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.

Sometimes GPs get things wrong; sometimes they communicate badly. You've been unlucky with your experience, but try to forget it now. You know what you need.

My DD has been on ADs for 9 years now (since age 14). She kept trying to come off, but then had problems again. She's finally accepted that being on them is fine and necessary, and is quite happy about the situation.

Another young teenage family member has ASD and OCD. Without sertraline (which she's been on since she 10) she can't function.

I do understand the push to come off, except perhaps for a previously well person having a one-off instance of mild depression that may be resolved; clearly, that is not your situation OP.

[quote LunaNorth]@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.[/quote]
Hey op, I know I’m commenting on your thread but my post was not a comment on your situation at all. I would be equally baffled by a change of tune from a GP.

*I don't!!!

I agree with you OP - and am on the same medication as you for the same thing. It is strange regarding antidepressants as no GP has ever suggested I need to wean myself off my asthma medication

I certainly think it was sensible for the GP to say that, I would be horrified to take this kind of medication for years and years. Most drugs or medicines like this, should be for short term use.

@motogogo

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

Why does she need to go through withdrawal, when she doesn't need to stop taking the medication?

That makes no sense when you also have experience of your daughter coming to harm when not on her medication.

What country are you in @Whereismymojo ? Because unless you have top cover private health insurance, you do not get to see a Psychologist (who don't even prescribe meds) or Psychiatrist. If a Psychiatrist had appointments just to dole out prescriptions, they'd never see any actual cognitive patients. You don't see a heart specialist every time you (rhetorical you, not meaning you) fill your script for blood pressure meds, or an Endocrinologist every time you need Insulin.

Why would you possibly expect a person on permanent medication for Clinical Depression to waste a Psychiatrist's time just for a script, when that's the GP's job? What country are you in that would even have that capacity? Because it's not done in Australia, in New Zealand, nor in the UK. It's not even possible.

God alive, save us from insensitive and frankly uninformed GP's! I've had a basin-full of them re: depression and psychosis over the past 30 years. The various emergency psychiatric teams I've been under at various times however, have mostly been wonderful: they are the true experts, not the GP's. In my 30 year experience of severe mental health issues, I have only had two supportive/informed GP's. With the help of one of them, I very gradually weaned myself off Quetiapine (an anti psychosis drug) over two years. The side effects of being on it for any length of time, and ultimately trying to come off it, were totally punishing and debilitating. I am now just on Sertaline, and have been for ten years plus, and I've never been better! My GP has advised me that I will probably be on it for life, which is fine by me! But funnily enough I was talking recently with my DH and DS (in his twenties) that I might try and come off Sertaline soon.
I get these mad ideas sometimes: they both looked at me in absolute horror and begged me not to. I don't ever seem to remember how ill I actually was when I have an 'episode', and of course this has a hugely negative impact on my family, not just myself. So I'm going to be a 'lifer' too, and I'm proud of the progress I've made to get myself well again. Good luck OP: you have to grow a very thick skin in your dealings with GP's and mental health. And fight your corner, give no quarter...

@1forAll74

I certainly think it was sensible for the GP to say that, I would be horrified to take this kind of medication for years and years. Most drugs or medicines like this, should be for short term use.

@1forAll74 I beg your pardon!??? Why would you be 'horrified'? Many/most people need to take them for life.

Would you make the same ignorant comment about someone on Insulin for Diabetes?

@ParvaAvis thank you. I know what you mean about forgetting how ill you can be without it. When I tapered I reverted back to how I’d been and it was a hell of a shock.

@1forAll74

I certainly think it was sensible for the GP to say that, I would be horrified to take this kind of medication for years and years. Most drugs or medicines like this, should be for short term use.

Oh piss off. There's nothing horrifying about looking after your mental health.

Opinions like yours are why people suffer.

@1forAll74

I certainly think it was sensible for the GP to say that, I would be horrified to take this kind of medication for years and years. Most drugs or medicines like this, should be for short term use.

Good for you! Clearly you dont need medication. Count yourself lucky maybe rather than being "horrified" at the thought of being medicated long term.

Id love to know your source for stating "medicines like this should be for short term use".

I've been trapped on antidepressants for 11 years.
First citalopram, now sertraline.
I needed them when I went on them, no doubt. But I cannot cope with the withdrawal symptoms (often mistaken by GPs for "old symptoms of anxiety/depression returning).
There are new NICE guidelines on withdrawal now, because GPs have been so woefully ignorant on just how bad withdrawal can be for just over 50% of patients.

I'm intending to try and wean off again soon, but only if my GP will prescribe me a liquid version of my antidepressant so that I can taper off by 10% increments over the space of about a year or so.

Yes some people may be better staying on antidepressants indefinitely. But unfortunately new research seems to be suggesting that withdrawal symptoms are actually the main reason people remain on them.

I think there is validity in the other gp being able to question if you want to be on the medication long term though, surely it's ok to look at that without it meaning that you have to stop it. I have mental illness and don't agree with that argument about antidepressants being like insulin for diabetics and surely that is my right too, we are all going to view this differently. I would love to speak to a doctor who treated me like a human being when I spoke to them about my mental health rather than being spoken to like a child and told what to do which as been more like the experiences I have had. I was repeatedly told to access short term CBT despite saying repeatedly that I was in long term therapy, that and with other issues I have now lost trust in my surgery.

