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.

They are the current fix all. In a few years we will see the fall out (I think it's becoming apparent already tbh). I think the issue is that they always look for the 'herd' answer, the one that works for the majority. They've decided not to prescribe anxiolytics, narcotic painkillers, even a lot of NSAIDs, HRT, and these drugs are miraculous for some people. But because 5% have miracles, 10% have very negative reactions, and the rest react just as well to the old 'bad' medication as to the new 'good' medication then they adopt the new one. I think the majority of people get a placebo reaction tbh and not much else from SSRIs but feel better that something is being 'done'. So they get the same pain relieving effect from codeine, as they do from fluoxetine.
Basically most medicines are pretty bullshit. We may as well be taking sugar pills most times. Except for the people who they work for, who get denied them on the basis of those they don't work for.

It's dangerous because if you treat all pain and fatigue and symptoms like that with a masking drug (be that anxiolytics narcotics NSAIDs hormones or antidepressants!) then you can miss the underlying causes. I would love to see people being treated for nutritional deficiencies and better screened for autoimmune conditions, hormonal issues (all hormones not just sex hormones and cancers). Instead we have people who 10 years ago got put on drugs for new symptoms , and now are being diagnosed with the underlying condition too late to do anything about it.

With reference to what I've said above - my Mum is now too weak and has too many underlying conditions to undergo further surgery of any kind. So she had a major op a week after lockdown, spent a lot of time in ICU, now has a hernia which her surgeon has rightly said she will not operate on, so if my Mum shattered her hip for example, she would just die in pain.

I have a long term conditon that was diagnosed very slowly me but very quickly in a friend, because she said she was exhausted and I said I was depressed. We both had fatigue

@MaxNormal she has had amazing care. Thank you. Her surgeon is nothing short of a miracle worker. I would happily nominate her for an MBE. We live in an area of great hospitals, cancer care and top region for heart surgery. When my Mum came round after surgery, the nurses said to her that her surgeon saved her life. As you will understand though, I'm worried about her osteoporosis.

I guess that people who are in great pain and are refused pain killers by their doctor will order them online.
Being in pain completely ruins whatever one is doing and makes it impossible to lead a normal life.

@Andante57

You can't buy them online can you?

Not legally anyway!!

It's a regular thing for me, too. I tell them 'My right SI joint is either slipping out, locking or is inflamed and my right ring finger middle knuckle is hot, red and swollen like a balloon'

'There is a type of pain that comes from the nerves or from being in pain for a long time and that can be helped by antidepressants'.

'No, it's a joint problem, it's not in my mind of my nerves'

'Have you been tested for fibromyalgia'

'More times than I can count. You can poke all the fibro trigger spots all day if you like, but this pain is in the joints'

'Well, we can't do anything else if you won't take medication for it. Have you considered the possibility that it hurts because you're depressed?'

'Can being depressed make a finger joint swell up?'

'Ah. Well it could help you sleep'

'By sending me hypomanic and batshit crazy because I'm not depressed? So I'll be awake for 86 hours at a time, hallucinating and still with a hugely inflamed finger and SI joint, rather than 18-20 hours and just being in pain from the inflamed finger and SI? I'd far rather not be batshit and have something to deal with the inflammation and pain in the inflamed joints'.

'Oh. sorry. I'll just give you this leaflet...'

'Is it on antidepressants and trying meditation? No thank you'

I have to take a low dose of an ssri to keep my autistic meltdowns and anger under control so my behaviour is acceptable to other people. I'm pretty much stuck on them for life. I do think they're overprescribed, particularly to women.

They're going to stop selling cocodamol over the counter, so I don't know what people are going to do for acute pain such as dental abscess, endometriosis, injuries or migraine.

@MitziK that's crap. Absolutely totally and utterly crap. I'm astounded at the replies to this thread. It's got me beyond frustrated and annoyed.

@rosiethehen I hope they help you. I know people who have to take certain medications for autism and ADHD which make them feel awful. One friend takes them during the week so he can appear 'normal' to his colleagues, but stays off them at weekends and hides at his allotment. I think, like any drug, a person should be treated like an individual. Not every person will get on with the first medication they are given. Be that for menopause symptoms, mental health, or joint pain.

