To think gps push meds too easily for mh

In a nutshell.

Is the evidence not rather grey on this?

'It only takes a couple of minutes... to assess the severity' also sounds like 'glib talk' to me though.

I have struggled my whole life with depression. IME most GPs have been sympathetic and want to help - but realistically prescribing ADs is all they can do. There was a time when they could refer you to the practice counsellor, but I don't think anybody has these any more.

My beef is with adult mental health services, which are stretched to threadbare and provide very little. There are CBT courses (useful but not always sufficient) and emergency services for the suicidal, and almost nothing in between.

The Government's fantasy that all these chronically depressed people just need to go back to work is a joke in the context of the vast unmet need for mental health services in this country.

@RobertaFirmino …..totally incorrect. It is not about ‘brain chemistry’ or ‘neurotranmitters’ I’m afraid.

Let’s just say patient A comes in to GP. History of depression/anxiety/panic attacks.

Your answer is there’s a pill for that?
The OP is 100% correct in their comment about pushing meds.
A GP does not have the time, nor knowledge, nor access to fundamental services, practices or therapies that could help.
They would prescribe medication to help patient A ‘deal’ with the worst symptoms, whilst healing nothing.

I’d like to know about your knowledge of mental health, illnesses and the like.
Patient A was abused very badly during childhood, young adulthood and only just survived for many years. Not fulfilling any potential.
Patient A has no access to nutritional food, safe housing, and is carrying a brain injury due to the abuse endured over a lifetime. Highly probable CPTSD.
A pill does not heal.
Patient A has endured horrific cruelty, abuse, etc and it’s akin to living in a war zone.

Patient A along with others would love some answers.

You do know that amitryptiline is an antidepressant? One which is very heavy on side effects and dangerous in OD.

Social prescribing is an empty buzz phrase to put responsibility back on patients who dont have the means or resources or treatments they need.

Or my late fathers wonderful advice “ just pull yourself together “ 🙄

I don’t really understand the point you are trying to make OP. Your posts don’t make sense to me.

Therapy is probably a better option for some people with mild depression but it’s not readily available for GP’s to prescribe. I would say a bigger issue than starting people on antidepressants is leaving people on them for years and years without review.

They usually tell you to start the meds and come back in 6 weeks. Then they can start talking you through lifestyle stuff. If someone is sitting there in crisis asking for help and they get told "eat better and walk more" it's not going to actually help them in anyway. The meds help get you into a better mindset ready for further help at the 6 week mark.

It's not a perfect system and many people don't engage with it properly or don't go back, or can't get an appointment, or see a different GP who didn't know exactly what was happening. We do need an overhaul of our MH system as it's failing many people right now.

But the issue isn't the meds themselves.

Well I havent read the whole thread OP but its much more nuanced than your OP which people probably have already pointed out

You do need to be in a fit state emotionally and mentally to be able to take advantage of therapies, so sometimes people need meds to get them to that point

On the other hand GPs dont have much else in the treatment armoury, long waiting lists etc even if available. CBT is usually offered but that is not only ineffective for lots of people but is usually only 6 sessions, it cant touch the sides and I think its not that useful for people who are ND

Therapy is also not a fix all that its often made out to be on here, like as if you have therapy and then its all ok, some people cant respond, some people dont hvae the emotional insight, some people dont have the intelligence or cognitive functioning to manage therapies. The quality of therapists are really varied too, you can swap about for years trying to get one thats right and the NHS doesnt have that option for us.

Sometimes poor MH is simply like any other illness and needs chemical or physiological intervention and drugs is what keeps someone on an even keel

Sometimes its solely a lifestyle change thats needed but perhaps someone needs medication to get the motivation to exercise or lose weight or move house or job or any number of those changes that are needed.

I think meds are a really positive thing personally but I do also think that society needs to be structured in a more emotionally healthy way.

How about 'Pull yourself together'? That's always worked for me!

Thanks for this post. I struggled with depression for years. Fortunately for me, I had none of the complicating life factors like the ones you see in your patients.

I ate well, exercised regularly, but the only difference it made was in people’s perception that I was somehow exaggerating my symptoms.

anti- depressants were a game changer for me- and I’d echo what your patients said. I avoided them for so long because of the stigma, but they sorted me out. I’ve been off them for years now, so it’s not a lifetime thing.

This. Without my laundry list of meds including antipsychotics, mood stabilisers and antidepressants I'd be fucking dead.

I have schizoaffective disorder and medication means the difference between living a near normal life & being permanently sectioned.

Why so much hate for psychiatric medication? Someone with heart disease, high cholesterol or diabetes don't face the same stigma.

Why shouldn't a GP prescribe an affordable life changing & life saving medication without insisting on 'lifestyle advice' first. Why not both?

If you had an infected wound, would you accept antibiotics for it? Or would you try lifestyle changes first? Like bathing it more often, or just pretending it doesn't exist?

Anti depressants have a poor evidence base
In terms of positive impact for mild to moderate depression.

They also have side effects and can be difficult to withdraw from.
For severe depression and crisis they can of course be live changing or even saving.
But these reasons would not be the basis of most decisions to prescribe.

I think GPs are really stuck between a rock and a hard place , they are time and resource poor and patients may often seek a prescription as a sign that something has been done for them.
The percentage rise in prescription of ADs is quite breathtaking. Many children now on these drugs too.
It can't be a good thing overall

Well said 👏

Some people, yes, but there are a surprising number of people who dont seem to know. And GPs are doctors, so they think in terms of medications.

But thats not always the case is it? Not to mention the implications for some job applications etc.