Upset by GP - was she right?

[LunaNorth]

I’ve been on citalopram for six years, for generalised anxiety disorder, plus health anxiety. I suffer from OCD in the form of intrusive thoughts, too. All this is just for context.

Citalopram has given me my life back, tbh. I tapered off it two years ago, and all my symptoms returned. I went to see the GP who prescribed it, and we agreed that i should stay on it. She put it that some people need an asthma inhaler, some people need insulin, some need citalopram. All fine.

Until last night, when I had my review to get my script renewed. Some GP I’d never met rang and when I told her I’d been on it for six years, started to lecture me about how she only prescribes for 6-12 months; how after that it stops working; how people think they need it because of the withdrawal when they stop, but if they can ride out the bumpy time they find they get better; on and on.

She asked me nothing about my mental health, my history, nothing. Just kept booming, ‘nobody is going to take it away from you, but...’ and then launching into another lecture.

I came off the phone really embarrassed, anxious, doubting myself and I haven’t really slept. I also plunged into a big emotional eating binge.

I’m sorry this is long. I’m just cross but also wondering if she was right - not in her approach, but in what she was saying?

Thanks for reading if you’ve got this far.

They will be under pressure to cut costs, hence the hard sell.

Ignore her and tell her you want your prescription. If she persists, tell her you want links to the research showing antidepressants stop working after six months.

She gave me the prescription, which is why I’m wondering what the lecture was all about.

It was like she wanted to get it off her chest!

I think it’s always hard when it’s not your normal GP.
Ignore her, just ask for your normal one when you next ring.

Aw sorry you felt how you did. Maybe she felt she was obliged to let you know what she knew and equipped you with some knowledge to make your own informed decision x

It certainly didn’t come across like that, but it might be helpful to try to look at it that way

If you ignore the fact that she is a GP she is just a dick. That sounds like her motivation was cost saving not your well being. I wouldn’t give it another thought. You have sorted out your mental well-being and found out what works for you.
Phone your surgery and put a telephone request for your usual GP to give you a call. She can review your meds based on your shared history she is a much more qualified candidate.

I would email the practice manager and give your feedback, make sure it's shared with the GP in question. Medics need feedback to reflect on the impact of their practice. Otherwise how can they develop into better doctors?

A GP I saw for my son said IVF babies are more likely to get genetic disorders and deformities and so she will refer him for further pediatric tests. I wanted the consultant appointment and so let her book it, but then I asked for the research she’d read and she sent me some random Google link around ICSI. I complained about it / her and they must have had concerns about her anyway because she was removed from the practice not long afterwards.

She can review your meds based on your shared history she is a much more qualified candidate.

How would you know a GP is more 'qualified' because she's had OP on the same drug for 6 years... just because she knows her history doesn't make someone more qualified. Anyone could look at notes and put someone on the same medication for another 6 years....

That was a really ignorant comment.

Some people 😂.

I've been on citalopram or a similar SSRI one and off since my teens (I'm now in my late 40s). I tried to go off it multiple times in my 20s and 30s on the advice of GPs whom I now consider to have been pretty unhelpful and clueless. One GP said to me, 'You're too young to be on medication for the rest of your life.' (Would he have said that to a person with diabetes, etc? I think not!) Every time I've gone off it, I've slowly descended into crippling depression again. Finally I got a GP who told me, 'It's cheap as chips [!], as long as it helps you you should carry on taking it.'

So I've made my peace with it and I've stopped trying to go off it. It's not even a particularly high dose, but it makes an enormous difference to my quality of life. On meds, I'm a functioning mum and uni lecturer. Off meds, I eventually reach a point where I go to bed for days at a time with depression, and it takes me ages to claw my way back. On meds, I still feel low and depressed from time to time, but the difference is that I don't STAY low and depressed. A couple of days go by and I wake up feeling better. Knowing that the low ebb will pass helps me get through it. Without the citalopram, I have no bloody idea whether the low ebb will pass and how long it will take.

So frankly any GP who wants me to try stopping citalopram now can get lost. I'm not going to play Russian roulette with my mental health in order to satisfy some GP all over again that yes, I really do need the meds.

I would just dismiss the advice of that GP. You know your body and mind much better than she does. Be strong and advocate for yourself! See someone different if she won't refill the prescription. I identify with all the feelings of insecurity and self-doubt, but you know from experience that the meds are helping you. Hold onto that knowledge and trust yourself. Good luck!

I think most people are supposed to try tapering off ADs after 6-12 months of feeling better, but then if symptoms return, there's nothing at all wrong with going back on them. The way I see it, whatever negative points there may be about me being on Sertraline long term, they are completely outweighed by the difference they make to my overall quality of life.

Ultimately a GPs goal will be to wean you off them? And yes another GP looking through your notes would be surprised that you have been given 6 years of repeat prescriptions without investigating other forms of coping mechanisms - Are they even designed to be taken indefinitely?

@andivfmakes3

Ultimately a GPs goal will be to wean you off them? And yes another GP looking through your notes would be surprised that you have been given 6 years of repeat prescriptions without investigating other forms of coping mechanisms - Are they even designed to be taken indefinitely?

If she’d have asked me I could have told her that before agreeing to meds I did eight years of talking therapy.

