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.

It infuriates me that there is still a commonly held view that antidepressants are something that people should aim to come off, regardless of the outcome. You see it all the time, with people 'celebrating' that they don't need to take them anymore, there is still such a stigma around mental health.

I've suffered horrendously in the past through this idealisation of coming off medication at the soonest opportunity, and have always ended up in a worse state than I started with (have been on and off antidepressants for over 20 years now).

Some people are lifers - if that enables them to have a full and meaningful life, there's nothing wrong with that.

I'd be complaining.

I hate meds r/v time. I've been on the same meds for donkeys years. I don't want them reviewed. I know 2 of them theoretically have a warning about being prescribed together but frankly you are taking them off me from My Cold Dead Hands as without them I am a wreck who can't get out of bed.

I just want my sodding meds, it was a hard enough journey to get them right without someone who doesn't know about it coming along to meddle.

You have my every sympathy. I bet that GP has never done SSRI withdrawal either personally - it's not 'riding out the bumps', it was fucking shite. Never ever again. Never.

I’m a lifer.

Every time I’ve stopped ads, sometimes quickly, sometimes more slowly I have ended up back in major depression completely unable to function. Once I ended up in hospital after trying to kill myself utterly convinced it was the best thing to do for the sake of my son. Hellish.

I started in my teens. Regardless of whether I like it or not or how well life is going or how cautiously I taper I cannot come off and stay off of them.

I have friends and family members who’ve just taken them for a year then stopped and been fine or been fine for several years before needing them again. It’s well known that some of us have to stay on them for life. My life got much easier and was devoid of train wrecks once I accepted that I’m one of those people.

Now I just need to navigate peri menopause as best I can to avoid catastrophe.

I can’t comment on the AD aspect but I had similar with a GP - went to see one and had a great appointment, agreed on tests and plans etc then another one phoned me later (I can’t remember why she needed to get involved tbh now) to say all the tests were pointless and wouldn’t make a difference so no point going ahead. I’d never met this GP and she was quite abrupt and I was a bit upset so I can completely understand if you were OP.

Well, exactly. Even if I did want to come off them, now would not be the ideal time, as I’m just coming into peri-menopause, lost both my parents in the last 18 months, plus the coming-out-of-lockdown weirdness, empty nest syndrome, etc etc.

None of which she knew about as she never bothered asking. She didn’t even know what I needed her to phone me about, so she’d not read my notes.

I’m just cross. I feel so crap today, my stomach is off after a big emotional eating binge, and I’m knackered because I didn’t sleep well.

I’m not usually a drama Queen, honest.

@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.

@OrangeSharked Would you suggest a Diabetic go off their insulin after 6 months?

Clinical Chronic Depression is due to your brain not making enough of the chemical Seratonin and other chemicals, just as Diabetes is due to your Pancreas not producing enough insulin.

Why the stigma? Why are you so determined that the OP 'tries again' when you wouldn't suggest that to a Diabetic on insulin?

Why do you and others consider mental health such as Chronic Depression to be more of stigma and something to 'solve' than Diabetes? Neither can ever be cured. Chronic Depression is a chemical imbalance. Diabetes is a hormonal imbalance.

Neither can ever be cured. If you have Chronic Depression, you will have it for life, just as you will have Diabetes for life.

So why are people urging others to ditch their life-saving medication? How can that be responsible? Why they stigma that it should be ditched after 6-12 months?

Well we’ve backed you up on her twattishness so try and just write it off now.

Do whatever you need to feel better. I seem to be having a bit of a duvet day when I‘should’ be using my day off to get stuff done.

I’ve done a few bits but I’m tired from a week of really poor sleep and hormonal and have a busy day at work tomorrow so it is what it is.

I can tell you than it won't be cost as citalopram is as cheap as chips
More like her personal ideology I should think
Total bollocks that antidepressants 'stop working' I would not listen any more after she said that.

Some people have a simple one off episode and can and should come off. It's not good practice to leave people on medication without review (any medication)

However other people have recurring illness and antidepressants have been shown to prevent relapse with trial evidence out to at least 2 years so she is plumb wrong in her opinion. Some people need ongoing treatment.

If she did want to offer you a chance to review if you wanted to come off it should be an offer at a good time for you with appropriate monitoring.

Ignore her and try to speak to your usual Gp next time.

It doesn't sound like she talked to you in the right way but she is correct in that you need to go through withdrawal. It's actually the opposite of cost cutting, they are being told they shouldn't be leaving people on meds because that's cheaper than talking therapies. My dd was told after a year they would be reviewing her meds, unfortunately every time she's comes off within 3 months she's back in a&e

Yikes, sorry OP, I was reading through the thread and responded before I actually responded to you.