No, in England and Wales, GPs are not paid to prescribe antidepressants. What a stupid assertion to make.

Pretty much every medication had costs and benefits. Many of the posts touch on chronic pain and long term on opiod/opiate pain relief certainly has costs yet is appropriate for some people compared with the alternative. That said, there is evidence that anti-depressants can be an effective alternative.

"Some of the more effective and commonly used medications for chronic pain are drugs that were developed to treat other conditions. Although not specifically intended to treat chronic pain, antidepressants are a mainstay in the treatment of many chronic pain conditions, even when depression isn't recognized as a factor."

In simple language -
www.mayoclinic.org/pain-medications/art-20045647

When prescribing, it can take time before the appropriate medication or treatment for that patient is reached, even after the correct diagnosis is reached. It wouldn't be sensible to prescribe for the rarest condition first and different patients react differently. Even when the condition is identified, different patients find different medications are most effective or offer the best balance between therapeutic effects and contraindications - there are several different anti-depressants and not everyone finds the most popular to be effective. It's possible that genetic analysis might eventually help prescribing but, until then, there is often an iterative process. It will feel unsatisfactory even if the diagnosis is correct. I would say patients who feel unhappy when it takes several different medications to hit the best solution don't necessarily see the 95 out of a 100 patients for whom the earlier medications worked best.

That said, doctors get things wrong.

That said, some patients arrive with fixed and incorrect beliefs - simplistically I want antibiotics for this virus with no secondary bacterial infection.

Or 'how dare you offer me antidepressant for pain relief when other pain relief hasn't worked, this isn't in my head' even though pain relief has a significant cognitive element or else placebo effect in pain relief wouldn't happen.

Here’s a few facts to throw into this little anti GP thread

No we don’t get paid for prescribing antidepressants.

Antidepressants are not addictive. Opiate pain killers are. Opiate painkillers are abused and sold to addicts. Scientists are constantly trying to develop painkillers that don’t have a street value. They thought gabapentin and pregablin would work, but guess what, junkies get a high from them too.

Some antidepressants are very effective at relieving pain.

All tablets have side effects. If you don’t want tablets and you don’t want physio and you don’t want counselling, then don’t bother the GP because we don’t have magic wands. When it’s bad enough we can refer you to hospital, where you’ll be offered the same things.

Maybe GPs should all quit and people could consult the experts on mumsnet instead!

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.

You're advised to reduced them so that you can restart on them easier if any symptoms come back with reduction. For example, SSRIs increase the number of neurotransmitters and also strengthen the neural pathways. (Which is why they can take 4-6 weeks to start seeing any help even though they increase the serotonin fairly quickly). Stopping taking them immediately could lead to them reducing again.

Also, depending on the type of pain, SSRIs are actually prescribed properly. As well as increasing serotonin, they can also lead to an increase in norepinephrine, which inhibits neuropathic pain.

And I would say the majority of heroin addicts I’ve known have blamed a doctor for their habit, saying the doctor gave them opiates in the first place, and then they got hooked.

@slashlover

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.

You're advised to reduced them so that you can restart on them easier if any symptoms come back with reduction. For example, SSRIs increase the number of neurotransmitters and also strengthen the neural pathways. (Which is why they can take 4-6 weeks to start seeing any help even though they increase the serotonin fairly quickly). Stopping taking them immediately could lead to them reducing again.

Also, depending on the type of pain, SSRIs are actually prescribed properly. As well as increasing serotonin, they can also lead to an increase in norepinephrine, which inhibits neuropathic pain.

I don't take ADs for pain, I take them for major depression and PTSD. My son takes a different one for OCD. I have no intention of stopping them, possibly ever (my depression is the result of the death of my child and my son's conditions so none of those is ever going to change; my PTSD is the result of the treatment my deceased child went through), nor my son - there is no cure for OCD even though he has had adjunct therapies which have helped. He also has autism and ADHD, again, no cures.