I’ve also stopped drinking alcohol, I take lots of exercise, have changed jobs to a less stressful one - trust me, I’m trying.

But it’s not enough. I need citalopram too.

@andivfmakes3

Ultimately a GPs goal will be to wean you off them? And yes another GP looking through your notes would be surprised that you have been given 6 years of repeat prescriptions without investigating other forms of coping mechanisms - Are they even designed to be taken indefinitely?

Sorry, but that's an ignorant comment. Some people are able to come off them in the short or long term, others can't come off them without returning to the same mental state that led them to seek help in the first place. So yes, some people are on SSRIs permanently, just like some people are on insulin or asthma meds, permanently, and that is what is right for them.

@cassandre thank you for your comment upthread, you’ve made me feel a lot better. You’re right - the symptoms still crop up, but the meds make them manageable.

I've also done talk therapy multiple times, stopped drinking alcohol, practice meditation etc etc.

But the citalopram is an essential element of my self-care regime, in order to avoid the suicidal ideation that I used to experience on a fairly regular basis.

Yes, I find meditation helpful. It’s hard, isn’t it? I really didn’t need to feel like this.

ThatsnottheHunty
I think a shared history of a patients medical history and knowledge of them personally is an important relationship.The experience of the OPs attempt to come off the drug previously, and knowledge of their ongoing stability whilst on the drug is important information.
I think that being aware of a patient personally and having met with them over a 6 year period to discuss their medical well being and jointly deciding that remaining on an effective drug longterm is the best plan for their well-being is a good thing.
It doesn’t compare with a new GP just phoning up and being flip. I think fresh eyes can be helpful if there is a constructive review but this new GP asked the OP nothing about her medical history.
I think your comment sounds ignorant not mine.

I’ve been on sertraline, fluoxetine and now Venlafaxine alongside sessions of CBT. I kept weaning myself off as I thought I didnt need them, even after a GP said I should stay on them. My GP practice merged with another and again another GP recommended going back on them and took the time to talk through why I kept stopping.

I’ve come to terms with the fact i’ll probably be on them for life because without them, even armed with my coping mechanisms learned in CBT, my mental health rapidly declines. I have no qualms ordering my inhalers every few months, now my SNRI is just as vital to me as my Ventolin.

I’d dismiss her lecture entirely

Honestly If they told you anti depressants stop working after 6 months I would make a complaint because that isn’t true.

I sometimes think gps don’t have a clue with antidepressants.

[quote LunaNorth]@cassandre thank you for your comment upthread, you’ve made me feel a lot better. You’re right - the symptoms still crop up, but the meds make them manageable.[/quote]
Ah good, I'm glad you're feeling better!

I have friends with OCD and as far as I can tell, it's not a condition that just pops up for a spell and then goes away (though it may well be for some people, I don't know). It's something that you have to find strategies to manage in the long-term.

That's how it's been for me with my depression. I think I turned a milestone when I realised that I wasn't ever going to be miraculously cured of depression/anxiety: that it was part of who I was and that it would probably never disappear completely, but that (on the positive side!) I was getting better and better at managing it, after years of finding out what things helped and what didn't. My quality of life now is better than it has ever been.

But I wouldn't go off my citalopram now, because I would perceive it as a self-destructive act, that would have negative repercussions not just on me, but also on my family, my loved ones and my work.

As you can tell I feel strongly about this! I think there's still a lot of prejudice against the idea of people being on meds for mental health long term, but if you talk to the people who have made that decision to stay on meds, they will be eloquent in describing why -- as some voices have been on this thread!

@CaraherEIL

ThatsnottheHunty I think a shared history of a patients medical history and knowledge of them personally is an important relationship.The experience of the OPs attempt to come off the drug previously, and knowledge of their ongoing stability whilst on the drug is important information. I think that being aware of a patient personally and having met with them over a 6 year period to discuss their medical well being and jointly deciding that remaining on an effective drug longterm is the best plan for their well-being is a good thing. It doesn’t compare with a new GP just phoning up and being flip. I think fresh eyes can be helpful if there is a constructive review but this new GP asked the OP nothing about her medical history. I think your comment sounds ignorant not mine.

I agree 100% with this comment.

It's really not about cost as per PP. Citalopram is uber cheap.

I'm assuming this GP has a lot of experience of prescribing and taking people off citalopram. So I would believe them when they say that many people do just need to ride the withdrawal symptoms.

It also gives you useful information. You have been on them a long time, longer than many and it might be worth giving it another go to come off. As the GP said no one is taking them away from you but its something for you to consider. Its possible the GP was annoyed with the previous GP for keeping you on them for 6 years.

@OrangeSharked

I'm assuming this GP has a lot of experience of prescribing and taking people off citalopram. So I would believe them when they say that many people do just need to ride the withdrawal symptoms.

It also gives you useful information. You have been on them a long time, longer than many and it might be worth giving it another go to come off. As the GP said no one is taking them away from you but its something for you to consider. Its possible the GP was annoyed with the previous GP for keeping you on them for 6 years.

But why should OP come off them? There's nothing wrong with being on medication long term. They're not supposed to be a short term solution for most people and many people are on them for a lot longer than 6 years!