@Leafy12

I think there is validity in the other gp being able to question if you want to be on the medication long term though, surely it's ok to look at that without it meaning that you have to stop it. I have mental illness and don't agree with that argument about antidepressants being like insulin for diabetics and surely that is my right too, we are all going to view this differently. I would love to speak to a doctor who treated me like a human being when I spoke to them about my mental health rather than being spoken to like a child and told what to do which as been more like the experiences I have had. I was repeatedly told to access short term CBT despite saying repeatedly that I was in long term therapy, that and with other issues I have now lost trust in my surgery.

@Leafy12 Clinical Depression means your body isn't producing enough of a chemical such as Serotonin.

Just as Diabetics' Pancreas isn't producing enough Insulin.

They are both caused by an inadequate supply of a naturally occurring chemical or hormone.

So.....how are they not exactly the same?

There are valid medical concerns about longterm use of citalopram causing serious damage.

Far from being a lousy GP, she was keeping a patient  properly informed about the  longterm  effects of their medication.

Like the prescribing GP should have done.

Read the whole link; but this is just a small part

"

Long-term use of antidepressants may put people at risk for type 2 diabetes, and SSRIs may cause heart rhythm abnormalities at higher doses. A European study linked citalopram with increased electrical abnormalities of the heart and that these abnormalities became worse with increasing doses. Those with pre-existing heart conditions should speak with their doctor before taking citalopram, even as prescribed.4,5

Some people who take SSRIs may problems with blood clotting because of decreased serotonin in blood platelets. People who take the drugs are at increased risk for stomach bleeding or bleeding in the uterus. Combining SSRIs and NSAIDs (aspirin, ibuprofen) increases this risk "

@1forAll74

I certainly think it was sensible for the GP to say that, I would be horrified to take this kind of medication for years and years. Most drugs or medicines like this, should be for short term use.

Horrified? Just as well no one's asking or forcing you to, then. Why should "most drugs or medicines like these" (do you mean SSRI's? Antidepressants generally?) be only for shirt term use? What do you know about them? According to DDs psychiatrist, and all info I've found, SSRI's are safe long term.

@2bazookas

There are valid medical concerns about longterm use of citalopram causing serious damage.

Far from being a lousy GP, she was keeping a patient  properly informed about the  longterm  effects of their medication.

Like the prescribing GP should have done.

Read the whole link; but this is just a small part

"

Long-term use of antidepressants may put people at risk for type 2 diabetes, and SSRIs may cause heart rhythm abnormalities at higher doses. A European study linked citalopram with increased electrical abnormalities of the heart and that these abnormalities became worse with increasing doses. Those with pre-existing heart conditions should speak with their doctor before taking citalopram, even as prescribed.4,5

Some people who take SSRIs may problems with blood clotting because of decreased serotonin in blood platelets. People who take the drugs are at increased risk for stomach bleeding or bleeding in the uterus. Combining SSRIs and NSAIDs (aspirin, ibuprofen) increases this risk "

Well, that’s done my health anxiety the world of good.

Cheers for that.

I'm not saying there's anything wrong with being on antidepressants for life if its definitely what you need. But many people do successfully come off antidepressants, and it can be of benefit for them.

It doesn't mean that needing antidepressants is anything to be ashamed of, or a negative thing. But if you do take antidepressants would you not want to know that many patients come off them successfully? Should you not know your options? The GP presumably has a lot of experience of patients successfully coming off ADs

Its different to insulin, no diabetic has ever had the option to stop insulin. But I'm sure if they did, if there was a way that diabetics didn't need to take insulin for life they would grab it with both hands. Patients should know all their options for treatment.

Incidentally I have had many years of mental health problems. And now I currently do not take antidepressants and it has benefitted me, I was functioning on ADs but I feel much better now off them.

When I was taking antidepressants I needed them, but I don't currently. I cant say what will happen in the next 10 years, chances are at some point in my life I will need them again but its been 5 years since I last took them and I feel better without them at this point in time. In my case GPS juts blindly threw antidepressants at my mental health to try and make the problem go away.

Clinical depression is really not as simple as a serotonin deficiency, that model is pretty outdated.

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

No because diabetes and depression are completely different, the former being a physiological illness.

Depression isn't caused by a chemical imbalance in the brain but by the way we process life events.

And of course depression can be overcome, it's wrong to say it can't but insulin dependent diabetes is a lifelong condition that will always need to be medicated.

And of course depression can be overcome

Ah, okay, some of us just aren't trying hard enough!

@BeaLesshasty

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

No because diabetes and depression are completely different, the former being a physiological illness.

Depression isn't caused by a chemical imbalance in the brain but by the way we process life events.

And of course depression can be overcome, it's wrong to say it can't but insulin dependent diabetes is a lifelong condition that will always need to be medicated.

@BeaLesshasty I suggest you check your facts as you are ill-informed. Clinical Depression is indeed caused by a chemical imbalance.

Short term Depression is processing life events.

A Depression that lasts longer is called Chronic Depression and is due to a lack of the chemical Serotonin. Your misinformation is what we are trying to battle. Major Chronic Depression is lifelong and is due to a chemical imbalance. This has been scientifically known for many years now.

Clinical Depression is about not enough of a chemical being made, just as Insulin is. Pure, and simple. Full stop

No, it's not.

It all depends doesn't it? What causes the depression, what/why you are on them, is it a temporary cause
I mean I'm on antihistamines, 4 a day for life and nobody queries that 🤷🏽‍♀️
I've come off citalopram before but now back on it. Without it I'm panicky, miserable and want to self harm

Long-term use of anti-depressants is linked to increased physical health risks. No drug is free of side effects.
I was on citalopram, never again. It took three goes to come off them. Even though I tapered the doses very gradually I was plunged into a deep depression. I only came off them the third time because I was not working and had prepared so I did not really need to do anything else while withdrawing.