No, the GP was not right, and she was being irresponsible and I would definitely put in a complaint. It sounds like you have Chronic Depression, and that is for life. Temporary Depression (ie 6-12 months) and Clinical Depression or Chronic Depression means you cannot cope without the meds. It is not transient or temporary that responds to therapy + medication. Yours, like mine, sounds like it a chemical imbalance and medication is needed to correct that imbalance, and you will most likely need it for life. That the GP didn't even bother to use protocol and ask you questions shows that their advice, if taken by you, could have been very dangerous. Please, so no one else has to be put on the spot like you were - or worse - you need to put in a complaint. That they advocated you going off your medication without even asking your medical history is adequate enough complaint in itself.

That should read: Temporary Depression (ie 6-12 months) and Clinical Depression or Chronic Depression means you cannot cope without the meds, are two entirely different things. Clinical/Chronic Depression is not transient or temporary Depression that responds to therapy + medication.

She didn’t even know what I needed her to phone me about, so she’d not read my notes

This happens so often. If you are a GP (or other practitioner) read the notes before the call! Takes 30 seconds to glance through the last few entries so you know what you are talking about and you'll get the time back on the call not wasting time asking questions you'd have known if you'd read the last few notes.

I don't understand this obsession with 'weaning people off' drugs that work. If my GP were to say I should pull myself together and come off the meds I take for hypertension, I'd be at serious risk of a stroke - my BP is scary high without the drugs and both my parents were the same.

The meds keep me in normal range and well. Mental health meds keep the people who use them well in the same way. This is stigma at work, pure and simple.

@Worriesome

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

What she knew? What knowledge exactly are you referring to?

I have acute anxiety disorder, I've been on citalapram for coming up 12 years!! 🙈🙈🙈 I was told at the beginning I would pretty much be on them for life which is fine by me, I can't cope with the idea of the alternative. I have done counselling and CBT but neither of those worked for me

Thank you all for sharing your stories. This thread has been such a help

@cassandre

OK yes, OrangeSharked, but 'many people' is not everyone.

It's really interesting to see how the comments on this thread differm depending on whether they come from people who have first-hand experience of long-term mental health troubles, or whether they come from people who make no mention of any first-hand experience with mental illness but still think you should take this GP who has never met you at her word.

But it’s still not representative - they are not the only two camps in this. There are people who have coped /do cope with extreme mental states through non medical therapies. The people invested in psychotherapy for example, are not here.

This thread is full of people either taking their gp’s word as gospel, or disregarding it when they are not stating what is wanted.

It strikes me as very odd that you are all turning to a GP for serious mental health and CBT as a solution (cbt is cheap to deliver and is not the same as therapy) . Hope this doesn’t shock you but gp’s have little professional experience of mental illness. This is a very U.K.-thing “speak to your gp about mental health” - they are medical practitioners - they have not got degrees in psychology or psychiatry - it baffles me you all go to them for this (and get put on drugs).

If she thinks you should come off of them can you ask for a physiatrist referral to make a plan of how to do it? I wouldn’t come off of meds based on a GPs opinion alone. Maybe I’m biased because poor information from a GP for a sibling of mine to come off of their meds tipped them over the edge into a full on breakdown, which could have been prevented with better medication advice.

My mother has been on citalopram (or similar) for over 20 years. In my mother's case, and from the brief experience of times when she has forgotten to fill her prescription, it would not be worth attempting to take her off them and I would be horrified if anyone suggested it, not least a GP. I really think if anyone is considering this it should be handled by someone with considerable mental health experience and training, not a GP.

• psychiatry

@Whereismymojo I had psychotherapy for eight years.

It helped me sort my life out but it didn’t help me feel better.

It took a hell of a lot for me to go on meds. Hence my chagrin at the GP’s apparent assumption that I’m seeing it as an easy fix. I’m not.

You are assuming those of us with long term conditions have never seen consultants and specialists. I have in the past.

@Whereismymojo Not all all GPs are Specialists/experts in Endocrinology, that doesn't stop them from prescribing Insulin.

Clinical Depression is about not enough of a chemical being made, just as Insulin is. Pure, and simple. Full stop. So why are you surprised a person needing a chemical replacement goes to......a GP? It's EXACTLY who they should go to.

[quote CokeDrinker]@Whereismymojo Not all all GPs are Specialists/experts in Endocrinology, that doesn't stop them from prescribing Insulin.

Clinical Depression is about not enough of a chemical being made, just as Insulin is. Pure, and simple. Full stop. So why are you surprised a person needing a chemical replacement goes to......a GP? It's EXACTLY who they should go to.[/quote]
With respect I disagree. I see this a lot in this thread, but I do not see it this way, at all.

And I take thyroxine and I only see an endo, it is not managed by a GP.

The people invested in psychotherapy for example, are not here

Er, yes we are! Several years psychotherapy, numerous bouts of CBT, and no they aren't a substitute for my citalopram.

Mental health treatment is about both, not either or.