Feel slightly annoyed with the GP for suggesting sertraline to my teen

[Mumofone200]

My 18 year old son says he has been suffering with anxiety. Heart palpitations and worry about his future mainly during lockdown and up to now. He has attempted to start 3 college courses at different colleges but has dropped out after a short period of time. He now spends a lot of time at the gym working out; sometimes with friends and time on his Ps5; he’s not that active as in Going out. We had a heart to heart and i suggested that he maybe talk to the GP which he did tonight. I feel slightly annoyed with the GP offering sertraline and not encouraging him to change his routine etc as a starting point. I know doctors prescribe medication to heal but isn’t 18 just too young to start medication for something that could be improved by therapy or a change of lifestyle. He is currently not engaged In Education employment or training and this is also a worry. I’ve e tried sitting him down to job hunt and have even applied for jobs on his behalf but nothing is changing. I really think he is. It stimulates hence the mental health decline. I’m really worried. Any suggestions

I just wanted to make sure he wasn’t suicidal. Would feel awful if something terrible happens

And the new (drafted) NICE guidelines do say that a range of treatments should be discussed and offered before medication is considered...

Mental health problems are sometimes easier to get rid of when you can think more clearly. Let him trial the meds and support him through to the point he's ready and wanting to change his life

So much misinformation.

Two antidepressants have a bad reputation for withdrawal symptoms - Paroxetine and Venlafaxine (an SNRI) - these medications need to be withdrawn from very slowly in order to minimise withdrawal effects.

Sertraline, amongst other SSRIs is very well tolerated. All SSRIs need to be withdrawn from gradually in order to minimise withdrawal effects and relapse. None of these medications are addictive. They can be started with a low dose then increased gradually if necessary. Most people aren't on them long term.

Talking therapy has been shown to work best after a medication treatment has been started as people respond more positively to talking treatments if they're feeling better in terms of mood and decreased anxiety.

And the new (drafted) NICE guidelines do say that a range of treatments should be discussed and offered before medication is considered...

Which aren't generally available, are rationed or there are long waiting lists. Meanwhile, the patient needs some kind of help.

My Dd18 was also really suffering with anxiety thanks to Covid as well as Autism and other problems. She got prescribed Pro something.
The GP told her she could either take one everyday or she could decide when she thinks she will be in a situation that might trigger her anxiety. Just having that option has helped her anxiety all ready. She's more confident about trying things she usually would have refused. She has taken 2 in the 2 months that she's had them. I think it made her feel validated that she was listened to and someone was trying to help.

assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/940255/PHE_PMR_report_Dec2020.pdf

That's the NICE Report

www.youngminds.org.uk/young-person/medications/sertraline/
This talks about the withdrawal for Sertraline. There's plenty of personal and professional stories about this around regarding this, and it's (ie the wider issue of psychiatric medication withdrawal has been hugely overlooked and ignored until recently).

1:16Bluesarestillblue

@BarrowInFurnessRailwayStation for many people (especially younger people) the first few weeks of sertraline are awful. I’ve taken them on and off for around 20 years and every time I have started taking them I have been a nervous wreck

That's not the case for everybody. If they're started off at a low dose and initially taken at night this can minimise side effects.

This talks about the withdrawal for Sertraline. There's plenty of personal and professional stories about this around regarding this, and it's (ie the wider issue of psychiatric medication withdrawal has been hugely overlooked and ignored until recently).

Withdrawal from SSRIs has to be carried out in a particular and gradual way, over a period of time, even months if necessary.

Withdrawal is still not a reason not to start medication. The risks to the person's mental health, wellbeing and safety need to be weighed up against the possible discomfort of withdrawal.

That's not the case for everybody. If they're started off at a low dose and initially taken at night this can minimise side effects.

@BarrowInFurnessRailwayStation and minimising side effects does not mean it is the case that everyone will be fine either.

I mean, even NICE agree there's issues with providing medication as a first line treatment - and there are treatments available in some areas that aren't over subscribed and that can be accessed still (i.e. Mood Gym, Social Prescribing, Psychoeducation Groups).

@BarrowInFurnessRailwayStation

I’m getting the impression that lots of people think SSRIs are the only anti-depressant available and that seratonin deficiency is the only reason for depression.

I don't think most people can be expected to have a comprehensive knowledge of causes and treatment of depression and anxiety. SSRIs tend to be first choice these days. GPs aren't going to be routinely prescribing tricyclics or SNRIs.

What I meant is that there are lots of posters saying the OP shouldn’t be opposed to medication for her 18-year-old son because they were prescribed SSRIs and they worked.

But they’ll only work if the problem is that you have a seratonin deficiency. If it’s something else, you might spend years taking them and never feel any better, but feel unable to do anything because no one has told you there are other options and everyone keeps banging on about how brilliant SSRIs are.

In think it’s shocking to be so accepting of GPs routinely prescribing a drug because it’s cheap and the first port of call, rather than because it’s the right drug for the condition the patient is suffering from.

Fine, try those then.

Do you know for certain that the GP didn't also discuss or offer to refer for talking therapies or online CBT, and perhaps your son declined it in favour of the medication? Most GPs would offer more than one choice. Might be that he didn't feel in the right place yet to engage with therapy, which is fair enough I think, reading other poster's experiences.

