Are GP's being encouraged or paid to prescribe antidepressants?

[FrolickingLemon]

Not sure if I'm being unreasonable, but here goes.

About 2 years ago a felt I had perimenopausal symptoms. Described about half a dozen or more symptoms over the phone to GP. I was almost 48 at the time. Her first answer was would I like to take an SSRI? No. I wasnt depressed. Joint pain was one of my symptoms, and apparently SSRI's can help with that. I countered that I was a sports Therapist and that many of my clients were on SSRI's for depression and anxiety, yet still they came to me with joint pain for muscle and joint pain. I also voiced my concerns about side effects and how difficult it can be to come off antidepressants. She said they were way better and safer than opiates and anti inflammatories. Still wasn't buying it.

A year later and I'm diagnosed with osteoarthritis. Was given codeine, but made to feel like shit for taking it. Like I'm some sort of drug addict. I totally get that some people get addicted to opiates, but that wasn't me.

At the same time, my Mum was absolutely shattered. Short of breath and it was getting her down. Lots of other symptoms and underlying problems. GP asks if she would like antidepressants? We visited the GP not long after this and long story short, my Mum was severely anaemic due to microscopic bleeding. Turned out to be bowel cancer. Mum had a big op just after lockdown and is recovering nicely.

I had another appointment today with GP regards to ongoing osteoarthritis pain and also further perimenipause issues (hot flushes- I'm now nearly 50) Again, she wants me to take SSRI's. I did a lot of research beforehand and read a lot of threads of MN in the menopause section. So many people say they had immediate joint pain relief from HRT. GP has said all along she is sceptical about this, but I'm edging closer to going on HRT.

But why the love of SSRI's? Sorry, this was longer than I intended. I've done family research too with regards to risks and benefits. Would be grateful for anyones personal experience.

I doubt it's 'big Pharma', but is it possibly the nhs that doesn't want doctors to prescribe certain medications due to expense? No idea what the relative cost of antidepressants to hrt or (non addictive) painkillers is, but i do know that once you leave uk and have to pay a bigger proportion of the cost of your medications, you will be shocked at the price of some of them.

I think some doctors do over prescribe them, but starting an SSRI without arranging counselling and follow up at 2 weeks then around a month later as a minimum is poor practice and shouldn’t be happening.
No kick backs or incentives to prescribe, but certainly GPs are discouraged from prescribing some other medications used in anxiety / depression such as benzos and sleeping tablets so SSRIs would be seen as the ‘safe’ option. Also they aren’t addictive (though can have withdrawal effects if you stop suddenly) - and are relatively safe in overdose compared to some more old fashioned anti depressants.
None of the above is an excuse though for misdiagnosing someone or not following up to see if they’re helping! Partly because of an antidepressant isn’t helping then it’s a clue that maybe the problem wasn’t depression to start with.

You were right op. I've been stuck on two antidepressants since I was a teenager and I'm nearly 50.
Gps have been told to cut the painkillers and prescribe these.

YANBU. I was prescribed antidepressants for long-term back pain. I asked if there are any side effects and they said no, not really. Yeah, right!
I did some research. ADs didn't even fit my symptoms, so no guaranteethey would have helped at all. Then there's all the possible side effects and addiction + withdrawal symptoms. No way I was taking them, why would you even prescribe that? I get that they are needed for severe depression, but just handing them out like sugar pills? I don't think they are paid, more like encouraged to do it as a quick fix.
It's medically irresponsible and likely to backfire.

Thanks again everyone who has posted here. Pretty shocked and disgusted at some of the stories. I really feel I'd like the press to pick up on this, instead of just spouting the shite they are told which appears to be that AD's are the new cure all and savour of chronic pain.

*saviour

Spent some time working in prescribing support for NHS. There were always pushes to reduce AD prescribing. GPs are definately not being encouraged to prescribe them.
Some older AD can work for neuropathic pain, although off licence.

Anti depressants aren’t addictive. And there is a lot of evidence that opiates including codeine do more harm than good in chronic pain where there is actually a lot of evidence for anti depressants in a number of chronic pain conditions. They are not just useful for depression.

Yes some doctors prescribe them too fast because they are lazy or more likely because they get 7 minutes to see you and can’t even begin to address the conversation you need but funnily enough many are practicing evidence based medicine...

I went to the doc for HRT and she wanted to give me anti depressants. I now take menopace and menopause (both bought at Holland and Barrett) and my hot flushes and nightsweats have gone and I'm sleeping better. Magnesium helps with the insomnia.

Oh and they have “been told to cut the painkillers” (actually they have read peer review journal articles I imagine as they are intelligent professionals not just doing what some imagined boss tells them)

GP practices may not get extra funding for diagnosing certain conditions individually, but there is big money for them via the Quality and Outcomes Framework where they earn "points" for managing certain chronic conditions, one of which is depression. The more points they earn, the more money they get. So there is an incentive to diagnose and manage certain conditions.

Hi there, just to echo note of the same!
The issue is not GP’s or even the NHS. It’s the utter scandal of pharmaceutical company research. Basically they are involved in around 70% of published studies.
Then they also hold back all the data about the side effects and the trouble coming of them.
They are very dangerous! I have never been able to come off because I have been made so unwell when I try and stop. Once you go on them it’s a game you play for life.
Interesting reading on this:
Robert Whitaker - Pulitzer Prize nominated journalist (google his talks - he’s dedicated his life to this scandal)
Johan Hari - book lost connections also has stuff on YouTube.
Jordan Peterson - recently nearly does trying to come off benzos

The corruption runs so deep......

@Badbadbunny
Shitting hell - I didn’t know this. Will investigate!!!! Even worse - I thought GPs were just passive. I’m guessing it’s the practices not the unsocial GPs that oushthis sort of stuff.

