Meds DD 17years old!

[clareybel]

Wondering if anyone has some helpful advice.
DD 17 years old is under a neurologist for severe tension headaches and has a GONI every 3months which helps. Her consultant has now recommended Sertraline to help lift the mood, give some relief hopefully to the anxiety which in turn will help help with the tension and the headaches. She has Anorexia which is hugely under control as in she now asks what's for dinner I am starving hungry under control! We have tried every therapy under the sun all paid for by ourselves so this is really a case of we have tried everything and now maybe meds are the answer.
The consultant wants the Gp to prescribe, the GP won't prescribe. By the time Cahms see her she will be 18 due to the waitlist, adult services won't see her as she is just 17 so we are lost in a void in the middle and don't know where to turn. I have a call from her consultant scheduled tomorrow afternoon but I am quickly thinking maybe a private psychiatrist is going to be our best option.

Why has the GP overruled the consultant?

The consultant can and should prescribe long-term, s/he just won't want to. Be very forceful with the consultant via PALS that it is their responsibility to prescribed. Not acceptable to push SSRI prescribing, which is quite high risk, to the GP.

Because this is not typical prescribing and not licensed and so it's completely reasonable to expect the specialist to put their prescription pad where their mouth is and prescribe themselves.

The consultant has written to the GP presumably suggesting this medication?

or is it you telling the GP that this is what the consultant said?

the consultant can and should prescribe. Once settled on the medication and if there's no problems because of it then it'd be reasonable to ask the GP to take over, but starting up slightly unusual treatments should be done by the person suggesting it. It's a very commonly used drug, but for children IIRC only licensed for OCD/major depression... am pretty sure anxiety is off label, and while it can be done, it's usually started by the specialist. There are lots of easily googleable hospital trust guidelines for paediatric SSRIs that support that the GP is probably being reasonable. (It can cause appetite changes and that may be something the GP's being cautious about and wants the consultant to monitor in someone who's vulnerable to difficulty with eating/appetite).

We had a battle with my daughters GP getting them to prescribe a medication not licensed for under 12s when she was 1. Specialists can prescribe things that GPs can't, in this case we had gone privately. The private paediatrician gave us a private prescription and told us to ask the GP to issue an NHS prescription for the same thing. There were 3 items on it, 2 they were happy to prescribe but the 3rd they said they could only issue if a specialist had prescribed it. We told them 3 times that they had and it's on the prescription....they claimed we hadn't given them the prescription even though they had prescribed the other two items. We eventually spoke with the office manager and she found the letter the paediatrician had sent the GP outlining the medication plan and within half an hour the prescription was at the pharmacy.

Can the neurologist contact the GP?

Being 17/18 is a difficult time for mental health, the camhs in my area had a 16-19 service as part of camhs, bridging camhs and cmht. I was 18 when I was seen by them which was fine except when I was borderline for needing an admission as the children's wards wouldn't accept me and my Dr didn't want to send me to an adult ward. I had a mix of depression, anxiety and anorexia

GP’s cannot prescribe Sertraline to under 18’s it must be prescribed and managed by a child psychiatrist, after the first prescription the GP can issue repeats. When your DD is 18 the GP will be able to prescribe - how far off is her birthday?

Like other comments, the consultant should prescribe. My GP won't even prescribe melatonin for my daughter, has to be her consultant.