Can a GP prescribe antidepressants for under 18’s

[ilovebagpuss]

My DD 14 is struggling with OCD which she has intrusive thoughts with. It has been ongoing for many years and we have always hoped it would become more manageable. However this is not the case and we have been back to the GP regarding having some medication which I feel she desperately needs.
The GP said they cannot prescribe without the CAMHS advise and we all know that will take months.
Is his true or is it just flannel?
I would have thought a GP could prescribe anything? Otherwise what’s the point ? I understand they are not specialists but I’m not sure who to believe.
Will I have to pay for a private Psychiatrist to get anything prescribed and/or support outside of a crisis situation?
Any information gratefully received

@TeenMinusTests thank you for the insight that’s useful to know. We have a review with the Psychiatrist in a couple of weeks and I assume he will bump the 10mg up to 20mg which seems to be the standard dose.
Hopefully we will both see some more improvement in the next two weeks.
Is propranolol a sedative type medication? My DD thinks the melatonin help a bit but I think she thought she would take something that would knock her out. They are the slow release ones so she said they make her sleepy but she can stay awake too depending on how she is.

Propranolol is a beta blocker for anxiety.
DD's anxiety was keeping her too alert at bedtime.

The 'little blue pills' are Promethazine Hydrochloride Tablets which we use occasionally as well as melatonin as they seem to have more of a knock out effect.

Forgot to pop back and thank you @TeenMinusTests that was useful to know. Any information I can get I hoard. Quick update on my DD she felt the 10mg was not really helping her OCD and so both that and the melatonin have been increased just to 20mg of Fluoxetine and 4mg of melatonin.
I hoping the 20 mg has some benefit as I feel she needs the boost of seeing something help her.
The Psychiatrist and his assistant have been so helpful with amending doses and posting out prescriptions etc and then we have a review in 2 weeks booked.

Those are both the same doses as DD is on, though the fluoxetine is going up soon. This time it has taken 18 days back on meds to see a difference, but there has been some positive signs in the past couple of days.

GPs are reluctant to prescribe anti psycotics and anti depressants in children because they don't work in them as they do in adults. The adolescent brain is different from the adult brain and so drugs working on it have different effects.
In teens the evidence indicates that these meds have limited positive effect but do have side effects. Its therefore not the same as an adult.
I work in paediatrics (often with very mentally unwell children) and even paediatricians won't start antidepressants without psychiatric ok.
There's evidence to back up this view, though for a parent with an unwell teenager and under resourced CAMHS I can see why it will be so frustrating.

Yes frustrating and so scary when you have a child literally wailing in mental anguish and your GP says sorry off you go. If they were wailing in physical pain no one would walk away and say you might get help in 8 months.
There needs to be some sort of middle ground where a GP could liase with a Psychiatrist quickly and offer something/anything.
The system is broken but no one will do anything why don’t the professionals push for some other way some middle ground or option between having to go to A &E with a crisis or paying privately.
I suppose I would rather pay a separate part of NI for mental health treatment so there is something there to support people.
Or just say it’s broken and offer private health insurance for that particular element of the NHS just to pretend there is a service is so wrong.
Not having a go at you @negomi90 just having a rant I just found it all so lonely and terrifying.

Hi how much was the consultation and private prescription please?

pick DD's initial consultation was ~£350 and follow ups have been £200 or so. The first prescription wasn't massive, maybe £30 and then on NHS thereafter.

Yes similar here £300 for an hour then we had to pay £70 for the first prescription because the 10mg tablets are scarce apparently ? Anyway the next prescription was £20. The Psychiatrist says he will pass on the prescription to the GP after the next review so we don’t have to pay again.

@ilovebagpuss Is there a particular organisation that is best to go through in order to get a private psychiatry appointment?

DD was prescribed fluoxetine at 17, and my friend's DD was prescribed anti depressants at 15. Same (excellent) group practice. Both girls doing well.

Has the law changed recently?

@picknmix1984 We went through The Priory for no other reason than I know it is a big organisation with a good reputation. I couldn't do 'due diligence' as I had absolutely no idea how to choose and didn't know anyone to give me a personal recommendation.

I just found a local Psychiatrist who has a whole well being clinic and googled his work history and back history. He had worked for the NHS locally as well as a private hospital so I could see he was genuine and had transparency.
There are not many that will specifically work with teens and young people but he had experience of that from his NHS work. Then it was just a case of booking an appointment and hoping he was a nice chap to talk to.
Luckily he was lovely and came across very warm and normal that my DD just chatted away easily with him.

