On the Cheap

People in my world have long suspected that doctors and the NHS too often make decisions on the basis of cost rather than need. How long did it take for SSRIs to the place of tricyclics? Why is venlafaxine prescribed as a weapon of last resort? And did the advent of atypical antipsychotics really need to be delayed so long to the many rather than the few?

During my MSc in Mental Health Practice I learned of the complex mathematical equations used to evaluate cost effectiveness and efficacy of drugs right across the piste. But I had never until last week been knowingly affected by this flawed and baseless practice.

Last Friday I spoke to my GP for the first time in nearly three years. Yes that is how hard it is to get an appointment. He wanted to talk to me about medication despite my consultant reviewing things every three months. Apparently the pharmacist who has caused me so many problems in the last few months has now suggested that I be switched to a cheaper alternative to my Trimipramine. Since when did a pharmacist make decisions about my care? Especially as they have never actually talked to me about what I take and why. I have long doubted the effectiveness of antidepressants but the key indicator for me of relapse is insomnia. And having tried everything on the market with little effect it is the only pill that gives me consistent sleep. I certainly wouldn't change that for the world. Maybe I shouldn't take it for sedation but I done really care.

I'm speaking to my consultant on 5th January and it will be an emphatic no on my part to any spurious suggestion of change on cost grounds.

This aside I'm doing okay. True I'm utterly alone and cannot see anyone for Christmas. I am a little anxious but my mood is holding. Nearly everything is ready for the subdued big day. I'm not at work. I spoke to my therapist today. And my lovely friend Karen. In these uncertain times I cannot ask for more than that. What is is.

Normally at this time and date I would be sat at the bar of The Butt of Sherry talking to dad and old friends. But it is not to be this year. I will make the most of what I have, cook up a multitude of feasts, consume wine and listen to opera. The odd walk is welcome, I'm just back from a rather dark and damp wander. And there is always our new found lockdown ways of communication. The Selwyn crew on Christmas Eve. Dad and Miriam on Christmas Day. And who knows who else.

I will be on here on the day to wish you all a merry Christmas. Until then take care.

I Heard a Voice.