And I'm one of the supposedly rare people who has lost weight on mirtazapine, mostly because I was able to sleep better and had more energy for exercise and I also found it had no effect on my appetite.

I've been told not to stop taking them cold turkey, though. But they're not addictive.

Whatever. I'm fortunate I guess, in that I don't suffer from chronic pain.

And mirtazapine is apparently not a SSRI so again, perhaps not offered to people in chronic pain?

I've been told not to stop taking them cold turkey, though. But they're not addictive.

Because stopping them cold turkey could easily lead to an increase in your depression and PTSD. I stopped my ADs gradually (moving from two per day to one per day to one every second day etc.) and could feel my symptoms coming back so I went back to my original dosage. If I had just stopped them immediately then my symptoms could have come back full force which would not have been good, and could have taken longer to get back under control. I stopped them gradually a year later which was fine.

I've no plans to stop taking them at all .

And I'm not on an SSRI.

I was once prescribed anti depressants because I sobbed in GPs office about the length of time some potentially serious test results were taking. Thankfully the results came back clear but if they hadn't I'd be dead by now. I wasn't depressed, just justifiably worried about something with a clear resolution. The tests had been done but it took almost a month for me to get the results. I do wonder why they're so readily prescribed, I didn't take them.

Mintychoc1 people are sharing genuine frustrations here. I don't think taking it as anti-GP and getting defensive is helpful. It would be more useful if GPs genuinely took on board what people say and think about their treatment.

slashlover the reason you shouldn't stop ADs cold turkey is that your brain is physically dependent on them and you will likely have very bad withdrawal symptoms.

@JadesRollerDisco

Not legally anyway!!

No presumably it’s illegal.

I have a few chronic conditions, I have been considering asking my gp for antidepressants for my back pain. I was completely relaxed on Monday, more relaxed than I can remember and my back wasn't hurting - it always hurts!

I have taken antidepressants before, once when my mum died and the other for PND. I have no issues with taking them for reasons above.
I did however take exception to being asked at every gp visit if I was depressed when what I needed was more frequent b12 injections. I was not having depression on my notes for something that wasn't depression.

All tablets have side effects. If you don’t want tablets and you don’t want physio and you don’t want counselling, then don’t bother the GP because we don’t have magic wands. When it’s bad enough we can refer you to hospital, where you’ll be offered the same things.

Maybe GPs should all quit and people could consult the experts on mumsnet instead!

Um, actually, physio would be brilliant, thanks. Hydrotherapy, preferably. Maybe a free gym rehab referral, as I can't afford one at present myself? I could theoretically use the pool to deal with the hot, swollen, inflamed joints that my mind is apparently making happen. As long as I can use it in peak times, as I'm at work the rest of the day, so don't say it's only available off peak (as disabled people presumably don't have jobs).

I'd rather not take more tablets (prescriptions are expensive) and risk more bloody throwing up, ending up off my tits because I'm not depressed, or allergic reactions when actual physical therapy could potentially do something to actually help, as I'm quite happy self injecting biologics fortnightly (well, I say 'I', in truth DP does it because my hands are too painful/weak/swollen to operate the injectors), but only because they actually do something useful.

I've had it previously when asking for the medical OK to join a gym. Um, no, thank you, I just need you to sign this so they'll let me in the door.

I've had it when I'm covered head to foot in Psoriasis - admittedly, the second time I went for that, a different doctor took one look and gave me the diagnosis - before then, I noted the description on screen of my looking 'unkempt' and 'refusing medication' at the previous visit with it (doctors are shit at remembering that most people can read computer screens).

I think most people look a bit unkempt when their hair is coming out in clumps with silvery lumps of skin attached, it's 32 degrees and you're trying to find clothes that disguise the fact that you look vaguely leprous on the bus. One prescription of Dovobet later and I was fine within a fortnight. I still wonder why being covered in plaques necessitated a lecture about washing my hair more often and yet another offer of antidepressants when there was a slightly more obvious diagnosis that could have been made.

Contrary to your throwaway comment, you do wave a magic wand and think everything will be solved. Antidepressants.