I have awful depression and anxiety, antidepressants saved me. I will keep taking them for as long as I need them, they did wonders for me.

There is definitely a drive to prescribe them in lieu of properly treating chronic or long-term pain. There appears to be a pervasive idea that chronic and long-term pain is entirely psychosomatic.

I'm on one but it is indeed for depression and it's made a huge difference, especially to my sleep. I didn't get a counselling referral but honestly, I don't want counselling.

It seems to be quite difficult for many women to get HRT these days, too.

It’s interesting. A friend was feeling shit when he found out his wife was cheating and then she kicked him out. He was teary, struggling to concentrate and having trouble sleeping - well his life has imploded. He went to the GP for sleeping pills and came back with ADs. He decided to hold off a couple of weeks, took a week off work, started going yoga and meditating using stuff on YouTube and felt a million times better.

As far as his doctor knew he was taking them but no one contacted him to check how he was doing.

At uni I had terrible insomnia and nightmares. Asked for sleeping pills and was asked if I was depressed. I said only because I was exhausted and couldn’t sleep. Was put under loads of pressure to take ADs but held my ground, a few days of sleeping pills broke the cycle I was in and I was fine again.

They’re mind altering chemicals. It’s scary how often people are pushed into taking them when something else - either medical or holistic eg exercise, yoga - might help more gently. No side effects from a week off work and some self care. And costs the NHS nothing.

@Iwasonceabrownie

I have awful depression and anxiety, antidepressants saved me. I will keep taking them for as long as I need them, they did wonders for me.

I will, too. But I was honestly very depressed and suicidal.

Anne, you could more easily score fentanyl from a drug dealer than get hold of sleeping pills these days. They are seriously nigh on banned and they hand out ADs like sweeties rather than give out a week of sleeping pills. Despite my depression and PTSD and my drug working well for these, I still get dire jags of insomnia. I had to go abroad to get a doctor to prescribe a week's worth.

Curiously I went to my gp years ago due to getting really nervous doing large presentations, I’m talking over two hundred people watching, and wanted something to help. Bizarrely I was also offered anti depressants and had to make it very clear I wasn’t depressed.

I was given propranolol which is used when musicians get stage fright etc, and take one before something major. It works perfectly. But I was quite surprised that the go to was “are you depressed”, after describing the issue.

mrbob thanks. I didnt for a moment think there was some sort of imagined boss. I was wondering what the true driver was within the NHS / Govt in pushing ADs particularly for chronic pain. Yes I know opiates can be addictive. But as a sports Therapist, I am aware of my clients medical backgrounds. At least half of my clients are on SSRI's for depression, yet the meds have done nothing for their pain. Hence my concern about prescribing for issues other than depression and anxiety. And it worries me too that anecdotally it seems they aren't always being monitored and are difficult to come off. A lot of people don't like the way they make them feel. Pretty unnecessary in many cases, just from reading peoples experiences on here and family/ friends.

Iwasonceabrownie I'm in total agreement of them being prescribed for their correct use. And so pleased they work for you. I should have made it clearer that it's my experience (and obviously many others) that they appear to be being pushed if you so much as mention pain, tiredness etc.

Badbadbunny and someoneinthelaaaaaounge that is all extremely interesting.

People with chronic pain and even acute situational pain, such as after surgery, are literally being thrown under a bus. It's awful because, having had major joint surgery myself, if your pain isn't properly controlled, you don't heal as well. Surgeons know this, too. You're not able to get ROM back as quickly, which causes problems with vascularisation. But nope, can't be prescribing opiates, they will all turn into junkies. I'm so glad I had such surgery long before this huge drive to stop treating pain came in.

On the other side of the coin, I do have mental health issues. Got offered setraline during lockdown which I took for 3 weeks. In that period I had a constant headache and pins & needles. Was told to come off them and I thought I'd be offered another type of ADS as my symptoms hadn't improved. I wasn't but I do get sleeping pills (ptsd related insomnia) and temzepam.

@InDeoEstMeaFiducia that's very interesting that you say about chronic pain being viewed as psychosomatic. My Rheumatologist Physiotherapist said something to me yesterday along the lines of "I'm not saying its psychosomatic, but.." even though he knows I have osteoarthritis in all my joints as well as Hypermobility disorder. He started mumbling about it maybe also being fibromyalgia, which sadly seems to be viewed by some as entirely psychosomatic. Personally, I don't think I do have fibro, but that's by the by. And he knows I work as a Sports Therapist too and have a good knowledge of anatomy and physiology and how pain works. Not to mention a good knowledge of my own body and lifelong fairly high pain threshold.

I was offered ADs for migraine. A couple of weeks later dh was offered the same drug for back pain. The worst thing was that in both situations we felt rushed out of our consultations , we consequently didn't fully realise what meds we had been given until home from the pharmacy.

I took them for 48 hours but was useless at home looking after a baby due to feeling so spaced out. My husband had a similar experience and stopped taking them after a day or two.

@Dinosauratemydaffodils

On the other side of the coin, I do have mental health issues. Got offered setraline during lockdown which I took for 3 weeks. In that period I had a constant headache and pins & needles. Was told to come off them and I thought I'd be offered another type of ADS as my symptoms hadn't improved. I wasn't but I do get sleeping pills (ptsd related insomnia) and temzepam.

I have PTSD and related insomnia and couldn't get sleeping pills for bad jags (surrounding the anniversary of my child's death) for love or money. I had to go abroad, luckily I was able to do so. I know my condition very well and literally, a week's worth of 3.5mg of zop does the trick during that time but no go now, used to be able to get them here.

I take mirtazapine and I was one of those who lost weight on it, probably because it sorted out my sleep so instead of staying up all hours feeding my face and being too tired to exercise, I was asleep and then able to exercise a lot more.