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.

And lots of people with physical health problems do not take medication if the side effects or risks are too great. It is not that unusual for people to do this. I suspect those saying no one would stop taking medication for a physical illness do not know that many people with chronic health problems.
I even knew someone who refused to take medication that would increase her life expectancy by 10 years as the side effects of the medication were so horrendous. She said she would rather die 10 years earlier and live a much better life.

I think she might have a point but my god her delivery could do with some work.

I've tried a couple of times to come off ADs but the what I now recognise as withdrawal has been so awful I've gone straight back on. What I know now is that coming off my tablets wasn't making my symptoms worse, just the withdrawal.

I'm down to half the dose I was now and I'm feeling so much better in every way. I picked the right time to do it and have taken it slowly. I had to be in the right place to take it slowly and methodically though so maybe now is the right time.

My depression/anxiety was horrendous and I absolutely needed them no question, but it wasn't a free lunch.

This thread has been great and thanks to everyone who contributed, but I’m going to have to bow out now, because the talk of long-term side-effects (which I’m aware of already) is triggering my health anxiety.

Thanks again.

My experience with antidepressants is I tried stopping them at various times in my 20s, stopping lead to a revolving door of admissions due to the consistent low mood and suicidal ideation/ attempts.

For the past 12 years I take 2 seperate antidepressants daily and other medications, it's always questioned about it in hospital appointments. It's a case of if that's what it takes to keep on an even keel so be it. Still occasionally have down days but nothing close to the hell without anti depressants. As per op, it makes it manageable.

The GP was probably giving her opinion as she saw it, she doesn't have any background on you really, no connection and may have had negative experience of antidepressants which influenced her work.

Op
GP's are nor experts in everything &some have biases about certain treatments & diagnosis. Re ASD (for instance!!!!!) some doctors (Child development -& others) still believe its either parents have caused it because they are too protective or are bad parents (bit like migrants come here & simultaneously take all our jobs &/or don't work & live off the state - irony alert!) & apparently dc can't have asthma until they are over 2 &they don't need antibiotics when they have a chest infection (I hate to think what is said about me on my dc notes in the past)
Doctors are people & some have their blind spots about certain conditions - there is also the other side when you get a gp who has a real interest & develops some expertise in certain conditions or will admit "I don't know much about this so I will need to look it up"(I really admire people who say this).
Mental health, Learning Disability & Autistic Spectrum are often the Cinderella's of medicine when you are trying to get help for yourself or someone you care about (Along with Menopause ect ect ect)

@Cailleach

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.

How does not prescribing needed meds cut costs?

GPs don't claim to be experts, however, they have a lot of training in managing conditions that require medication. The OP (who has left the thread) does not appear to be under the care of a psychiatrist therefore it will be her GP who will be responsible for prescribing anti depressants and reviewing her needs.

Stopping someone's Citalopram is not going to 'cut costs' FFS. God some people are so paranoid about GPs.

@cassandre

Just ask my DH whether he thinks it would be a good idea for me to go off citalopram, you will get an unequivocal answer

Mine too. I’ve only been on a year, but omg the difference

I've been on citalopram for a decade. Three times I've come off, 3 returns to suicidal ideation. Still, once every 3 months I have to have a med review with a random person at my GP surgery before I'm allowed my prescription.

Last time when asked how I felt about coming off them by yet another person who doesn't know my history and clearly hadn't looked at my notes I just went, "well, let's hope I don't try and kill myself again!" And then waited. She issued it pretty quickly after that.

But I feel you OP! You know what works for you and keeps you on an even keel - it just seems to be that some medical professionals/surgeries have a thing about it (and not for any real concrete reason - if they said that citalopram would kill me next week I'd be concerned but 'hm you seem dependent'... yes, so what).

@LunaNorth I felt compelled to comment when I read this. The same thing happened to my DM who has GAD except she was taking another drug. She felt guilty like you and came off them. She was fine for two months and then the GAD came back with a vengeance and the same pills didn't work when she tried to get back on them. She was v.poorly for many months before she found one that worked. When she saw her regular GP he said she had been poorly advised initially particularly as no questions had been asked about her well-being at the time.

I’m on sertraline for anxiety for a year now. I have no intention of trying to come off them. I had anxiety symptoms getting worse for years before I started taking them. No I feel like me again.
Risks vs benefits like anything else. What are the risks of long term use?
What are the benefits?
Do the benefits outweigh the risks?
I approach everything in life like this.

@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.

Well then, aren’t you super lucky to not need medical help.

From NHS:
Is it safe to take it for a long time?
For most people, sertraline is safe to take for a long time.

A few people may get sexual side effects, such as problems getting an erection or a lower sex drive. In some cases these can continue even after stopping the medicine. Speak to your doctor if you are worried.

Taking sertraline for more than a year has also been linked to a small increased risk of getting diabetes. You'll be regularly checked for this.

Otherwise there don’t seem to be any lasting harmful effects from taking sertraline for many months and years.

As my erections are fine , I have lost weight due to feeling happier and more energetic and I’m not diabetic (will do a blood sugars at work every so often) I will argue the toss with any GP who wants to take me off it.
Personally my symptoms are peri menopausal I think so maybe once I’m well and truly post menopausal?

Some posters are being very ignorant. Normal cycles of depression can be overcome yes, however some people have a life long condition of major depression disorder that repeats and will always have relapses after coming off of antidepressants. No, for these people, it's not about how they handle life it is about the fact that their brains simply fall back into depression.

