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.

@Confrontayshunme

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.

Which means rather than change things, just numb them and dope them up (in the case of Amytriptyline - when it doesn't send them loopy), destroy their sexual response (thus making relationship issues worse), stick in a side order of weight gain and deny them the emotional and physical tools when they are most needed to be able to make changes or manage physical symptoms.

DP has anxiety. He gets betablockers because 'you wouldn't want to have something that affects sexual response and libido and nobody wants to be sleeping all day and putting on weight'. When he had a few days of poor sleep (this is a guy who could make sleeping an Olympic event), he came back with a prescription for Zopiclone as well. With a repeat set up.

It took my brother dying for me to get five days of Zopiclone. I don't object to only having five days' worth - but I do object to them being given to DP when he only answered their question about how he was sleeping with 'I'm waking up a couple of times and finding it a bit harder to go to sleep in the first place' (so hard that he was only snoring gently from midnight instead of 10.30pm - I know, because I was the twat sat in the pitch black still listening to him do it until about 4.45-5.25am when I left for work at 7.30am).

mummy's little helpers did untold damage to that generation, people think ssris are the same but they are totally different

I don’t necessarily think SSRis do anyone much harm, except for the long list of unpleasant side effects some people experience. It’s more that other conditions are missed or ignored because GPs don’t bother listening past “im fed up with feeling like this” and treat the fed up part, not the symptom that makes you fed up - eg chronic pain, sleep problems, anxiety caused by mineral and vitamin deficiencies etc

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

What are the good choices, that are actually effective Trixie? And what % of the population are they actually effective for in a meaningful sense?

What would you give for sleep? What natural remedy would you recommend?

I have nothing against prescription medication. The gp could have given sleeping pills or recommended melatonin or something. Sleeping pills would have been totally fine. I meant that natural remedies to the 'depression' like excercise and doing daily activities, talking to someone. He was sad due to a loss, not clinically depressed. Sometimes it is enough when someone with authority tells you that you will be fine and maybe ask to be in contact x amount of time and the re-evaluate. Giving a young man SSRI after 10min chat when he tells he has just buried their mother without sharing the side effects was not the best call in my opinion. But I get that they cannot give holistic care. Thankfully he went off them himself after a week when the side effects started.

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

They're very good for post-surgical pain, too, but often enough, they're under prescribed to patients because they might get addicted.

The gp could have given sleeping pills or recommended melatonin or something.

Melatonin has to be prescribed here. Stupid, I know, I think the UK is one of the few backwards countries who still has this policy (we're about 10 years behind on a lot of stuff).

I've been bereaved of a child, and yes, I agree, bereavement is not depression.

The trouble is much situational depression is unable to be changed, not due to something like death, but due to vast inequalities in society now, things a GP can fix, they are not wizards.

I do agree about the bias with regards to women, however, that's well-known to be true in medicine.

Personally cannot get zopiclone here from anyone. I do have a doctor abroad I get a week's worth from once or twice a year. But otherwise, nope.

I can't take diazepam, it made me loopy AF.

Again, I take AD's but not an SSRI and one known to have weight gain as a side effect, but I lost weight on it, 15kgs in total as I was no longer boozing all night to try to get some sleep (and eating alongside that) and then too slugged out to exercise.

And side effects for fifteen years after being on them briefly? He needs to try to find the root cause of his issues.

@InDeoEstMeaFiducia honestly I don't remember if it was a week or a month, but a relatively short amount of time. He has PSSD and GP's don't believe in it. But that is a whole other thread.

[quote Rewis]@InDeoEstMeaFiducia honestly I don't remember if it was a week or a month, but a relatively short amount of time. He has PSSD and GP's don't believe in it. But that is a whole other thread.[/quote]
For fifteen years, after a week or a month on SSRIs? I wouldn't believe that, either, sorry. I'd look for another cause.

Indeo, it does seem odd. And people don't seem to consider the counterfactual 'little Johnny would still have been with us if one the awful GP had done something like prescribing ADs like we asked, instead of just some counselling which took too long to arrange and wouldn't have worked anyway...'

For fifteen years, after a week or a month on SSRIs? I wouldn't believe that, either, sorry. I'd look for another cause.

People can differ hugely in their susceptibility to being injured by a medication. Its rare but its certainly not impossible.
I've got long-term damage from an antibiotic.

A friend was put on fluoxetine for anxiety and it triggered bad depression which persisted for years after he stopped.

