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Anxiety, and recreational purposes
(11-09-2018, 07:56 AM)magick Wrote: Late afterthought. With the usual "not medical advice" disclaimer, I think we across the pond have perhaps under-weighted what you said about the costs, both relative and absolute. I would be hurt over paying $270 / £210 a month for escitalopram, mirtazapine, alprazolam. FWIW I concur with you about dropping escitalopram (Lexapro - SSRI) as likely to be redundant alongside mirtazapine (Remeron). You are correct that the latter is helpful for sleep at lower doses; I've known people to use 15mg and 45mg so you're on the right track. The further info from you leads me to a mixed response. 

For the set of diagnoses that you describe, and whilst a medication-based approach is desired, you could ask your psychiatrist about monotherapy with quetiapine (Seroquel, but I refer to quetiapine fumarate, which is available as generic). You might like to know that, when I started taking it in 2012, I was at first offered Seroquel XR (and you probably will be; use caution). Our National Health Service had just sent round a memo instructing that patients be switched to the generic, immediate-release quetiapine fumarate. It is not a panacea, and not to be preferred over getting off benzos full stop if this is possible. Indeed, quetiapine is controversial; used long term there is weight gain and I should also direct you to this skepticism of limited evidence prescribing practices. Particularly: "Little is known about the reasons for off-label prescribing, but a historical perspective of sedative and hypnotic prescribing trends shows a move from barbiturates in the 1920s to the 1950s15 and then to benzodiazepines from the 1960s,16 mainly because of safety concerns. More recently there have been increasing concerns about the harms of benzodiazepines, in particular alprazolam17 which was rescheduled from Schedule 4 to 8 in 2014.18 When prescribers are confronted with requests for prescriptions to treat anxiety and insomnia they are aware of the hazards of benzodiazepines, but may not have access to, or skills in, psychological therapies.19,20 Quetiapine has sedative effects, so it is possible that quetiapine is being prescribed instead of benzodiazepines due to perceptions regarding safety and efficacy." Structurally, it's a thienodiazepene. I do not advance (nor share) a view that "because x, therefore you need y"; so far what I've suggested looks like harm reduction as compared with SSRI+TCA+BZD and, if required at all, it's likely as a means to an end. Among the second-generation antipsychotics, quetiapine has dose-dependent binding affinity for various different receptors which lends it anti-depressant as well as anti-psychotic properties.

Now, an obvious thought for you. Subject to what a pharmacy can fill (a fine thing to find out), you could ask to be prescribed generic escitalopram rather than Lexapro, generic mirtazapine rather than Remeron, and generic alprazolam rather than Xanax. So I had a quick look, figuring that alprazolam wasn't going to be among any of these discount drug programs - and came up with something better than expected.

"Rx Outreach is a non-profit, mail-order pharmacy that provides over 500 affordable medications to people in need. We have provided prescription medications to over 500,000 patients. Rx Outreach was a program that was developed by a subsidiary of Express Scripts, Inc. in 2004. In 2010, Express Scripts spun off Rx Outreach to be a stand-alone, charitable organization in order to improve access to prescription medicines for low-income, uninsured patients." (I've linked you straight to the eligibility criteria to avoid false hopes; from what you say, they appear to be met...) If they're an option, the prescriptions listed in your May post would weigh in at $30 for 90 days' worth of mirtazapine, $15 for 90 days' worth of escitalopram and $18 for 90 days' worth of alprazolam. That's $63 versus $816 for 90 days, taking ~$250 a month off the cost.
Thank you magick for the very valuable information on the discounted pharmaceuticals.
Sorry that I'm just now getting back on here to see the past couple of comments. Again, thank you all fellow reseachers!

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Messages In This Thread
Anxiety, and recreational purposes - by BustmBama - 12-04-2018, 03:22 PM
RE: Anxiety, and recreational purposes - by niamh - 12-04-2018, 04:47 PM
RE: Anxiety, and recreational purposes - by BustmBama - 09-11-2018, 02:52 AM

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