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.

The official advice now is to prescribe antidepressants, not pain relief, for chronic pain. Personally I think it's insulting and dismissive to the patient. And it is going to disproportionately impact women who are already more likely to have their symptoms minimised and dismissed by doctors.

@safariboot

The official advice now is to prescribe antidepressants, not pain relief, for chronic pain. Personally I think it's insulting and dismissive to the patient. And it is going to disproportionately impact women who are already more likely to have their symptoms minimised and dismissed by doctors.

💯

It's utterly Victorian, isn't it? Hysteria and all that total shit. Basic failure of the realities of anatomy, too, and the CNS. But hey, it's mostly women.

Yes safariboot My GP chirpily said to me yesterday "Ooh you will have seen in the news how we now don't prescribe opiates and anti inflammatories for chronic pain, so we will pop you on an SSRI like sertraline or..." To which I cut her off and said No. This is the second time you've tried to make me take SSRIs and I have said I am not happy to do so. And you know why. She tried to say that maybe I was feeling a bit down and teary - maybe with the pain - trouble sleeping perhaps? actually trying to make the symptoms fit the drug I chrlirpily replied that my life was wonderful thanks, and that I simply wanted to manage my arthritis pain.

@FrolickingLemon

Yes safariboot My GP chirpily said to me yesterday "Ooh you will have seen in the news how we now don't prescribe opiates and anti inflammatories for chronic pain, so we will pop you on an SSRI like sertraline or..." To which I cut her off and said No. This is the second time you've tried to make me take SSRIs and I have said I am not happy to do so. And you know why. She tried to say that maybe I was feeling a bit down and teary - maybe with the pain - trouble sleeping perhaps? actually trying to make the symptoms fit the drug I chrlirpily replied that my life was wonderful thanks, and that I simply wanted to manage my arthritis pain.

Jesus wept! A lot of these AD's have major side effects. As stated, I'm on one, but I was genuinely depressed and suicidal and I have PTSD from child bereavement and another child who is disabled. But the drug I'm on commonly causes serious weight gain (it had the opposite effect for me as it sorted out my sleep so I wasn't awake eating all night and then too tired to exercise) and I do have dry mouth, headaches and constipation.

I know people who are now hooked on illicit drugs for chronic pain after being fobbed off or 'popped on' SSRIs which have done nothing for their pain. Their pain was still there, so they became desperate. Ditto people with grave insomnia. It's ridiculous. I can't say I blame them, either, I'd likely do the same.

It’s nothing short of a major scandal how people suffering chronic pain are being whipped off the only drugs that help them, and left to suffer in agony with a much reduced quality of life, just in case somebody completely unrelated to them might try and score some off the black market.

How can it possibly be viewed as medically ethical to leave people in excruciating pain just in case somebody else might become addicted to a pain killing drug?

It’s fucking ridiculous.

And mrbob I’m well aware of the studies you cite. What always baffles me is how very few people are able to interpret studies accurately, and then apply the findings sensibly in real life situations. Studies show the likely effects of a medicine at a population level. They do NOT accurately predict response to a medication in any one individual. People respond to drugs differently. For starters, some people have different numbers of active genes for certain liver enzymes than others. And this can have a massive effect on how a drug is metabolised, and hence how effective it is, and how many side effects are suffered. There are many variables and this leads to a much more complex picture than can be accurately reflected in studies, which in any case never ever show anything is 100% ineffective, even within their own limited parameters.

It is incredibly bone-headed to insist that individuals must be mistaken in their experiences that a drug helped them, if that goes against the overall outcome of one or more studies.

And worse even than the utter stupidity of this, it is CRUEL to deny people adequate pain relief and leave them in agony, while gaslighting them when they attempt to explain their own experiences.

I agree. Ten years ago we were going through a series of miscarriages, at the same time I had a blistering skin condition on my hands. The dermatologist I was referred to said it was because I was depressed about the miscarriages and must be causing the blisters in my sleep! Basically said I was doing it to myself! He prescribed me antidepressants that did nothing except make me really sleepy. I stopped them after a week.

