an SSRI they have a long half life and don't work like fast acting sedatives...
I think you are inadvertently making her emotional reactions worse by thinking a quite normal life experience like this is letting her down or going to cause a problem. It's not. Going for patience and understanding rather than anxiety and outrage might be a better idea.

Thank you for the answers. It's good to know missing the dose wouldn't have had any physical effect. It was the psychological aspect that made dd worse. She had been struggling all day and this was the final straw that set her off.
In regard to her sorting it herself, she did last time. Hence me not realising sooner she would run out. A month review is no good as there's 28 days supply of tablets. I've already sorted the next review for 2 weeks before they run out next time to avoid this happening again.
To the pp who said dd is having a tantrum. Bit of a judgemental comment imo. A child in mental health distress having a meltdown is entirely different to a tantrum.

You should have been calm and explained/reassured her that the effects of the medication don't just stop because you are a few hours late. Then suggested something nice to do whilst you waited.

When my kids come crying and panicking to me I calm them down by being the voice of reason. Talk them through it.

You don't know what system the pharmacist has and how many other people who need their medication there are. I had to wait for a prescription this week for 20 mins and the chemist was empty. My children asked why it took so.long as they could see there was noone waiting. The point is, there are probably lots of people every day and if they kept pushing their orders back it would mean serious delays. So YABU.

I blame the government for this mess , to prevent stockpiling and waste , and get extra revenue from people who have to pay , they have put tremendous strain on GPs and local pharmacies with frequent prescriptions, and medicine reviews, but there is no extra capacity to provide them . I agree with the reviews but in my area despite building thousands of homes we have had no new gps and the system is no longer always joined up .

I completely get why you feel it was the pharmacy's fault but they wouldn't be delaying it for the sake of it. I've been in a position before when I've forgotten to get my repeat prescription for anxiety meds and it's frustrating but it definitely wouldn't cause any effects for a few hours of not having it. It can take several days for withdrawal symptoms and side effects to kick in so I think it could be beneficial to have a conversation with her or her have one with the doctors about this so she understands that and it should then hopefully curb any future meltdowns when she realises she is going to be ok

It's not the fault of the pharmacy, they processed the prescription as urgent within the timescale they have for such requests.
The GP should have tried to arrange an earlier review to ensure medication didn't run out, but they did actually speak to your DD on the day a new prescription was required and actioned it as urgent.
I know how this can be as my DH has mental health issues and can behave similarly if he thinks he won't get his meds in time. I think the only thing you can both do is keep on top of the dates in future.

Some advice - try to get your DD to take responsibility for her mental health treatment, while you provide support to her. While it's understandable that you want to look after her, it could be detrimental in the long run. She may stop trying to help herself and assume it is your responsibility, this can result in you getting the blame when things aren't going well (I've been there plenty of times!)
If you are waiting for NHS counselling or other therapy go private if you can or be prepared for a very long wait. DH waited 6 years for a psychiatrist appointment, and in that time had made several suicide attempts, and had many serious mental health episodes. The ultimate irony after all that time is all the psychologist does after the initial assessment is regular 5 min medication reviews as he is already stretched and there's no other therapy available on the NHS right now.

Yabu purely because you don't understand how the pharmacy works. Whether there is a physical queue or not there will be a priority in which they need to do things and it doesn't just need signing off. They have to make sure the drug and dosage is appropriate whether it has been changed or is the same as it was last month. The buck stops with them regardless of whatever you think, drs are human and get stuff wrong. You need to go back to the gp to make sure her next review is carried out whilst she still has some tablets. Her behaviour was poor and if she behaves like that after missing one dose or having it late I'd be questioning the dosage!

Every patient who is waiting for a delivery, will be returning for their medication or is in a queue thinks their meds are the most important because to them selfishly they are but we have to work on prioritising so if I have deliveries going out at 10am they take precedence and waiting times would be increased or I'd ask patients of they wanted to call back I would have however in this instance dealt with your dd's prescription as in my view it would have stopped her behaviour escalating and my team don't deserve to be treated like that but that is my perogative and other pharmacists might handle the situation differently.

By blaming the pharmacy you are excusing her behaviour and frankly it's shit.

@smileandsing that is really excellent advice.

Wait

you have to get a new prescription monthly? What a waste of time. My Rx lasts a year and is given out in three month supply. I guess Canada does have something right