To think gps push meds too easily for mh

I’m a GP. I hear this criticism all the time from people. I’d love to know why offering antidepressants seems to affront people so much, and what they would do to treat people’s depression instead. We are in the business of practicing evidence-based medicine. There is a lot of evidence for the efficacy of antidepressants and unfortunately a whole lot of unhelpful untruthful myths about antidepressants and about depression itself.

I wouldn’t say that I “push” antidepressants, but I do suggest them as part of treatment to the majority of depressed people I see. Because they work well for most people. I’ve had so many patients tell me once they’ve recovered from depression that they wished they hadn’t waited so long to try them in the first place because of those myths and misunderstandings. Depression is a horrible miserable illness and my main aim is to help people recover from depression. I don’t have an issue with that being achieved through antidepressants.

In terms of lifestyle advice, other than for mild depression, lifestyle changes don’t make a significant difference in helping someone recover from depression. If someone is ant the point of not being able to get out of bed and get washed and dressed in the morning they’re not going to be able to manage couch to 5K are they? And only so many things are within an individual’s control when it comes to addressing lifestyle. All very well for me to tell a disabled isolated single mother living on benefits looking after disabled children that her depression would be better if she got out to the gym more, cooked from scratch with fresh veg, slept for longer, socialised more, got a break now and again, had a loving supportive partner and more money. But she doesn’t actually have the resources to do so because that is how our society is set up.

We have to work within the limits of what is feasible and realistic as well as being effective.

I've had depression. Anti-depressants worked like a miracle for me. CBT and other therapies were mostly useless and time-consuming. I think a lot depends on the individual and the therapist though.

My first thought of "lifestyle advice" was to tell people just don't be depressed. 😉

Given that waiting lists for talking therapies often stretch to years and that many of the people seeking help for MH are often at breaking point, I think it's perfectly reasonable.

I've never been on antidepressants but I've seen first hand that they can be a life line for many people: I know several people whose lives they have literally saved. They're not appropriate for everyone but it irritates me when desperate people are judged like this for seeking something legal and extensively trialled which they know can help them.

I agree with the others. It is so hard to get therapy so meds are the option left.

What exactly do you think a GP is going to offer, to someone who has turned up to see them saying they are depressed?

The choices are:
Go away and hope it gets better - probably already tried before they got to the point of attending, many people have little ability to make changes to their lifestyle being stuck with their work/partner/family/place they live/physical health
Self refer to talking therapies - lots will have already done this, or not want to
Have medication

That's all the GP has to pick from.

People can’t wait 12 months for therapy, people can’t sit waiting - it’s the only option. Any lifestyle issues are probably because they are depressed and have no motivation.

There really isn’t much they can offer. They don’t offer group therapy where I am anymore and my clients say the wait for individual therapy is now greater than 6 months.

I dont think they push them before lifestyle advice but can appreciate not everyone can adjust their lifestyle (small kids, carers etc etc) and know other help is unlikely to happen.

There’s a lot of stigma around taking antidepressants and being seen as the “easy option”, as evidenced by your ignorant post.

antidepressants save lives. “Lifestyle advice” makes it sound like you think depressed people just need to go for a walk and drink more water

What else, realistically, can they offer which MAY be of some help sooner rather than later?

Doctors advise medication for illnesses which are often caused by the brain not making the correct amount of neurotransmitters - shock horror!

Is this based on your personal experience op?

They don’t have anything else to offer.

If it's difficult for people to access therapy then it seems like there are not a lot of other options.

Do you not think some people already know about the life style advice and would follow it by themsleves if they could?