Discontinued antidepressants?!

[Schnicklefritz]

Name-changed for this, as people may need to know location.

My DH was diagnosed with Severe Treatment-Resistant Depression and Psychosis in 2013. Over the course of 6 years, he was put on loads of different medications and antidepressants, most of which didn't help in the slightest. Eventually he was put on a high dose of Bupropion as well as Modafinil, Lamotrigine, Omeprazole, Aripiprazole, Flupentixol, Levothyroxine, and Trazodone. For 4 years now, this has helped and DH is relatively stable. He was discharged from his psychiatrist in 2020.

Cut to last month:

DH went to the pharmacy to pick up his prescription and they didn't have the Bupropion in stock. Fine. Went back a week later, and still nothing. Advised to speak to GP. Went back to GP to have the prescription sent to another pharmacy. Nowhere has it in stock. GP investigates.

Bupropion is no longer on the market in the UK. The drug itself hasn't been discontinued, but no providers in the UK stock it anymore. And nobody thought to report it or notify the GP.

So now my DH is left without his high-dosage primary antidepressant. No GP will touch his cocktail of medication and he is being referred to the Mental Health team, but likely won't have an appointment for 4+ months.

He is going into withdrawal. His symptoms of depression are coming back in full force and is very concerned the psychosis will return if unmedicated. Our situation has changed and we now have 2 young children. While DH was not a danger to others last time, psychosis unpredictable and I am scared of what could happen to my children.

Does anyone know what we can do? An alternative medication to suggest? A charity to contact? I'm not from the UK (DH is) and don't know the NHS system at all.

Any help is very much appreciated.

Dial 111 and select Option 2 for mental health?

I would call your local crisis team they should have a consultant psychiatrist if not part of the team but on call.
does your dh have a wrap plan?
MH provision is dire good luck

Or I would take him to A and E and ask to see the crisis team. Discontinuation can make you very ill physically, never mind mentally.

I'm sorry. Is there somewhere overseas you or he can get to that would sell it OTC? You used to be able to buy it online in the uk, so it's possible. Extreme I know and not a long term solution, but at least it will help slow the withdrawal.

This sounds very stressful.

Two suggestions:

1. Call the pharmacy department or medicines information desk of the mental health team he was under in 2020 for advice.

1. Call the medicines helpline of the pharmaceutical company who makes it to find out timelines or if there is anywhere your pharmacy can order it from.

An aside - independent pharmacies can sometimes order from a wider number of suppliers so you may need to change pharmacy if there is stock somewhere.

I think it needs to be prescribed to order it, but will try my home country. 111 has been effectively useless as they said DH needed to wait for his referral as he isn't currently a danger to himself or others. I didn't think A&E did mental health?

My suggestions are not helpful for out of hours, sorry. I would probably try 111.

It's worth asking for the prescription to be uploaded to the spine then calling lots of pharmacies as they may have old stock. We had this issue last month and it took 25+ pharmacies to track down Dp's antidepressant.

Have pm'd you.

A&E is for mental health emergencies as much as physical emergencies.

On Monday ring the MH team and ask to speak to the duty worker and explain to them that this is a priority. Either that or ask to speak to the psychiatrists secretary.

Bupropion is marketed in the UK as Zyban, an anti-smoking medication. It might be worth searching pharmacists or a private GP for it under that name, rather than the generic Bupropion.

Worst case scenario you can buy things like this online fairly easily

I had to resort to this when I needed specific drugs not available in the uk

This is absolutely awful OP & no doctor should ever leave anyone to go into withdrawal like that & should have urgently referred him to the CMHT.

All Mental Health teams have a crisis number you can call & you get through to a duty team who will triage & assess him over the phone. They will then make a decision over the phone as to action.

I would advise he say he’s experiencing suicidality & is acutely anxious fearful psychosis will return & is a risk to himself.

CMHT’s are so overwhelmed that they have quite strict criteria for who they have resources to be able to see & can be really stringent as you’ve maybe already found out.

Call them back & stress the urgency. Maybe tell them what happens for him when he last had a psychotic episode.

Good luck 💐

Could he have a private appt with a psych? Think it may be around £200. Our local private hospital has the same consultant psych who works for the NHS.

Might be worth it for a review of meds. I have similar condition to your DH mine is recurrent depression with psychotic features. I am on fluoxetine 40mg with a small dose of olanzapine. I was previously on mirtazapine with olanzapine but it made me very drowsy and hungry.

Hope this helps a little.

Look up your local Community Adult Mental Health team or Crisis Team - they are staffed 24/7 & deal with emergency MH calls as well as routine x

Have you tried an online pharmacy to bridge the gap? You've got a prescription, you may be able to order it in while you're waiting.

Have just tried an online pharmacy, but it is out of stock.

I work with the mental health teams. Your husband's case sounds really urgent. Urgent GP referrals get actioned in days by the community mental health teams in my area.
Ask for an urgent psychiatric referral.
Good luck

I have had DH contact his GP again for an urgent psychiatric referral. Thank you to everyone for your help!

I hope you've managed to sort things as best you can, sounds awful though, so I'm sorry.

Did you manage to find a supplier? I've almost run out and am getting very concerned about an unexpected crash in my mental health.

Try and contact the psychiatrist he was under directly - assuming he had a named psychiatrist.

@gorpalicious Unfortunately no. Anything in the UK is out of stock and overseas is out of our price range. We've had the GP contact the psychiatrist, but haven't heard back yet.

I got this response from Sigma Pharmaceuticals Plc a few hours ago:
"Unfortunately the brand “ZYBAN TABS 150MG” is out of stock and unavailable at the moment but the generic “BUPROPION 150MG PR TABS” is a product that Sigma stocks but is also unavailable at the moment. I have been informed that it should hopefully be available by the end of next week."

Followed later with:
"You could ask your local independent pharmacy to order this item for you as a specials order. They would need to have an active account with Sigma."

Which is more promising that I expected, even if it's another week, just need to find out which pharmacies have an account with Sigma.

Will update here if I find out more.

As someone said upthread, you can buy it as Zyban online. The first couple of places I checked have it in stock. It’s expensive but could tide him over as he switches to something else.