Dr refused anti anxiety meds

[anxiousflight]

Long history of depression and anxiety, it is mostly under control but something can set my anxiety off and I'll be bad for a couple of weeks.

I've recently moved drs surgery as moved house and my old GP would always give me about 10 diazepam or lorazepam a year, to help me through anxious periods.

I hate hate hate taking off on a flight and this has triggered my anxiety the past couple of weeks as I fly tomorrow first thing.

I booked an appt with new GP and first appt available was yesterday, the duty Dr said she was not happy to prescribe any diazepam as if there was an emergency I wouldn't be able to get off the plane??? I said, they help me rationalise and keep calm, they don't knock me out. She wasn't happy so said she'd get my actual GP to call me today. The receptionist called me at 4pm and said that my GP isn't happy to prescribe them either. Not happy that I was promised a call from my GP but she avoided the conversation and asked the receptionist to call me so I couldn't speak to anyone medically trained to help me. My medical records are there for drs to see so I cant understand at all why they couldn't issue me a small prescription.

I can't take propanalol due to an adverse reaction with my asthma a few years ago. So now I'm stuck without anything at all and I'm so panicky, I leave my house at 1:30am tomorrow morning.

Does anyone know if I call 111 will they be able to prescribe anything?

GPs don’t withdraw mental health drugs. They do sometimes refuse to continue prescribing them. I remember years ago if people stayed in hospital for a few nights, they were all routinely given temazepam so they’d sleep in the noisy ward. They would be sent home with a handful of tablets, and when they ran out they’d ask for more. And we’d say no. Just because someone developed a fondness for temazepam after their hysterectomy, it doesn’t mean the GP should keep on prescribing it for ever.

Mental health prescribing by secondary care is often a nightmare for GPs. Psychiatrists sometimes don’t follow guidelines, they prescribe things off licence, and they don’t complete the shared care agreements. GPs then have no choice but to refuse to prescribe the drugs that they have no experience in or indemnity for. It may appear belligerent and deliberately difficult, but it’s actually safe practice. You wouldn’t want your Boeing 747 to be flown by someone who only has a licence to flight microlights would you.

Well only if you are viewing the thread through a particular prism!

Because we have also had:

1. GPs are no longer insured to provide diazepam for this purpose and have been advised by the Aviation Authority and their own regulatory body that it’s use is not appropriate
2. diazepam is addictive and whilst it has a use for acute generalised anxiety disorders, it is not appropriate for short term milder anxiety
3. regular use of diazepam when flying has been shown to heighten fear and anxiety over time
4. there are specific health risks using diazepam at altitude such as increased risk of DVT and in circumstances where the patient needs to be alert in the case of emergency
5. Other medications and/or clinical approaches are more effective in most cases
6. There are social reasons why this is also not a good idea - invalidating travel insurance, potentially failing employer randomised drug tests and the drug being illegal to possess in some destinations.

None of that is based on prejudice or stigma but equally good reasons why an individual GP who is legally and ethically responsible for their prescribing decisions may choose not to issue a prescription in this case

As I've said I wasn't talking specifically about the OPs situation. It was more a response to other comments. However, even if a patient is using a drug PRN for their mental health, I would still suggest withdrawing that usage should be discussed with the patient.

We'll have to agree to disagree. A GP refusing to continue prescribing a med the patient has been on long term for their mental health without any plan is not best practice in my opinion.

No time to read the thread but get a bottle of Bach’s flower remedies from boots at the airport. The homeopathy does nothing, obviously - but the alcohol the homeopathic stuff is pickled in will give a similar sedative effect to 5-10mg diazepam. Don’t fanny about with the drops, drink half the bottle and then continue to sip as requires.

That's great criteria. Well done you.

That doesn’t happen unless new research comes out suggesting it is dangerous

I’m sorry my post has upset you but I would suggest you read my other posts on this thread to put it in context.

Of course she's not unreasonable for asking. But they've said no

It's not being withdrawn from OP. It was only given to her as a one off for one offsì

If you are so afraid you have to be drugged why on earth are you putting yourself through it.

So doctors should just have to hand out whatever the patient wants no questions asked just hand the drugs over?

Your comments about the word ‘benzos’ are just bizarre. I have worked as a consultant psychiatrist for decades, on wards and in the community. ‘Benzo’ is simply shorthand.

We use the word when talking to colleagues. Even at our monthly meetings with primary care colleagues at their practices; GPs here in London seem to manage to use and understand the term ‘benzo use’ without outrage. Your rigid assertion that it is only used by people dependent on benzodiazepines suggests you may not have quite the experience in this area as you are making out. Odd.