@ilovebagpuss

Yes frustrating and so scary when you have a child literally wailing in mental anguish and your GP says sorry off you go. If they were wailing in physical pain no one would walk away and say you might get help in 8 months. There needs to be some sort of middle ground where a GP could liase with a Psychiatrist quickly and offer something/anything. The system is broken but no one will do anything why don’t the professionals push for some other way some middle ground or option between having to go to A &E with a crisis or paying privately. I suppose I would rather pay a separate part of NI for mental health treatment so there is something there to support people. Or just say it’s broken and offer private health insurance for that particular element of the NHS just to pretend there is a service is so wrong. Not having a go at you *@negomi90* just having a rant I just found it all so lonely and terrifying.

I had an issue with this when one of my children was 17+5months. By the time the referral for Camhs was processed and he was seen it would have pushed him into 18+ and the GP could then prescribe anyway.

In effect they were asking him to go away and suffer for 7 months until they could prescribe. Not a good service for those that need basic help but technically they are children there was so little help available.

I ended up paying for counselling but it would have been good to have had extra options.

A friend has a 17 year old and the GP said prozac is licenced for his age. I don't know what age it starts being licenced at though

I think it depends on age and the type of mental health issue. Perhaps if they are pushing 18 and it is anxiety driven or depression the GP is able to prescribe? My DD being 14 and primarily OCD and something else they said they are not allowed without it being through a qualified Psychiatrist.
Thankfully we can just about afford it and from what I have heard about our county and CAMHS even if we had waited I don’t think we would have got anywhere.
I read a report online that 48% of GP’s had at some point advised parents to go private for their children’s mental health care and that GP’s as a group are also fed up of having to pretend their is anything other than crisis provision.

You will probably find it varies hugely from area to area (as everything else does given that funding varies massively between areas).
At my very large very well regarded practice we will not take on prescribing anti depressants for under 18s.
This is for a number of reasons.
In the last 10 years of my practice I have never yet come across a patient who has been treated according to NICE guidelines (ie been given - never even seen it offered - psychotherapy prior to anti depressants being trialled. Often they are given anti depressants that are not the ones on the guidelines either). The guidelines state "the only anti depressant in which the benefit outweighs the risks is fluoxetine" in children.
If I get a letter asking me to prescribe on shared care (with a decent shared care agreement) from an NHS consultant where the above had all been followed I would do it - I've never had it.
As it is I'm being asked to prescribe drugs where the guidelines clearly state that the risks outweigh the benefits - and those risks are increased chance of suicide.
There is zero chance (however empathetic I feel - and I do) that I am going to risk my licence over prescribing something that their consultant can easily prescribe (and that it's their fricking job to prescribe if they want to use something that they're comfortable with but which is not in the guidance).
I promise you that a coroner would take absolutely no notice of "well I felt sorry for them".
Every decision I make nowadays is with a thought about what a coroner or a lawyer would say.
We get complaints about absolute crap the whole time - I'm not going to risk a complaint about something serious.
The truth is that the system is broken. We have a crap government who does not give a flying f**k about normal people. Camhs is the bottom of a very big pile.
We all know that. We complain about that. We try and do things to fix the system.
But unfortunately the system is not going to get fixed without a massive injection of cash and, more importantly, with the powers-that-be actually wanting to fix it and caring about it.

Hello just a quick update if anyone needs this chat for info.
My DD has been on 20mg of Fluoxetine up from the 10mg for 2 weeks and it’s starting to help her. She told the Psychiatrist at our review that although she still has a lot of rituals to do she can occasionally ignore the voices and not do the action.
She also seems happier in herself than I have seen her in a long time and willing to engage in normal household life, shopping, watching a film just chatting.
She is currently upstairs helping her younger sister clean her room (she is mega messy) and I could cry it’s just a nice happy thing to do they are both chatting away.
I think In the past she has scared her sister a bit with the moods and shouting and crying and so she got in the habit of shutting her door.
Anyway next review is 2 months now and the prescription is being passed to our GP following the psychiatrists evaluation.
Still a long way to go but we have someone to turn to which feels so much better, albeit at a cost.
I know it’s not always about medicating I appreciate that but for us it’s been a way out of a dark place.

So glad it is going well OP.

