CAHMS refusing to prescribe DS 16 with Sertraline

[Zoomusicgirl242]

Hi, my DS, 16 (ASD / PDA /ADHD) was recommended Sertraline by a private psychiatrist who we had to hire after CAHMS discharged him twice for "refusing to engage". The prescription has to be carried out by his GP who refused to do anything other than pass it onto CAHMS who refused. In fact they seemed disgusted at my keeness to try meds after nothing else has helped him. He's been refusing school off and on for 3 years and regularly falls into depression and extreme weight loss. I see many mums of teens on here talk about success with Sertraline. Is this GP/CAHMS loop we are stuck in, a regional problem? We are in Lincolnshire. Thank you.

Private psychs are generally happy to write private prescriptions. Can you afford to pay?

Some gp practices will convert the private prescriptions to nhs ones.

Mine was prescribed fluoxetine at 16 by a private psychiatrist. We had to pay for private prescriptions until the dose was stable and then the GP took over.

I can see why a GP wouldn't be willing to be responsible for the initial prescriptions due to possible side effects in first few weeks.

Sorry, but you need to obtain the prescription from the private psychiatrist you saw. GPs are not obliged to do shared care (ie, prescribe upon ‘recommendation’ of a private consultant and take on board the costs of medications from their own budget) unfortunately, although some will. You could try speaking to an alternative GP at the practice, if there is one with specialist training in ASD and/or mental health as a different GP may be more receptive than the one you originally spoke to?

A private prescription issue/admin charge is about £50 and sertraline is about 28p per 50mg tablet, so a month’s supply would be less than a tenner on a private prescription. You’d, unfortunately need to have regular medication reviews initially with the psychiatrist until the dosage is correct (that costs us £250 each time for my DDs ASD/ADHD medication).

You can also speak to the psychiatrist and then your GP about ‘shared care’, rather than relying on them acting on a psychiatrist’s letter. It may be that the GP took umbrage at the presumption but may be receptive to a shared care arrangement where they will authorise the issue of the meds on the understanding that there is a formal agreement that recognises that the psychiatrist is the prescribing clinician (ie the GP is not liable for any issues arising…)

GPs cannot prescribe under 18s with meds. They have to refer the child to CAMHS to be reviewed by a psychiatrist. Only a CAMHS psych can prescribe. If you want to meds you'll have to go back to the private psych to prescribe

Any chance the person you saw is a psychologist? Rather than a psychiatrist?
Why would they not just write the prescription if they feel it's indicated?

GPs can (and do) prescribe SSRIs for under 18s but very, very rarely because it's against NICE guidelines.
In most cases it has to be a CAMHS psychiatrist or a private one but then you will be paying private prescription prices and need to pay for titration.
Sertraline doesn't suit everyone though so it's a bit of a case of trial and error when it comes to anti-depressants.

It may not help. My 18yo went on Fluoxetine and then sertraline, neither has helped him at all.

But they won't know unless they try.
Fluoxetine was a game changer for my DD.

Sertraline worked well for my autistic DD with OCD. After a horrendous time with CAMHS and local GP I got and continue to get a private prescription from a psychiatrist through Clinical Partners and it's changed her life for the better. The private prescription is only about £20 a month.

I'm just saying this because that's what I read on here so many times. That it saved people's kids. I was so set on meds because I thought it was the 'answer ' and it's done nothing and it's difficult to deal with when you thought it would fix your child.

That's fair (and sorry it didn't help you).

DD has improved with a combination of meds and therapy, both supporting each other.

Reading responses here - my DD was prescribed both fluoxetie and sertraline under 18, both by the GP directly and in response to CAMHS (after a 20min consult!) but neither worked for her. Nor did any of the subsequent meds. Took a knowledgeable GP once she reached 19 to try something that does actually work for her, citalopram, and by a GP who understood that you need to slowly titrate (on 2.5mg intervals every 2 weeks, until reached 30mg).

Which ever medication OP’s DC is prescribed, it needs to be monitored monthly and gradually increased. In our case it has taken 3 years to find the right medication, so it’s ntot a case of receiving a letter recommending sertraline be prescribed and letting the GP run with it. It needs supervision and management.

This is why I feel OP needs to go back to the original private psychiatrist and ask them to manage it for the first 3-6m, and then asking GP for shared care once the right meds/dosage is arrived at.

Same worked brilliantly for my autistic daughter

Have you tried medication for his adhd

I'm hoping my son will be given citalopram.

Both DH and I have been on it at some point in our lives and it helped both of us.

Been life changing for my DD. Much lower side effects (Asd/Adhd so a bit sensitive to any side effects!!!) She was suffering extreme anxiety/panic attacks/OCD but now is more even, 2/3 through an access to HE diploma, and holding offers to university in September (including Russel Group and top 10 unis for her subject). Before this DH and I thought she would be on disability benefit, never get L3 qualifications and would be stuck on minimum wage part-time jobs for life.

It’s so important to be open to trying new meds if the first ones aren’t right - but sertraline is great for many many people, so it’s a great first line medication.

It's because of the side effects. CAMHS have to follow nice guidelines which is therapy for under 18s. The rate of severe side effects like suicidal ideation is higher in teens than in adults. The guidelines reflect this.

Thank you so much everyone, I really appreciate your advice and experience. It never occurred to me that I could have gone back and asked the Psychiatrist (but yes, maybe she was a Psychologist???? Good point!). She was under an umbrella private practice. I would definitely have paid if she had asked and definitely gone back to her to ask if I'd thought about it but we got stuck back in the CAHMS loop so it didn't occur to me! Wow, thank you. This was back in December. So glad I asked here!!!

My understanding is only a psychiatrist not a psychologist can prescribe.

The private psychiatrist can prescribe for a fee for ongoing meds. I agree that if time demonstrates it works and they're stable then the GP could agree to take over.

Just had fluoxitene suggested for Autistic/ ADHD teen.

And it sounds like the GP needs a prescription themselves - for being a one cell ignorant bell end. Was it a male per chance?

People wonder why parents like us are on our knees right now.

Good luck. Hope it helps 🙏,

Honestly GPs aren't meant to prescribe these to under 18s due to side effects.
It isn't the GP's 'fault'.

It needs to be a clinical psychiatrist. Until DD was 18 she stayed officially under his care, with him writing to the GP after each review explaining the meds required.

It was reference the part where OP explained the GPs reaction to the suggestion itself that meds were suggested here.