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.

thanks but too expensive for me unfortunately

If you go to A and E, you can see the crisis team. I had to wait for 6 hours mind you. I went on the Thursday and they sent the GP an alternative prescription the next day. Then I had a follow up appointment on the telephone with the Psych on the Wednesday,

Not sure if this helps any but it says online the withdrawal from this med is not bad. I

Can the GP not ring the psych at the MH team who prescribed it for advice? When I was discharged the letter said to the GP they could do this if needed.

Ask your GP to do an advice and guidance to the mental health team ( basically an email asking them what to prescribe instead) they normally answer within 5 days.

The withdrawal from any antidepressants is deemed "not bad". The reality is very different. Nausea, vomiting, dizziness, headaches, brain zaps, and occasionally, seizures. Plus all the symptoms that the drug was there to relieve in the first place...

www.ncsct.co.uk/publication_zyban_stock.php#:~:text=On%201st%20December%202022%20GSK,150%20mg%20prolonged%20release%20tablets.

Unfortunately the official NHS guidance of alternative drugs to Bupropion is a nicotine patch... Everywhere else in the world uses the drug as an antidepressant. It is a fairly big deal that people like my DH are being left without an alternative and there appears to be nothing the psychiatrist can do.

Bupropion is usually for smoking cessation.

It's currently out of stock pretty much everywhere due to a manufacturing issue at GSK and contamination with nitrosamine residues which can be carcinogenic. This is an ongoing problem which started back in December 2022 and GSK are still conducting a very complex investigation. I'm afraid there's no word on when it will be resolved.

Using it as an antidepressant is an unlicensed indication, which is often by consultants and experts. Therefore, you'd need to be seen by the same expert or a similarly qualified one who initiated the treatment to be able manage any changes to such complex needs. For licensed indications only, the company makes recommendations, so in this case it's signposting to other nicotine replacement therapies, but obviously not for treatment of depression.

Who started your husband on bupropion for depression?

No, it's only licensed for smoking cessation. There's no territory, including Europe, North America, UK, and Asia, where it's licensed for anything else. Anyone prescribing it for depression is using it in an off-licence indication.

I know the hell that is antidepressant withdrawal @Schnicklefritz & feel for your DH (& you). In view of likely difficulties getting it in the long term has the psychiatrist suggested your DH be switched to a different one under guidance? If there’s no guarantee of getting it how can he be put in this position of uncertainty & forced withdrawal. every time? Obviously I don’t know how well he tolerated other antidepressants or if he will have to taper off Buproprion anyway before he can start a different one. But it’s really concerning that people dependent on these are being made so vulnerable like this 💐

Christ, this is appalling. I hope you can get this sorted.

Has he spoken to his gp? This would be my first port of call if I couldn't get my anti depressants

He has tried many antidepressants before he was prescribed Bupropion by a psychiatrist. He has been on Venlafaxine, Fluoxetine, high doses of Trazodone, Lithium, amongst others. GP won't touch the medication because it's beyond their comfort zone and no psychiatrist will currently see him. He has been told they can maybe put him on Duloxetine, but he would have to come off Trazodone.

GPs wont touch meds prescribed by the mental health team.

Has he tried Venlafaxine? Its best to use the buffered one, unbuffered is very harsh on the digestive system. Its very good for anxiety and psychosis as well as depression. It does have some side effects, including very vivid dreams. It can cause slow weight gain in some people, approx 1 - 3lb per 18 months. It can cause drowsiness when you start to take it.

@Thelnebriati He was on Venlafaxine for about 6 months, but unfortunately it did nothing to help.

@Schnicklefritz @MooseBreath You haven’t mentioned any of the tryciclics - the older ones who have been replaced by SSRI and SNRIs as first choice for depression (because the side effect profile is worse than these newer drugs) but will be prescribed for treatment resistant. Have these been considered?

it seems he’s tried SSRIs and SNRIs and SSAI so maybe tryciclic makes sense next?

or second generation antipsychotics?

@Schnicklefritz @MooseBreath sorry, I see he’s on a mood stabiliser/anti convulsant and antipsychotics.

maybe tricyclic and /or MAOIs haven’t been considered due to interactions?

@Orangepolentacake I'll be honest, I know nothing about these medications and don't have a brain for chemistry or biology. I've passed on your suggestions to DH to bring to the GP. Thanks!

www.boots.com/online/psc/
Long shot OP but this allows you to check the stock of all Boots stores local to you.
The BNF states that other drugs in the same class are duloxetine or venlafaxine, but they won't be the same.
Sorry if this is no help to you, and you get it sorted.

@MooseBreath I know you shouldn’t have to but if he can’t get to see an NHS psychiatrist if you are in a position to I’d seek a private consultation with one. GP’s know F all about psychiatric drugs, withdrawal & tapering schedules & poly pharmacy. A review and supervision with a different medication as other PP’s have suggested for a few months privately if affordable may be the only & safest way for your DH.

,@Companyofwolves Companyofwolves
I know you shouldn’t have to but if he can’t get to see an NHS psychiatrist if you are in a position to I’d seek a private consultation with one. GP’s know F all about psychiatric drugs, withdrawal & tapering schedules & poly pharmacy.🙄FFS.

Sorry?

Clicked send before I meant to.

@Companyofwolves
GP’s know F all about psychiatric drugs, withdrawal & tapering schedules & poly pharmacy.

🙄 FFS. What a stupid, ignorant and downright wrong comment.