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.

@Floatyboat

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?

Gosh you’re quite keen on sticking to your conspiracy theory there. I haven’t seen a drug rep in years....

@QuestionMarkNow

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...

I agree although I do think that some people seem to have little insight that they have mental health problems and that anxiety can cause physical symptoms in particular I agree that of course that should be after looking for other reasons. The problem with the diagnosis of ME is that the symptoms overlap with many other things and actually most people with ME also have mental health problems. There is good evidence that those with ME and chronic pain benefit from psychological therapy. Doesn’t mean that they are depressed and yet a treatment that can be used for depression is effective....

I think for some GPs (not all) antidepressants are an easy quick fix rather than dealing with the issue

I remember years ago not long after my son had been born going in for an appointment for him and crying over something - I was immediately asked did I want antidepressants (I was crying over something stupid - but had he asked I would have told him my nephew had just died and I was grieving)

However when my DH was prescribed them (and he was depressed) the GP did see him regularly - he was only on them short term and was mentioned along with exercise etc

I do remember one colleague saying once that the GP had prescribed her antidepressants after the death of one of her parents but said they were good in a short term fix for situational depression (for example after a death/relationship breakdown etc) but that if someone was on them long term for years then the issue had turned into addiction to the antidepressants - I don't know how true that is

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

What utter nonsense @MaxNormal

If someone takes fluoxetine and then later feels depressed how on earth can you say with any certainty the fluoxetine caused it. Rather than just an evolution of the original problem or a new problem.

@Floatyboat I don't appreciate your rudeness.
These are medications that alter your brain chemistry. Its not beyond the wit of man to imagine that there are going to be unintended consequences in some cases.

@MaxNormal

Everything we ever consciously experience alters brain chemistry.

How can you know intuitively know the antidepressant caused a problem years later? That's all I'm asking. I guess it's conceivable it did but it could be all sorts of things.

@Floatyboat there are plentyof medications that can cause long-term or even permanent complications. I don't know why you'd even try to deny this tbh.

No medication is 100% safe. In most cases, we'd hope that the risk/benefit ratio means that more people are helped than harmed but it does not mean that no-one is harmed.

There are support groups for a lot of the ADs, most commonly people who have found that their "discontinuation" symptoms don't abate longer term. A lack of belief from the medical community is one of their major frustrations.

I know far more about this personally than I'd like thanks to permanent damage from a medication, although non an anti-depressant. I'm one of the "lucky" (ha) ones in that mine is medically accepted but it's given me a lot of sympathy for others who have wound up with long-term issues.

And yes I do believe my friend when he says the fluoxetine caused him issues, he's not really prone to dramatics or exaggeration nor is he stupid.

Yes, GP's get incentive payments (I think it's £175) for certain conditions.
It's called QOF digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-collections/quality-and-outcomes-framework-qof
I have Pernicious Anaemia and belong to large support groups. We have nearly all had misdiagnoses from the QOF before being tested/treated.

It's interesting to see there are many doctors on this thread denying they get incentives.
IMHO it's the most corrupt, dishonest profession I've ever had the misfortune to encounter. I've come to this conclusion after seeing my records and how they colluded in domestic abuse and then concealed it from me - this was not down to one doctor but several (almost hitting double figures).
If a doctor told me it was raining I would have to get wet before I'd believe them.

@MaxNormal

Of course drugs cause harm, what I'm asking is how your friend can be clear that fluoxetine caused harm in his specific case.

@Floatyboat tbh believe me or don't yoyre an Internet randomer

So you are relying on faith, not reason?

Well, I've just phoned my GP and I can't get anything. I've been suffering from increased anxiety, worrying and depression for the past 3 months due to a particularly callous relationship break up and not being able to access my normal social activities, and the GP was pretty disinterested on the phone. Didn't ask me a lot of questions, just wanted to get rid of me. So I self referred to a charity she recommended and had a talk with a counsellor. It was useless - full of a lot of platitudes about being a woman in my forties and a lot of women in my forties suffering from, for example, weight gain (Which doesn't apply to me) and having to accept being less attractive. It was as far too general a level for me. Its actually made me feel much worse and quite depressed.

Crikey @incandescentSilver that's truly shocking. Could you possibly call the surgery and try and get another appt with another GP. We have also just had letters through to say our local practices have all signed up for an online GP service called Livi. I've heard great things already. I've got friends who have gotten an appointment within 20 mins. And this has been for ongoing issues. Yet the practitioners they have spoken to have taken a bit of a fresh / start again approach. Worth looking into. And hopefully this type of service is helping surgeries who are perhaps struggling with patient numbers. I do wonder if they are all just under too much pressure and don't have the time to deal with patients as they would like.

Seems crackers that I could have a script tomorrow for antidepressants largely for osteoarthritis. No history or symptoms of anxiety or depression - when someone like yourself sounds in real need.

Sorry you had the condescending attitude towards 40+ women too. Hugs

Ive had a big fight on my hands with regards to ADs being prescribed instead of HRT. It seems to be a first port of call despite going against the NICE guidelines. You need to push for the treatment you want.

I think GPs are far too keen to hand out ADs.

@QuestionMarkNow

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.

For some, it works very well at reducing certain neuropathic pain and it certainly can be used for that reason. There are studies which show it may be effective

I remember going to the gp 25yrs ago and being offered antidepressants for a couple of symptoms I had. I didn't accept them, good job really because those symptoms turned out to be a baby! I was in the early weeks of pregnancy.

But the prescribing of ADs for chronic pain IS actually evidence-based. And it does not imply that a doctor has decided that the person is depressed, or that the symptoms are somatic. These drugs just happen to also be effective for some types of pain.

Don't get me fucking started on this topic! it's one of my pet peeves! it makes me so angry.

I too as told I was depressed by a locum GP, years ago, after the birth of Ds2. And she insisted I take AD's, and that I wasn't fit to look after the ds's and she'd already phoned SS, despite me telling her I'd already filled out the Edinburgh test twice and there was nothing wrong with me, other than a difficult non sleeping baby!

my Dh went mad and spoke to the Practice Manager. It all got nasty!

This kind of thing, fills me with rage.

@GwendolineMarysLaces

But the prescribing of ADs for chronic pain IS actually evidence-based. And it does not imply that a doctor has decided that the person is depressed, or that the symptoms are somatic. These drugs just happen to also be effective for some types of pain.

Which ones? Is there an official list?

I'm genuinely interested in this.

If you Google the name of the drug you are interested in, followed by pain relief then Cochrane, you'll find the evidence.

I found this straight away, thanks.

The review could find no convincing evidence that antidepressants relieve back pain or depression more effectively than placebo. Antidepressants did not result in any other apparent benefits in the treatment of back pain.

Antidepressants did cause side-effects, however, adequate information about these was not provided in the trials.

I'll stick with gentle physio.

@JamieLeeCurtains

I found this straight away, thanks.

The review could find no convincing evidence that antidepressants relieve back pain or depression more effectively than placebo. Antidepressants did not result in any other apparent benefits in the treatment of back pain.

Antidepressants did cause side-effects, however, adequate information about these was not provided in the trials.

I'll stick with gentle physio.

But there are many many reviews- you've just picked one where the findings support your preconceptions.

It was honestly the very first Cochrane article that came up on the suggested Google search. I didn't pick anything. It was simply there, at the top of the list. So I read it.