My DD has been back on her meds for 6 weeks and is now up to 40mg. In the past 3 weeks we have seen some good steps forward, she has managed some limited independent schoolwork, and yesterday went into Boots.

@ExcellentGPbutnotapsychiatrist I hear what you say but yet again am disappointed that yet another HCP is blaming a Conservative government because their personal politics are left wing. I am old and had my first baby in 1994 and my 3rd in 1998. In the interim under Labour my local hospital was closed, the PCTs were set up and were an enormous bureaucratic layer where in my area the CEO could not read a balance sheet despite a £60k salary in 1999!

FWIW my dd aged 16 was told by a GP (I was there) that CAMHS were rubbish and wouldn't see her do her mum needed to find her a therapist by googling the Internet. Most reputable therapists will not see a teen actively self harming by od and cutting. As a lay person I was not qualified to do this.

I read the senior partner the riot act and help was given re a therapist and referral to an adolescent consultant psychiatrist sourced through BUPA. After therapy dd was prescribed 20mg fluoxetine and the GP was happy to support this. However an additional 5mg per day was needed for optimum benefit and it made a huge difference (this is contraindicated by nice who say there is no marginal difference between 20mg and 40mg - the psychiatrist, dd and I would disagree). 5mg is available only in liquid form and it tastes like vomit. A compromise was 10mg every other day. I did not appreciate one if salaried gp's muttering about the expense and claiming it wasn't possible. I really do not wish to be put in a position to to have to say "and what about the impact of losing my taxes and her taxes because neither of us can work due to sub optimal care. Some GPS need to have a hard think about how and who funds the NHS and to be cognizant of the fact that it is free only at the point of delivery.

Finally GPs commission services through the CCGs and need to take greater control over monitoring how their commissioned services are run and making them accountable for the quality of and delivery of services. Our local MH Trust was given 2.3m extra in 2015/16. They pissed it up the wall on an additional layer of bureaucracy. There has been another inquiry and yet more funding. For as long as the woeful CAMHS teams continue to exist where professional practice is poor and poor practitioners incapable of listening remain the gate-keepers to Psycholigists and Psychiatrists there will be no improvement and yet the Commissioners allow this to be perpetuated not year on year but decade on decade. Inquiry 1 and relaunch 2009, 2 2014/15, 3 2018/19. Perhaps you would like to remind yourself who was in power between 1997 and 2010. Not the Conservatives and not the LibDems. Perhaps you need to have a long, hard and non partisan think.

Hi just an update again it’s been a useful place for me trawling for info so I hope this might be of help. We have been trying Lamotrigine a mood stabiliser for the last month after a lot of work semi diagnosing a mood disorder linked to the OCD and visual hallucinations.
It’s been a real success so far hardly any side effects and after a slow build up the current dose is really helping. DD says she feels calmer and able to deal with mood changes better. The OCD is still there but sort of faded so some days she can ignore it totally.
Our psychiatrist was willing to let her try this medication as she is so mature and self aware but also children take it for epilepsy from a young age so it is used but for a different Illness.
We are just so pleased that 6 months on we feel we are on a stable medication that is a huge help and hopefully we can avoid years of teen crisis where basically through CAMHS nothing is done except a bit of talking therapy and maybe antidepressants after a very long time asking.
My advice if you can afford it would be go fast and go hard as soon as you can and see psychiatrist and psychotherapist. Yes I have had to put some costs on a credit card but it has been the best money spent.
We also have the contacts now for any further issues so can call on them and we will have reviews through her teen years to check the medication etc. I am paying privately for the medication but it’s pretty cheap considering what a help it is so I don’t care.

I am really glad your daughter is feeling better. We have diagnosed genetic ocd in our family (my mum, myself and my daughter) - I really hope your daughter continues with therapy as it’s been life changing for me. We have recently had to put my daughter on serotonin and I think it’s working. Worth mentioning is if the ocd is affecting your daughters school work her pyschatrist can ask her school to give her extra time and support during exams etc.

My daughter has recently started on fluoxetine and was prescribed by CAMHS psychiatrist. I was told by my GP that in order to get a repeat it would have to done through the psychiatrist.

Patienceofasaint1 the psychiatrist should write to the gp specifying the dose then the gp can prescribe. They do this all the time.

Borderterrierpuppy. Thanks for this. I’m due to speak with him in a couple of weeks so I’ll mention that as I don’t have much confidence of them posting the prescription in time!