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.

Opioids are a very poor choice for chronic non-cancer pain.

As you know so much more than your corrupt doctors, you’ll be aware of that.

I don’t know what a sports therapist is, is your degree in physiotherapy or exercise physiology?

Serin has hit the nail on the head here. Sadly too many GP's no longer treat patients holistically. They know a little about a lot and have a long list of medication they are either not allowed to or strongly discouraged from prescribing in favour of cheaper alternatives and are more interested in QOF points and their bottom line than helping patients. I think Minty's attitude is very poor and sadly a reflection of many GP's attudes today, dole out pills - check, record an offer of counselling (knowing full well the length of nhs waiting lists) check, now off you go and if you don't like it - tough. I've met and worked with a lot of gp's and frankly many of them are arrogant and uncaring and I think this attitude of self aggrandisement needs to go in favour of a kinder and more evidence based approach.

I think it’s just because they’re a quick fix. They don’t have the time, money or resources to properly help people - you know, talk to them, look into their issues, find out what’s going on, arrange counselling or treatment or whatever else they might need - so they just fob you off with pills.

Really not my experience or those of my circle

Some antidepressants are very effective at relieving pain.
@Mintychoc1 are you talking about amitriptiline?
Because as far as I know, yes it’s prescribed as a painkiller (well it relaxes muscles really which can, in some cases, help). But it also gave never been put on the market as a painkiller and shouldnt be used as such.
If this is but the case, I’d live to see the research on that.

@Aridane

I think it’s just because they’re a quick fix. They don’t have the time, money or resources to properly help people - you know, talk to them, look into their issues, find out what’s going on, arrange counselling or treatment or whatever else they might need - so they just fob you off with pills.

Really not my experience or those of my circle

I have one GP who is as you describe Adrianne. It’s lovely. He knows me even though I rarely go and see a GP. The others in the practice? More like what the OP describes

So yes there are some. But, ime, very few

Amitryptiline can be fucking brilliant prevention of migraines, treatment of neuropathic pain such as fubromyalgia. My neurologist gave it to me

You're correct op. Big Pharma has secret contracts with gp's and gives them ten percent commission on every SSRI they prescribe. Nobody knows about these contracts though so you can never prove them. That's how controversial they are.

I think this is a very interesting thread and some of the experiences mirror my own.

I was put on antidepressants for my migraine and life was shit. (Can't describe it any other way!)
They didn't help me, and side effects were horrendous. Sadly it took some time to convince my GP that they were not the right choice for me.

It's a fine line that GP's have to negotiate. But in the end, it's the patient who knows how they feel. Replacing pain with lethargy, mubness and 18 hours sleep a day is not always a a better choice to pain.

My bf went to gp (before we were together) with symptoms to feeling down and not being able to sleep. The reality was that he was sad. His mum had just died. He was given SSRI's after a 10min conversation. He took it and immediately had side effects and stopped them. The side effects still follow him 15 years later (though gp thinks he is making them up). As someone who works in health care, I truly believe the gp should have recognize that it wasn't depression, it was sadness and Maybe given something to sleep and recommended some more natural remedies.

My cousin has depression and anxiety and definately should be on medication.
With him the trouble is that there is no follow up. His meds get reviewed by always a different doctor sometimes with the patient and sometimes without. My other cousin (his brother) that is a pharmacist checked his medication list and was shocked how many were doubles and some counter effected others. Then there were medications that were way too strong to his situation.

I went to GP for B12 injections and she was really pushing antidepressants.

@Rewis. What would you give for sleep? What natural remedy would you recommend?

It’s not a GP issue, I think it’s an underfunded and under resourced NHS. Underfunding and short staffing stifles thinking and diagnostic skills. So quick fixes become necessary.

It’s not surprising that levels of care can suffer after years of driving the NHS into the ground. Look at how all treatment had to stop in order to treat Covid.

I started them this year and I’m very glad I did
I did toy with them a few years ago but the GP asked me to go away and think about it , and at that time I didn’t

It’s a trick one . They do work , and they help
In my Situation I needed them

But I also agree they shouldn’t be handed out for Peri meno !

The painkiller issue is a way trickier one
No easy answers there

How much of the work a GP does do we really need GPs for. At my practice it can be quite hard to see a GP now, in the first instance you see a nurse practitioner. If that's acceptable, there must be huge potential cost savings for the NHS there.

Antidepressants aren't very addictive. Opiates on the other hand are highly addictive - life ruiningly addictive

Trixiebelden77 I know opiates are bad for long term pain. I've said this myself. I've said I don't like taking them. In one of my posts, I explained that I'd gone back to the GP as my arthritis has been exacerbated by lockdown so wanted to take codeine to see me through the worst days. The ones where I can get in and out of the bath for example. My swimming was helping wonderfully. But that and my physiotherapy ended abruptly in lockdown. Like a PP mentioned, I'd love some hydrotherapy. Anyway, my physio has restarted, and I'm due to see the Rheumatologist again very soon and I'll have some scans done to see which of my joints are worst as it looks like I need my right hip replacing (followed by other joints in the future)

At no point have I said I know more than my doctors. Nor that they are corrupt. I have enormous respect for the doctors and consultants currently helping me. However, my point was and is that I don't like the way antidepressants are being pushed. And it seems a lot of people here have similar experiences. It certainly has created an interesting discussion.

