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.

That GP is a twat. Ignore them

I personally don't think she is right, suggests she is implying it's just giving you a placebo affect now? I've been on citalapram for maybe 7/8 years? I came off it during my first pregnancy for about 4 months and I was an absolute wreck. When I went back onto it I was fine again. I lowered my does for my second pregnancy and had to go back up again. I think some people just need the extra Serotonin.

GPS are all individual practitioners. They have trained at different medical schools, done different jobs as juniors. Yes they all passed they same competency exams to qualify as a GP, but they will still have their own ways of doing things or own thresholds of what they are comfortable with. After all, it is their job and reputation on the line. All I mean is that just because your usual GP is happy to keep prescribing doesn't mean the new one has no right to make you aware of what she did. I agree she sounded clumsy in doing so and that she made you feel anxious and embarrassed. But she was allowed to share that information about the risks with you and was right to do so.

@cassandre I’m the last person to downplay the importance of good mental health and I’m not saying antidepressants aren’t life changing and even life saving for some people. However this just isn’t the same as insulin for a diabetic. Without insulin, my sister’s body would cease to function and she’d be in a diabetic coma and die in a very short space of time. That’s not similar to suicide through mental health at all. People committing shocked is a very different and not at all analogous scenario.

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

I understand perfectly. And I understand that depression isn't caused by a chemical imbalance.

And depression isn't "incurable" - it's not a physiological illness. And most people who have it don't commit suicide so it's not life threatening like untreated diabetes is.

@TheHoneyBadger

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.

pharmaceutical-journal.com/article/opinion/antidepressant-withdrawal-can-be-a-horrible-experience-are-tapering-strips-a-potential-solution

www.apa.org/monitor/2020/04/stop-antidepressants

www.rcpsych.ac.uk/docs/default-source/mental-health/treatments-and-wellbeing/print-outs/stopping-antidepressant-

printable.pdf?sfvrsn=2c9a63e0_2

www.madinamerica.com/2020/10/psychiatrys-top-experts-acknowledge-lasting-harms-antidepressant-withdrawal/

@TheHoneyBadger
You are wrong about withdrawal I'm afraid.

"Over the past two years, an increasing amount of evidence has emerged around the harms caused by antidepressants and their withdrawal. Often what appears to be a relapse of depressive symptoms is actually a consequence of antidepressant discontinuation; this can, in turn, lead to chronic use of antidepressants. The life-threatening effects of polypharmacy and chronic psychiatric drug use have become a matter of concern to the global medical community."

@TheHoneyBadger

www.rcpsych.ac.uk/docs/default-source/mental-health/treatments-and-wellbeing/print-outs/stopping-antidepressant-printable.pdf?sfvrsn=2c9a63e0_2

I have been on ADs for years due to OCD. At one point I saw a psychiatrist who said to just stay on them, basically. I don't have any issue with taking them for life and am always surprised at people who refuse to take them.

On the other hand the best therapist I ever saw was of the opinion that it might be worthwhile working towards coming off them. I refused to consider it. I know myself and my OCD and I'm not interested in going back to the darker times.

How am I wrong? I said cessation syndrome can be horrendous (I nearly lost my life coming off of cymbalta and being virtually psychotic so I'm not downplaying it believe me). My point was that even if you successfully come off, which I did repeatedly in my 20's, you still have to wait out to see if the depression will return and for some of us it does. If you are fine after stopping them but then several months or a year are majorly depressed again then that isn't cessation syndrome but recurrent depression.

I personally would not want my child to take antidepressants and would want him to try everything else he possibly could first and only resort to them if everything else and time failed. If he ended up having to and they were the only thing that worked for him and after a couple of times of recovering, having a year without symptoms and coming off of them safely his depression recurred as bad as before I wouldn't see the point in him making further attempts at coming off and putting his brain through that chemical rollercoaster.

Does that make sense?

I'm in no way belittling cessation syndrome.

Also worth bearing in mind, for fear of lurkers being terrified, most people can take antidepressants for a year and come off of them with next to no problems and some antidepressants are known for being easier to stop taking than others.