@Lacedwithgrace

Mental health problems are sometimes easier to get rid of when you can think more clearly. Let him trial the meds and support him through to the point he's ready and wanting to change his life

He's 18 and legally an adult. It really is up to him what he chooses to do. Its not a question of what the op lets him try.

I don't think you're being U; you are clearly worried and want the best for your child. Medication might help but I feel the GP should have included some form of therapy along side a course of anti-d's ie CBT. Most NHS Trusts provide a mental health service such as Steps2wellbeing that offer group or 1:1 therapy sessions. You can self refer, he won't need the GP to refer him for this. Maybe Google nhs therapies in your local area or speak to a nurse/GP or check your surgeries website for a phone number. Additional complimentary therapies may help, such as mindfulness or meditation courses or acupuncture (I found this brilliant for me). All this, perhaps in combination with Medication may help your DS. Good luck, I hope you both find the help he needs.

Withdrawal from SSRIs has to be carried out in a particular and gradual way, over a period of time, even months if necessary.

Right, so that worked wonderful post Brexit when medication stocks were fluctuating left, right and centre and some people simply could not get their Sertraline don't you? It works very well for patients who have memory issues linked to their mental health and miss a dose - within 24 hours some of them experience withdrawal effects and end up in what they think is a downwards hill towards a crisis, which in terms panics the hell out of most of them.

GPs do not know enough about withdrawal effects and simply should not be prescribing medications as a first line treatment to an 18 year old reaching out for help for the first time (unless there's a huge back story the OP has not mentioned). Two week review maybe yes if other things haven't helped, and after the 18 year had some time to think through the risks and rewards associated with any medication.

@Warmduscher the NHS doesn't have the resources, staff or imagination to be able to tailor which drugs are needed by which people. SSRIs are generally a blunt instrument, but are usually effective unless there is another underlying cause of the mental distress.

They're useful, available, affordable and usually effective. That's the best the NHS has to offer at the present time.

OP he might need the support of the Sertraline before he feels able to start putting the other well being measures into place. It's incredibly hard to take those simple steps, even when you know they can help, when you are going through a period of poor mental health. My DD was put on them for a while, she definitely got worse for around 3 weeks, but then it all kicked in and gave her the impetus she needed to take further positive steps. She eventually went back to the GP to put a plan together to come off them.

[quote Bluesarestillblue]@BarrowInFurnessRailwayStation for many people (especially younger people) the first few weeks of sertraline are awful. I’ve taken them on and off for around 20 years and every time I have started taking them I have been a nervous wreck[/quote]
Bit dramatic there. You can't possibly speak for everyone. I'm actually on these tablets now after the birth of my baby plus a family member being ill and they've helped immensely. I've had no side effects.

Yes, and @Ready2020 you cannot speak for everyone either.

I had a horrendous time with medication as well - it is not "dramatic" to say how it is for some people. It absolutely needs to be talked about, and thankfully, as shown by the change in NICE guidelines and all the pressure from psychiatrists, it is now being talked about and people are being listened too.

@Mumofone200

My 18 year old son says he has been suffering with anxiety. Heart palpitations and worry about his future mainly during lockdown and up to now. He has attempted to start 3 college courses at different colleges but has dropped out after a short period of time. He now spends a lot of time at the gym working out; sometimes with friends and time on his Ps5; he’s not that active as in Going out. We had a heart to heart and i suggested that he maybe talk to the GP which he did tonight. I feel slightly annoyed with the GP offering sertraline and not encouraging him to change his routine etc as a starting point. I know doctors prescribe medication to heal but isn’t 18 just too young to start medication for something that could be improved by therapy or a change of lifestyle. He is currently not engaged In Education employment or training and this is also a worry. I’ve e tried sitting him down to job hunt and have even applied for jobs on his behalf but nothing is changing. I really think he is. It stimulates hence the mental health decline. I’m really worried. Any suggestions

Sertraline on its own isn't enough, you need therapy along side it. My GP even said to me taking the meds with therapy is pointless. If it ends up not being right for him there are others meds to try.

mean, even NICE agree there's issues with providing medication as a first line treatment - and there are treatments available in some areas that aren't over subscribed and that can be accessed still (i.e. Mood Gym, Social Prescribing, Psychoeducation Groups).

Which all very much have their place BUT in many cases by the time someone feels ready to speak to their GP they are too far in it for them alone to have an impact.

If things are at the point the OP is sadly worried he is a suicide risk (as per her recent post) then he is probably at a points he needs more support before he can access things like social prescribing.

21:22Mumofone200

I just wanted to make sure he wasn’t suicidal. Would feel awful if something terrible happens

Suicidal ideas can be at an increased risk during the first few weeks of starting treatment, so your ds will need to be monitored by the GP who has prescribed them.

In the meantime, try to keep talking with him about how he's doing generally and urge him to seek help if he does start to have self harm urges or ideas.

Also, OP, is there any chance he started to take anabolic steroids for his gym workouts?

YABU. For other interventions to work, mood must first be stabilised. Often talking therapies are not effective until medication has helped even out the highs and lows.

It's not poison and you're being very controlling