To think gps push meds too easily for mh

YANBU - in my early 20s I went to the GP explaining I felt tired all the time and had for a long time! GP said he thought I was depressed and prescribed AD. I took them and couldn’t get out of bed all week - so I stopped. After years of blood tests not showing anything, a dr listened to me saying about the pressure around my eyes and sent me to ENT - polyps! Different person after surgery.

i think AD can support people with MH illness however doctors need to be more accountable for leaving people on them forever! They do not follow up or care or support people to come off them. Withdrawals can be horrendous and when it’s a struggle, they increase meds or add new ones in - starting the whole reduction and withdrawal process again and it can feel impossible.

I hope one day we look back and it’s unbelievable that this ever happened.

That’s really interesting. Thank you for sharing. Hopefully this improves here.

Any of them could have prescribed it then could they not? And/ or written to the GP stating ‘please prescribe amitriptyline’. Depending on the reason for being under a crisis team GP might be reluctant to prescribe a drug known to be lethal in overdose. Either way amitriptyline is hardly a holistic lifestyle option suggestion. It’s just another drug.

Evidence rather grey on what? I’m certain they saved my life. I don’t need any more evidence than that to say confidently that they save lives.

I love my ADs. Just wish I'd taken them sooner. I know that's not the same for everyone, but they have been life changing for me. So glad my GP prescribed them.

The first thing all the patients said to me when I was sectioned was you need to try to get a psychologist. Patients valued them highly and considered them gold dust.

oh, for sure. I trained in the US, where everyone, psychotherapists, counsellors and psychologists all do the same basic training, and then take specialist classes for what they want to do. When I moved back to the UK, I really struggled to find an equivalent role to what I had in the US, so did a training here. It was eye opening. I was in the school of nursing - wtf? Nursing and psychology are very different disciplines, and one does not necessarily set you up for the other.

Dont get me wrong, I have supervised a lot of people who have switched from nursing into therapy and been great. But also seen a lot who are appalling, who really see it as nursing with worksheets and really put people off therapy.

The training structure in this country is too much influenced by different bodies who lobby for their own members, and not enough overseen by an impartial body. So I do think there are more really crappy practitioners out there.

I would like to see the HPC license all mental health professionals with common expectations for training and knowledge.

As for psychiatrists - they are not trained therapists. Some get additional training. But many do not. And I find in the NHS they feel like they walk on water - I was used to a much more team spirit collaborative approach before I moved back to the UK.

Sleep, stress management, trigger recognition and management, exercise like yoga, mindfulness like meditation, mood management, talking therapy, cbt, it’s a lot of work. But the brain is plastic and having been one of the rare individuals who went to the edge. It’s possible to train the brain to recognise the ledge and go back.

What lifestyle advice is going to replace the medication for my schizoaffective disorder?

Are all people with schizophrenia & schizoaffective having meds replaced with this advice & therapy.

The biggest cause of cancer are lifestyle choices & factors - can we delay cancer treatment & offer lifestyle advice first - if they fail to comply they don't get the chemo?

This is true. I had two psychiatrists. One literally knew nothing but medication. Frankly they were awful they didn’t listen at all. I felt they considered me a case to be ‘managed’ rather than I could recover.

The other psychiatrist was great. She was really thoughtful and holistic really.

I had to fight for a psychologist and luckily got one. He was really important in my recovery. It’s funny you say they are underrated by professionals. The first thing all the patients said to me when I was sectioned was you need to try to get a psychologist. Patients valued them highly and considered them gold dust.

Yes I thought that was odd

GPs prescribe too many antidepressants and yet I am cross because my GP did not prescribe me an antidepressant!

However the NHS don’t want to put in the leg work, and they don’t want to risk it.

I think it is less a situation of not wanting to do the leg work and more about structure. The NHS has a focus on doctors and nurses - there are relatively few psychologists and in many areas psychotherapists and counsellors are not valued or prioritized.

So if most MH staff are medical model trained, they are going to go towards medications.

As for risk - yep, the whole NHS runs scared. But look at what happens when something bad happens.

Mine didn’t. When I’ve spoken about my health anxiety over the years, my GP has told me she doesn’t think I need meds - the decision to start them took place after lots of discussions.

She is very balanced - I now take them. But it wasn’t a quick decision and wasn’t seen as a quick fix.

I agree it’s the lazy option sometimes.

I do believe in psychiatric medicine. But I think it should be seen as acute firefighting rather than necessarily long term (obviously there are many exceptions).

I had first episode psychosis. Thankfully I had a friend who guided me through it. After I was medium recovered they said you need to get off these meds. Sent me the papers to back it up. He was right. Newer research shows people with the right support who stop antipsychotics after a short period with FEP; do have better long term outcomes.

However the NHS don’t want to put in the leg work, and they don’t want to risk it.
Stopping the antipsychotics increase the short term relapse rate. And every relapse makes the situation more likely to develop into longer term conditions like schizophrenia. But statistically as a whole cohort; the cohort who do stop are better off in long term stability and relapse.

Its tough. I am super grateful I had that extra support and whilst the early intervention in psychosis service is world class it still has a way to go imo.

In most areas you can self refer to NHS Talking Therapies so you don’t need a GP for that. What else have they really got to offer apart from meds?

and lots of 'therapists' don't seem to be any good

So, any profession will have good and not so good practitioners. But this is why 1. psychotherapist and counselor should be protected titles. 2. Accreditation should be done by the HPC. 3. Consumers should be better educated to interview potential therapists.

In this country we also have a glut of people who only have a narrow focus or one theoretical orientation. Instead of people who have a good solid base in common with people who practice but who may use a different orientation or approach. IAPT services did not help. There are a lot of people claiming to be psychotherapists who only have training in CBT, and not very good CBT at that. It got highjacked by some professions such as nursing or OTs, who do not necessarily come in with a psychological focus.

That paper has been heavily criticised for bias
Joanna Moncrieff has made a career out of being against antidepressants. I would take anything she says with a huge pinch of salt.

https://www.nature.com/articles/s41380-023-02093-0

why the rapid increaase

Services for MH are in freefall crisis. Waiting times have increased so much that even people in crisis may have to wait. IME when GPs knew that people may be seen quite quickly they were more ready to suggest waiting. But in the absence of other services, offering meds at least feels like doing something which may help.

Sorry that was in response to @WasItLoveOrSomethingElse