I have a friend and my sister who have taken them periodically in their life and then when better stopped and had no symptoms of withdrawal at all. Gaps of 5-10 years off of the tablets.

And please god if any lurkers are watching on antidepressants DON'T just stop taking them if you've been scared by this thread or felt made to feel weak etc. If you're going to do that be well and stable for a good stretch, pick your time carefully and then taper down under a doctors supervision with regular reviews. If you do struggle with side effects there are options - the best is to switch over to prozac which has a longer half life anyway and is available in liquid form for very slow titration downwards.

I have come off other anti depressants no problem. Citalopram I had horrendous withdrawal.
There is lots of research that says anti depressants largely have a placebo effect.

There's also research that they change your sleep and increase rem stage which has been observed to be reduced in depression and theories that that is what causes the anti depressant effect.

There are allsorts of theories and lots of unknowns as to why these classes of medication work and on a wide range of conditions including pain.

They do that to my friend about sleeping tablets.
she has been taking them for 40+ years since her baby had cot death.
WHY threaten to take it away.
It’s so distressing for people.
I completely sympathise with you. They obviously have to do a lecture every now and then.

HoneyBadger - stop it, no one is trying to make anyone feel weak for taking prescribed medication. I'm challenging your pseudo science that depression is caused by a chemical imbalance. I'm challenging people who claim depression is the same as diabetes with regards to the need for medication and I'm challenging the dangerous assertion that there is no hope for people who have suffered depression long term. There is.

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

SSRI (of which citalopram is one) are cheap as chips and largely safe. That's why they are so widely perscribed- they are certainly the modern day " mummy's little helpers". They have only been around since the '90s so we don't yet know the very long term effects eg: 20-30 years use. TBH it's far easier to issue a 'script than questioning a patient's need for the meds. Good on the GP.

I do worry about the millions of (mostly) women who have been on tbese meds longterm.

These

Excellent posts again Honeybadger.

Norked, I'm sorry the withdrawal symptoms are so bad for you. People who want to come off ADs should get maximum support from their GPs in doing that. It's really tricky because different people's bodies respond in different ways to different meds.

I don't think anyone in this thread has tried to argue that citalopram and similar drugs are a panacea. For some of us they have made an incredibly positive life-changing difference, but again, it's all about each person making an informed assessment of the benefits and risks and finding the strategy that works best for them.

I have been on sertraline for more than 3 years, tried weaning myself off twice and miserably failed. Did one year of NHS CBT, utterly useless.
My nutritionist is trying to get me into meditation, I just don't get it.

I dread these reviews but any GP suggesting this gets told to fuck right off.
Stand up for yourself and don't get fobbed off.

@letsgetbackto2019 sounds like you’re addicted to it, telling a GP trying to help you break that addiction isn’t helpful

@ConfusedAdultFemale I honestly don't think you can have any clue about my medical situation based on a couple of lines I wrote, sorry.

I don't believe I've said it is definitely caused by a chemical imbalance - I've actually said repeatedly that it's not fully understood, that there may be several different conditions caused by different mechanisms that are under the umbrella of depression and there are various theories as to why these drugs work for some including increasing rem sleep. Bizarre.

You're 'stop it' shows how insensitive you are to mental health problems. There might well be people reading this and feeling scared by what they are reading or beating themselves up for being weak and taking medication. I'm pleased for you that you've not been in that vulnerable a place and therefore see it as hyperbole to address it.

I’ve been on SSRIs for a decade and my attitude is that I am the expert at managing my mental health through a combination of holistic methods that include long term low dose SSRI use. Most GPs appreciate and support this. Those that don’t hear ‘I’m very happy with how my medication has worked for me over the past X years and am stable on my current dose’ (rinse and repeat as needed )

Also - SSRIs can be life-changing and life-saving. I’m not arguing for their unlimited handing out, but some of the things being said here could put vulnerable people reading this thread off trying medication as part of their treatment plan. I appreciate everyone has different opinions, but please think before you post.