My degree is in anatomy and physiology - Sports Therapy. I treat sports injuries and that includes a significant element of the emotional / psychological impact.

GPs definitely seem to be doing everything they can to stop prescribing painkillers like codeine.
And people seem to be misinterpreting that recent study - I seem to think it said that opiates were no better than antidepressants for chronic primary pain i.e. pain not caused by anything else?

I have a very failed endometrial ablation which has left me in agony for approx 10 days a month. Several times now my GP has refused to give me co-codamol for it, instead tries to give me anti-depressants. My pain is caused by blood backing up behind scar tissue. There’s a physiological reason for my pain. If I don’t address the pain, I can’t function. And it’s not the whole month, just around 10 days I struggle with. (There’s pain at other time’s, but it’s manageable).

Multiple time’s he’s offered me anti-depressants (which incidentally didn’t even work for my depression when I was depressed in the past), and Tranexamic acid (which if he looked at my notes he would see I can’t take because I’m epileptic and in the past they induced seizures). Also naproxen, which again I tried and didn’t help, but also dragged my period and therefore the days of pain out even longer.

I’ve done pretty stupid things when I’ve not been able to get pain relief before (none of which I’ve told my GP) - taken double or triple doses of OTC co-codamol (probably not the greatest for my liver, but desperate times), and tried desperately to find weed (I don’t know anybody who uses it, but figured I might find somebody in the park in the evening who does 😳). Sometimes just drank.

It riles me even more that my pain has been caused by a procedure that doctors did, and they know exactly what the cause of my pain is.

I dread that time of the month because of the pain, I dread it more because I never know if I’ll have adequate pain relief for it.

I take Citalopram, an SSRI, I know it has helped me along with CBT. I had a massive breakdown 4 years ago, the second one I have experienced. I was barely functioning, literally. I am fortunate to have an amazing G.P. one of the old school, she got me therapy, also mindfulness course, to follow after I had been taking the SSRI, this was because, I would never had made it anywhere, let alone speak to anyone. At the beginning I saw her fortnightly, then monthly, now its 6 monthly. She said when I am ready to give up the meds she will support me, they are not addictive, you just should come off gradually. I know so many who have come off them.
I am not doubting there are gps who hand them out, but my practice has been very supportive.
My Dad, like many of his generation was addicted to valium, diazepam, in those days you bought your gp a bottle of whiskey and he would prescribe, mummy's little helpers did untold damage to that generation, people think ssris are the same but they are totally different.

Not where I live. They push you towards talking therapy first. At least they are not trying to push you onto MAOI drugs. Way worse.

I asked my friend about it (GP), and she said that she often sees people who are suffering from long term health problems or are carers and they are more than twice as likely to suffer from depression. She said that she gives them frequently because they help with the situational aspects (anxiety and pain and inability to fix things) precisely because she knows how long it takes to get treated for some things. She also said that with women in late 40s and 50s that menopause often occurs at the same time as job redundancy, retirement, problems with partners and children and dealing with aging parents and she gives them almost because she knows the AD's will help to diffuse the emotional pain so they don't have to deal with both physical and emotional pain. I think that is a good answer.

They’re the equivalent of being given steroid injections for everything, instead of treating the true cause.

The reason is that they're both quick and cheap, shut you up and make you docile.

Go private and see the difference in treatment.

The naivety on here re the NHS is quite surprising.

Another thing to consider is that once you’ve been prescribed AD’s for depression or anxiety any doctor you visit at any point in your life after that point will attribute your symptoms to depression or anxiety. It’s as if once you’ve been diagnosed with a mental health condition you’d become unable to develop a physical one. No doubt this is especially true if you’re a woman.

Broken arm? How’s your anxiety?
Chronic aneamia? How’s your anxiety?
B12 deficiency ? How’s your anxiety?
Complete decapitation? It must be your anxiety.

Dr’s will only prescribe diazepam (or any other benzodiazepines or hypnotics such as zopiclone) for a limited number of reasons and even then not in large quantities or frequently. They will prescribe larger doses/long-term under the direction of specialist- e.g. psychiatrist or neurologist.

My psychiatrist happily prescribes zopiclone, 10 days worth per prescription. It's about the only useful thing he does. He also hands out temzepam in 3 weeks at a time prescriptions (although it seems to have zero effect on me).

No one will prescribe me anti depressants though which just highlights how ridiculous this is. I am depressed, I hate myself, my ptsd symptoms are hellish atm and nothing but people who are happy apart from chronic pain can have them...

KingOfDogShite that's actually a really good point. Another reason I do not want it to he recorded on my medical record. If I was to take the antidepressants whilst not actually having depression, I bet I'd have some questions asked when my firearms licences are up for renewal - the police access medical records for obvious reasons.

Dinosauratemydaffodils That is madness. And very sad too. I do hope you can push to get something that helps you. Can you try another GP? I'm so shocked that your psychiatrist just does out temazepam.

@FrolickingLemon

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.

I’ve never been offered HRT. I am hypothyroid and HRT apparently interferes with the absorption of synthetic thyroxine. So guess I will just have to take the risk of heart disease and osteoporosis. I seem fine so far though.