Ten years on I still have the condition on my hands and was referred to a different dermatologist who did a biopsy on one of the blisters and it turns out I’ve got a very rare skin condition and fingers crossed if my blood test results are okay I will be starting on some medication for it soon that most definitely isn’t antidepressants.

Present yourself with symptoms of minor hypothyroidism and they offer you anti-depressants.

Cos you have to pay for those. As soon as you are officially diagnosed with a thyroid condition you become entitled to free prescriptions. And they don't want to do that, so they palm you off.

Totally agree that ADs are prescribed far too freely. I was feeling moderately depressed when I moved from Australia to the UK as might be expected with feelings of homesickness and displacement, and because I'd moved the GP had no records of any previous medical history. Within 5 minutes of a phone consultation I was offered ADs - it was that easy. I never ended up picking up the prescription and had a few sessions with a counsellor and felt much better within a few months. I'm not saying ADs don't have their place, but it does seem there's an attempt to chuck them at any problem, regardless of how appropriate or necessary it is, rather than consider a more holistic approach. It's lazy and quite frankly, dangerous.

Shit. All these different yet similar scenarios. Shocking!
I really feel like I want to do something about it.

It’s nothing short of a major scandal how people suffering chronic pain are being whipped off the only drugs that help them, and left to suffer in agony with a much reduced quality of life, just in case somebody completely unrelated to them might try and score some off the black market.

How can it possibly be viewed as medically ethical to leave people in excruciating pain just in case somebody else might become addicted to a pain killing drug?

This. And frankly, I wouldn't be surprised if more don't turn to illicit drug dealers once their pain relief is yanked from them and they're told they are making it up/it's all in their heads/you can be counselled out of it/AD's will cure it/insert other utter gubbins. At least the dealer doesn't ask questions, and the drugs are cheap.

I don't know why there's this persistent myth that anti-depressents aren't addictive. Of course they are, they cause a physical chemical dependency in the brain. "Discontinuation syndrome" is just a polite way of saying withdrawal symptoms.

"New research suggests antidepressant withdrawal symptoms might be more common, more severe and longer lasting than previously realized" www.apa.org/monitor/2020/04/stop-antidepressants

If AD's are not addictive then why can't you stop taking them cold turkey? And don't trot out psychological guff, those drugs work on bloody neurotransmitters, that's a known fact.

I don’t think it’s kick backs.

I think it’s easier for doctors to assume that if you’re female your problem is depression or anxiety, and weight related if you’re fat.

It takes an average of 8 years to be diagnosed with endometriosis. How fucked up is that.

@FrolickingLemon

Yes safariboot My GP chirpily said to me yesterday "Ooh you will have seen in the news how we now don't prescribe opiates and anti inflammatories for chronic pain, so we will pop you on an SSRI like sertraline or..." To which I cut her off and said No. This is the second time you've tried to make me take SSRIs and I have said I am not happy to do so. And you know why. She tried to say that maybe I was feeling a bit down and teary - maybe with the pain - trouble sleeping perhaps? actually trying to make the symptoms fit the drug I chrlirpily replied that my life was wonderful thanks, and that I simply wanted to manage my arthritis pain.

@FrolickingLemon, fwiw the advice. To avoid opioids etc.. IS a good idea. However, the follow in from that is NOT to put people in ADs. It’s to direct them towards other therapies such as acupuncture (which is seeing as just as efficient if not more than all the painkillers they used to give)

Your GP has read only half in the advice!!

Is the NHS even funding acupuncture? Bloody hell, we had to go private to get one of my children's mental health sorted out.

QuestionMarkNow thanks for your post. I agree, half the info. But also understand they are pushed for time. But my GP knows me very well, and I thought she would know better than to push ADs. I know codeine is bad. I avoid it if I can. I don't take Naproxen etc as I also know that's bad. I've been involved in a couple of road traffic accidents in my life and was once prescribed diazepam. I took it for 2 days then stopped. It was awful. I have a high pain threshold. I don't have an injection when having fillings, and had nothing with childbirth despite the pain. However, I have to at some point, resort to something. I've done yoga for 20 years, ran marathons, done boxing. I can now not open a jar (having to ask 8 or old DD for help) or even get down on my yoga mat. I told the GP that lockdown had exacerbated things as I couldn't go swimming which was helping. I just needed something to get me through the worst days. I don't feel I could become addicted as I don't even like or want to take them. And it doesn't give me a high like it does with some people. However, I understand that addiction to codeine is a problem for some. And that long term opiates are bad. My Rheumatologist recommended Celebrex. But again, the issues are huge.

