GP won't prescribe 60mg Mirtazapine.What can I do?

Hi,

I have been taking 60mg/day of Mirtazapine for the last 6 years, it has been very effective, I have tried without success many other medicines before.

I started taking Mirtazapine abroad, because I moved to the UK 2 years ago.

Until now doctors in the UK had no problems prescribing me the required dosage, I have letters from the psychiatrist (the original one, when I was not in the UK) with the diagnosis (depression) and the prescribed 60mg/day.

Until now: because the new GP is refusing to prescribe more than 45mg/day, because it is not in the manual.

Obviously I am very worried, I am not willing to go down to 45mg, it is too risky.

Please, what can I do?

If a psychiatrist (maybe a private practice) is willing to prescribe me the 60mg/day in the UK, would/could the GP accept that and prescribe me the 60? (I am thinking of contacting the old doctor, who has colleagues who share the same approach).

Thank you for your advice.

Hi and welcome. We can't give specific medical advise as we aren't trained to do so - however I would ask your GP why the change in policy and what they are proposing to help you over quite a large drop in dosage. You could ask for an urgent referral to the CMHT or a psych, but these will take time. How long do you have before you run out of your current prescription?

Hi Suzi,
Thank you for your kind reply!
I am not asking medical advice because 60mg have been prescribed already to me for a long time (6 years: 2 in the UK, 4 in the continent).
I only wish to keep on taking what has been already prescribed.
The problem is that I had to change GP, the new GP is not willing to prescribe 60mg, because, according to the manual, the max dosage is 45mg/day.

I am sure I can find a psychiatrist in the UK willing to support the 60mg/day dosage (as I have been taking until now).
Would the prescription/opinion of the psychiatrist help with the GP?

Thank you for your help.

Hi and welcome. I have in the past been on mirtazapine, while on a mental health unit, under psychiatric care and under the GP care. In all that time, I understood that 45mg was the highest dose that could be taken. I have to admit I’m surprised you were able to get a UK GP to prescribe that high a dose at all

I am not sure if you'll get anyone to prescribe a dose which is higher than what is stated as the "maximum" one tbh, but you could call your local pct and ask if they can help you?

Hi Suzi, thank you for your advice, I am not sure, how they can help? I have record of recurrent prescription from the previous surgery, my old doctor prescription and I an not the only one in UK wha has been taking 60mg https://patient.info/forums/discuss/...azapine-325306

But your PCT might be able to suggest a route for you to get the dosage you are currently on. As I said, we can't comment on maximum dosage or medication as we aren't trained medical professionals. Best to ask those in the know - maybe another Dr at your practice or another one?

Thank you Suzi.
Please how do I find my local pct in west London? I read that now they have been replaced by some other institution https://en.wikipedia.org/wiki/List_o...sts_in_England.
Thanks again Suzi.

Start here and ask for their help? http://www.wlmht.nhs.uk/about-wlmht/who-we-are/

Thank you a lot Suzi!

They might not be able to help, but it's a good starting point...

Please Suzi, do you think it would be a very bad idea to change surgery?

If you don't get on with your GP or don't trust them then I don't see how you can continue with them, but that's just my opinion. I would suggest contacting someone such as the mental health organisations in your area or ask friends/family for recommendations..... But they may say exactly the same as the Dr you are seeing now...