These things can happen, brain chemistry is delicate and all it takes is for your genetics to be such that a particular liver clearance pathway doesn't function the same as the majority of the population.

@InDeoEstMeaFiducia that's ok. You dont have to believe it. I'm not the one for non-evidence based diagnosing, but based on the studies and anecdotal evidence we believe in it even if gp doesn't and cannot really provide alternative explanation that sounds plausible. I'm happy to be wrong though.

@Zilla1 I agree with this aswell. There is also a problem where people who need treatment don't get treated. But the solution cannot be wither pushing pills or not doing anyhting.

A friend was put on fluoxetine for anxiety and it triggered bad depression which persisted for years after he stopped.

Chicken and egg surely

Ive had chronic neck pain (disk bulge confirmed on mri) with pain extended into my shoulders & arms. I was prescribed amitriptiline when my breast fed ds was 3 months old. Guess what happened? Completely knocked me out & found ds in the middle of me & dh without any clue I put him there I could have smothered him! Scared me so much I didnt take them again!

I saw a consultant physiotherapist who said I needed to empower myself

At present I am taking duloxitine & codeine but still in Agony & no one seems to care. I too was asked if I was depressed when I cried at the gp's (mixture of pain & frustration!)

I am a doctor. There is no incentive or encouragement to prescribe antidepressants. However there are certain conditions which aren’t depression or anxiety related which they are useful for. They can be useful for hot flushes, neurocardiogemic syncope and for a wide variety of other things. Of course if you are perimenopausal etc then HRT May be best and should be first choice really.
Amitriptyline, which was widely used as an antidepressant previously is now used for a range of other conditions, including chronic pain, migraine, tension headaches, neuralgia extremely effectively.
What is not widely understood is that actually depression and anxiety can cause physical symptoms like fatigue, muscle and joint pains, chest pain and some people are absolutely in denial of this.
Of course there will always be those with other diagnoses or people that will not respond.
In terms of those presenting with mental health problems, the waiting list is around 6m for psychological therapies so although that would be a great option it just isn’t practical for most people to wait with nothing...
Also much more research is being done into pain and other conditions and painkillers are not always the answer... I’m not saying antidepressants are though

I am a doctor. There is no incentive or encouragement to prescribe antidepressants.

Well is that not what big pharma would pay you to say?

What is not widely understood is that actually depression and anxiety can cause physical symptoms like fatigue, muscle and joint pains, chest pain and some people are absolutely in denial of this.

@Idontlikepeas, my experience is that GPs seem to be in denial that someone can be fatigued, have muscle pains etc... and they are NOT depressed.
Just look at how long it takes fur people with ME to be diagnosed for example. They are usually fobbed of with ADs instead ‘because there is nothing wrong with them’, aka blood tests are normal. And god forbid they’ve had ADs before. The chance they will be diagnosed are reduced even more...

Also as far as I know Amitriptiline might be working well fir many things but isnt licenced for that...

My cousin is a GP and I think the SSRI thing is from the NICE guidelines. It's advised to try this before giving HRT a go.

From what I gather, SSRIs are not just for depression/anxiety, can be used for menopausal symptoms too

On the bit about being encouraged or paid to prescribe, my cousins GP practice where she works doesn't even let pharma reps come in so I don't see how a GP would somehow get paid by a pharma company to prescribe a certain medication

There is no financial incentive to prescribing SSRIs
RCOG suggest 3 month trial of antidepressant for symptoms of menopause.
If you have no contraindications to HRT get your GP to prescribe with you knowing the risks of treatment.

It would be unethical for any doctor to receive financial gain for treatments as it will skew the way they practice. There are cues that you are giving within the consultation that is directing the doctor down the antidepressant route.

What are the correct dosages of amitriptyline for various conditions, e.g. chronic back pain, does anyone know? I've googled but I'm none the wiser.

Floatyboat people know themselves, and what their own normal is. It's incredibly frustrating to have that dismissed.

JamieLeeCurtains pain dosages are low, around 10 or 20mg initially.

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.
Yep. I dread going to the GP about anything cos they just jack up my AD prescription.
Currently suffering badly from PMDD but there is no treatment for me because I'm progesterone intolerant and already take anti depressants
I would love to come off the fuckers but every time I try the PMDD is horrific. Plus I get withdrawal symptoms too- even with tapering
Wish I'd never started the things tbh

Several posters have said they are not addictive but you can experience problems coming off them.
Sorry I might be dim but isn’t that the definition of addictive?