Caught between the devil and the deep blue sea!

I was offered acupuncture a few years ago on NHS for plantar fasciitis. In the end, they decided it probably wouldn't work. What a bloody farce. I have paid for acupuncture a year or two ago for my shoulder injury, but it just became too expensive and not actually that effective. I've had so many injured joints and hypermobility for so long, it was always going to result in this. But I'm only 49 and I don't want my 8 year old to become my carer.

Oh and @InDeoEstMeaFiducia you really seem to have been through the mill! to you and thank you for all your excellent posts.

Do you think the HRT patch is risky OP?

Im wondering wether to ask for it, but I think it will be a long road to getting it

I think it's not as simple as an incentive. My partner works in health care regulation and this would have come out. But I do think the NHS is under resourced and women are routinely ignired/dismissed. So SSRIs are often offered as one of the only available solutions. I take citalopram and SSRI for anxiety and reoccurring depression. I actually had mental health issues fro around 4 years before I took them and although wlthey were offered not pushed. I'm 35 now and have a few hormonal health issues. I'm actually slightly dreading the menopause as I just feel that there's no where near enough research and solutions for how it impacts women. This is just one example where ethey are offered to address symptoms which should have other treatments.

Hi @Wilsonscaresme when I first asked about HRT 2 years ago I fully read up on the NICE guidelines. I also did an evaluation family history wise. We have no history of breast cancer. And for me, the clincher was that HRT can protect against heart disease and osteoporosis. My Mum never took HRT and now has heart disease and osteoporosis. My aunty did take HRT, said the benefits were amazing and doesn't have heart disease or osteoporosis. They are the same age. Make of that what you will.

@FrolickingLemon

Yes safariboot My GP chirpily said to me yesterday "Ooh you will have seen in the news how we now don't prescribe opiates and anti inflammatories for chronic pain, so we will pop you on an SSRI like sertraline or..." To which I cut her off and said No. This is the second time you've tried to make me take SSRIs and I have said I am not happy to do so. And you know why. She tried to say that maybe I was feeling a bit down and teary - maybe with the pain - trouble sleeping perhaps? actually trying to make the symptoms fit the drug I chrlirpily replied that my life was wonderful thanks, and that I simply wanted to manage my arthritis pain.

This is utterly fucking chilling. It is completely unethical.

I'm not in the UK anymore, but I had no problem up until last year getting repeat prescriptions for cocodamol for debilitating periods that make me puke/ faint/ writhe in agony.

Being left without appropriate pain relief would have wrecked my mental health. So then yes, I certainly would be bloody depressed after a few months of struggling with intolerable period pain!

@FrolickingLemon it was osteoporosis that finished my mum off, and not pleasantly. She did have cancer but was doing really well on the treatment then her thigh bone just snapped one day.

Horrible pain and deterioration and she didn't last long after that.

Might have been a very different outcome if she'd taken HRT for her earlyish menopause. (The cancer was not hormonal, btw).

Also, codeine makes me feel a bit shitty and unwell generally. I don't have the remotest inclination to take it unless in dire straits and absolutely NEED it, ie when in severe pain and feeling miserable from the codeine is the lesser of two evils.

I understand opiates are addictive, but not everyone is at risk of developing an addiction.

Shit @MaxNormal my friends Mum had a similar outcome. Also, my Mum currently has cancer and I worry that a broken hip or such like may be the beginning of the end. Despite her having seen her amazing surgeon last week who described her as "thriving" it is all so totally fucked up.

Sorry to hear about your mum @FrolickingLemon, I hope she's getting good care.
Our bone health is honestly so vital for our later years. And yes HRT has risks, if you're prone, but at least it also has benefits.
I'm not saying ADs don't have some benefits - but for people with serious clinical depression! Not pain or menopause.