I just wanted to say I’ve had a very similar experience to you I also suffer with anxiety and I have extreme pain attacks to the point my throat closes up. The only medication that has ever helped me is diazepam. The minute the doctor left who was helping me every other doctor refuses to point me on it so I am left cold turkey. The anxiety upsets my stomach it causes violent nausea and diarrhoea. So since they wouldn’t prescribe diazepam I was using anti sickness to control the symptoms. Now they won’t prescribe the anti sickness. I’m currently under weight but I’ve been able to maintain now my weight it going to start dropping off. So long story short doctors hate Diazepam.

Nobody needs to get on a plane OP. If you know you get anxious avoid planes. Sedatives have numerous terrible long term side effects and your GP is right to not prescribe

OP I hope that you manage to get on the plane and have a lovely holiday.

Having watched the programmes on Oxycontin, I feel very strongly that GPs should not be prescribing highly addictive medication unless absolutely necessary. A flight is not essential. These medications can change the wiring in your brain, even irregular doses have a negative impact on you. At one time Diazepam was handed out like sweeties, so I think many have lost perspective on how powerful and potentially dangerous a drug it is.

As for the 2nd GP not ringing you back, I think that was reasonable considering the amount of time this issue had already taken up, expecting a 2nd consultation over a flight is unreasonable to be honest. GPs are working flat to the mat, unwell patients are being delayed due to pressure on their resources. I think the GPs gave your request a lot of time to be honest.

Promethazine is an antihistamine which is first line for anxiety and /or agitation even in inpatient psychiatric services.

DD was prescribed promethazine. She commented on how sleepy it made her. Aren’t GPs saying on this thread, they don’t want to prescribe diazepam because of the risk of DVT, and people being too drowsy to respond in emergency situations on aeroplanes? Is promethazine any different for an occasional user?

I would expect psychiatric staff to use terms like "benzos" as these drugs are things you deal with daily. I don't expect patients to use those words unless they are habitual users.
But I take your point that you work in London, and I work in a small town in the midlands, so maybe we aren't as casual about street-value drug usage.

I would expect psychiatric staff to use terms like "benzos" as these drugs are things you deal with daily. I don't expect patients to use those words unless they are habitual users.
But I take your point that you work in London, and I work in a small town in the midlands, so maybe we aren't as casual about street-value drug usage.

I find this level of judgement a bit worrying in a GP but unfortunately not uncommon.

So much complete rubbish stated here, it's really painful to read.

Yes diazepam and similar can be additive for some people. Fir many others it's a life saver during difficult periods and events.

I was prescribed it in the 90s not knowing what it was by my doctor. Fir every day use for months! It was the norm then where I lived. I stopped it of my own accord and suffered no bad effects. I had no need for it for many years until a very very bad experience flying. It was horrendous. The equivalent of expecting someone petrified of spiders having to lay in a pool of them for hours.

Thankfully my GP at the time was great and prescribed it for flying, 10 at a time. It was the only way to get me on a plane. I must have flown 20-30 times taking it and not once experienced any issues or concerns. Not once did a staff came to me to ask about my ability to escape in an emergency.

I also relied on it during the menopause when I came crashing with extreme anxiety and panic attacks. Without it, I could have continued to work. A life saver but oh surprise, when the menopause got better, I naturally stopped taking it. It's been 5 years and not once have I craved it in any way. I still have some leftover which I'll use on my next flight as I always have.

I had to laugh at the advice of tacking in different ways and taking a course. How utterly patronising. They can tell me everything about safety and statistics, it won't take away the fact that a plane I was supposed to be on did crash and all died. CBT doesn't take away the terror that I feel as soon as something doesn't seem normal to me like the time the pilot had to abort the landing.

I do get better the more I fly, and that's thanks to the couple of pills I take. Shout me, I'm clearly a crack head 🥴

Good grief! Do people really agree that the doctor is unreasonable to prescribe addictive drugs to people, for a reason such as this! I must be living in a different world!

Why is everyone focussed on the diazepam and ignoring the fact OP was refused lorazepam? Its not addictive after one dose ffs.

I mean it's not a course of them is it so I doubt addiction was high on the doctors list, it isn't like OP gets them regularly by the sound of it that it'd flag as being of concern. It's more likely as the guidance has changed there's less appetite to go against them as a prescriber which is fair enough, its their registration on the line at the end of the day. As it's for a voluntary activity the risk/benefit balance probably just doesn't swing enough for them, but it might for other doctors.

Untreated anxiety needs to be taken more seriously, It can escalate into something that can wreck your life.

It's highly individual. Antihistamines like promethazine or doxylamine can barely move the needle for some people and knock others out cold. Doxylamine is commonly sold at airports around the world (though not in the UK) as a flight sleep aid. The whole NICE/BMF guidance is around a fear of long term benzo dependence and not people "being sleepy on the flight" - that's just the nonsense they say to fob patients off.

There is a real and mildly sinister push in this country to reduce medical or artificial interventions as much as possible, even when they work. Perhaps the clearest example is when you see it with childbirth for example with mums being dissuaded from having caesareans or all the nonsense around bottle feeding.