Depression can have very physiological or somatic effects - not just emotion and mood. Some people despite feeling well, life going well etc will suddenly start sleeping through five alarms, sleeping for 16 hour stretches, others will cease being able to sleep more than a couple of hours at a time and have next to no rem sleep. All energy can disappear despite mentally and emotionally being ok and life going great and then that it all gets stolen away again by the somatic symptoms taking over and that getting in the way of life, relationships, work etc and leading into the emotional and mood aspects.

Some comments on here show a lack of awareness of what depression is and how it can manifest in different people, and the difference between normal short cycles of depression following major life stress or trauma or several losses in a short period of time and major depression which can descend out of nowhere for no damn rational reason and steal away the wonderful life you've built up for yourself in it's absence.

Of course for some people it can be a short term solution (though the last time I read up best practice was to have 12 months symptom free before beginning carefully tapering off).

Others are staying they are trapped on them because of withdrawal. Yes the withdrawal syndrome can be horrendous but the fact is that's stage one of the test of coming off. Anything pretty immediate is withdrawal syndrome. The return of depression if your brain is unable to manage without assistance to balance those neurotransmitters correctly usually comes about 2 to 6 months after stopping medication. And it's sneaky. You don't notice it gradually creeping in and it's not till you find yourself shaking under the duvet because you know you can't go to work but you also know you can't pick up the phone and speak to someone to let them know that once again you're sat in a doctors office crying and saying I don't know what is wrong with me, everything was great, I love my job, my life etc but now I'm scared to go outside and I'm crying and if the doorbell goes i have a panic attack etc.

People who don't understand these things shouldn't comment.

The links to diabetes may also be via weight gain - eg. some people gain weight on ADs and increased weight gain puts you at higher risk of diabetes - so an indirect increased risk which ideally can be mitigated.

Untreated depression is life threatening. Many of us know that first hand and are lucky to still be here.

I've been on antidepressants and mood stabilisers for the past 20 years due to Bipolar Disorder, I will be on them for the rest of my life. It completely depends on why you require them in the first place.

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's scary that people put so much faith in GPs.

They know a little about a lot of things and fill in the gaps with GP mythology. I come from a medical family, there are lots of them and as much as I love them, it is amazing what they come out with.

Oh and the idea of people who suffer with depression being weak or poor at coping with life is nonsense often. I'm fantastic in a crisis, have worked through crazy shit over the last year in schools, have been a great first responder at car accidents and diving accidents and am a great support to people when a family tragedy occurs.

It's not the big things I'm poor at dealing with and I have high emotional intelligence in many ways and am a qualified counsellor and teacher. Depression for me, as someone with the mood disorder rather than someone having an episode of depression, isn't about BIG stuff or real life stuff hardly at all to be honest. Historically it would be out of nowhere and about nothing and it was all the small things that became insurmountable.

Mine has rarely had any connection to real life events. I grieved after a miscarriage but worked through it head on and didn't become depressed, I was heartbroken by a relationship that meant the world to me ending in my mid 20's but I didn't become depressed - I was just heart broken and had to work through that. Having had to cope with depression and learn so much about myself and people and the emotions and brain etc and having developed so much compassion has actually made me great at coping with life and normal, albeit tragic stuff.

When you have major depression disorder it isn't like depression as you think of it. It's literally an illness that comes back without any connection to current events or how you're thinking or whether you're stressed about a real life thing. People don't seem to get this.

One real life event it does seem to link to for me is any kind of infection. If I get an infection my mood and energy and feeling of being so heavy I can barely move and brain fog comes before the pain or swelling etc local to the infection.

My first episode of major depression came after having glandular fever and then a serious infection after surgery.

We don't yet understand all the links, causes and mechanisms of depression and what we put under the broad umbrella of depression may turn out to be several different 'illnesses' or syndromes currently treated in the same ways.

I had an american GP when I was at Uni who was the first to be really interested in my health prior to my first episode of major depression. He said it was very common that people with early onset major depression disorder had glandular fever, or mono as they call it, in adolescence and he was interested in the effects of inflammation and the adrenal system.

Others have looked at bowel health and there is research going on there.

This is annoying for you. I would be upset too. I would simply say, a gp who knows me better had made the decision I stay on this and I would prefer having any discussions about this with them.
Maybe this gp is trying to appear to be taking an interest in every patient but got it wrong here. I would also speak to the practice manager about how this made you feel. You may find this difficult but it might help to write it down first. Try to forget it hard as it might be x

She’s not wrong about weaning you off the meds. I was on a different anti-depressant as I dealt with PTSD, depression and anxiety from enduring a series of really horrific trauma. I was on them for 3 years.

It wasn’t the meds or the talking therapy that helped me recover (mostly, if I avoid triggers). It was surrounding myself with positive people and finding things I love doing. I got rid of all the toxic people in my life.

It definitely isn’t the same as insulin for a diabetic and you shouldn’t say it is. Without insulin, several of my family members would die within a very short period of time.

That said, it should be your choice ultimately to take ADs or not. I think GPs should be giving you better advice and support in making the best choice for you - not a lecture.

Great posts Honey Badger.

Cutie, that's awful about the traumas. However someone who is able to recover from mental illness by cutting toxic people out of their life doesn't sound like someone whose brain suffers from a permanent chemical imbalance.

Lottie, diabetes is certainly not the same as long-term mental illness but it's analogous as both can be life-threatening. Suicide is the number one cause of death in the UK for men under 45.

I would love to not need SNRI’s, by that I mean I wish I didn’t have crippling intrusive thoughts and physical manifestations of anxiety. I managed a full year off them and thought I was doing wonderful but I really wasn’t. My physical symptoms were awful but I continued to say I was grand and didn't need the pills, I had learned coping mechanisms and could talk myself around.

I honestly don’t see myself ever stopping my SNRI and that’s fine for me.