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’m not controlling. Simply weighing things up and just want the best for my son

I understand your concerns. Two of my kids have suffered from anxiety and depression. The older one was older than your son when she asked for ADs. She has a history of panic attacks and depressive episodes so presumably this was taken into account. However she took the meds erratically and I told her she should take them regularly. One night she went for a walk, ended up in a situation where someone thought she was attempting to take her life and called 999. She denied it but it was an unusual place for her to go. She was sectioned overnight but released the next day after she convinced them all was fine. We don't know the full story, not sure she knew either, but think she had a suicidal impulse that night caused by the meds as she had previously been apparently fine. She hasn't taken the meds since and is now in a much better place with her mental health due to circumstances changing.

On the other hand, our younger child, still under 18, has suffered massively since the pandemic began. Lots of panic attacks and feeling over whelmed, dark thoughts and some minor self harm. He had been seeing a therapist for some years but began to refuse, also refusing school, college etc. Poor relationship with us where we'd get the blame for everything. We were surprised when he was offered ADs but glad in a way as it's been going on for nearly two years now. He's only recently started taking them but there is already a noticeable difference in him - moods calmer, no shouting or recriminations, more able to deal with things he's been finding difficult etc. Looks like the meds can really help, hopefully, as nothing else was working.

YABU. For other interventions to work, mood must first be stabilised.

This is such outdated thinking now - there are other ways to lift or stabilise mood. And these can work without medication, and whilst they may not work for all people, they do work for many.

And OP, hats off to you for caring, thinking and reflecting on this. Hardly controlling at all.

medication isn't the enemy. I am on just 25 micro? grams of sertraline and its made a huge difference to me. if he went on the medication, he may feel more able to change his routine etc.

medication for mental health problems shouldn't be avoided just because of opinions/stereotypes etc. If he needed insulin, thyroxine, or whatever, I think you'd see it differently

Nobody posting on this thread was in the GP appointment with the OP’s son. Therefore nobody on this thread can possibly say whether this was appropriate management or not.

It may well have been. I’d hope talking therapies were offered alongside / instead of sertraline but it’s possible that the patient didn’t want those, or felt they needed medication to get to a point where they could engage with that, or was asked to self refer etc etc.

Also, unfortunately there is no such thing as a blood test to tell you which neurotransmitter you are deficient in and therefore which antidepressant will work. There’s some research working towards this but no proven benefit in clinical practice yet. Sometimes it’s helpful to do blood tests to rule out other issues like anaemia but that really depends on symptoms.

He's a gp not a life coach. Can't you take him to a councellor if thats what you want for him? Or help him yourself. You sent him to a medical practitioner who found a medical solution, I'm not exactly shocked.

[quote BarrowInFurnessRailwayStation]@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.[/quote]
SSRIs weren’t useful at all to my DD. She didn’t have a deficiency of seratonin so it wasn’t a blunt instrument for her, it was completely the wrong medication.

In addition her mental health deteriorated further over the two years she was on it because as far as her GP was concerned, she’d received treatment for her depression and there was no longer anything to discuss, but nonetheless she was still in mental distress.

There was no other underlying issue that would have made it difficult to diagnose her accurately. The one-size-fits-all diagnosis was just the wrong one for her.

If giving the wrong medication for a mental health problem is really “the best the NHS has to offer at the present time”, heaven help us all.

Can I please ask you to just STOP with medicine being a last resort?

Especially with mental health, many (I want to say all) patients need to start taking the medicine to get to a place where they can start exploring the problems.

I would also point out that I'm not surprised he is embarrassed by how he feels, given your approach to mental health.

The GP practices are dealing with an enormous surge of children and young adults struggling, and that was before covid.

Give him credit for going, and stop wondering how you can"fix" him, and open up a line of conversation where he feels he can explore his feelings with someone, preferably a professional.

A very wise GP once told me that using therapy alone for mental illness was like trying to treat type 1 diabetes with diet.

Once you are taking the insulin, a good diet will make all the difference.

I'm not saying every problem should be medicated, but in this instance I think they made the right call.

Setraline is a good 1st line approach. It may not turn out to be the right thing for him, but everyone is different. If he doesn't improve, or starts to feel very unwell, incisor he needs to check with the doctor. For god's sake, don't say"well they're clearly a bad idea", he needs to try something else.

Meanwhile, it's not unusual for young depression and anxiety to be the result of someone finally losing the ability to hide/ mask neurodiversity.

I'm not immediately saying your son is autistic, and undiagnosed, but just pointing out that it's a common issue. Maybe have a look at some up to date info on neuro diversity and anxiety etc.

Meanwhile, it's not unusual for young depression and anxiety to be the result of someone finally losing the ability to hide/ mask neurodiversity.

I would wholeheartedly agree with this.

ADHD can be a significant reason as well.

I'm not saying every problem should be medicated, but in this instance I think they made the right call.

How can you possibly make that judgement unless you’re the OP’s son’s doctor?

How can you possibly make that judgement unless you’re the OP’s son’s doctor?

Um, because the GP prescribed medication? 🤦‍♀️

@BarrowInFurnessRailwayStation

How can you possibly make that judgement unless you’re the OP’s son’s doctor?

Um, because the GP prescribed medication? 🤦‍♀️

No, I was asking how that poster felt able to state with confidence that it was the right treatment for the OP’s son, despite never having met him or being his doctor.

Unless you think prescribing medication is always the right decision for every patient presenting with mental distress?

No, I was asking how that poster felt able to state with confidence that it was the right treatment for the OP’s son, despite never having met him or being his doctor.

Err, because the doctor wouldn't have prescribed it if it wasn't the right decision?

Unless you think prescribing medication is always the right decision for every patient presenting with mental distress?

So doctors aren't in control of their own prescribing decisions now? You do realise they have to follow certain protocols and guidelines when prescribing these medications?

@Mumofone200

Warmduscher Are there tests for dopamine and seratonin levels? I’d prefer if he would consider taking bloods to see what the deficiency is before committing to medication. I know he’s an adult but he’s still my child and very much dependent on me financially emotionally etc I have a right to guide him

No.no blood tests for this. Not sure what tests another poster meant but never seen this in 34 years as a GP

@BarrowInFurnessRailwayStation

No, I was asking how that poster felt able to state with confidence that it was the right treatment for the OP’s son, despite never having met him or being his doctor.

Err, because the doctor wouldn't have prescribed it if it wasn't the right decision?

Oh I see. You think every prescription of SSRIs is the right one, despite calling it a blunt instrument?

It definitely wasn’t the right decision for my DD.

@BarrowInFurnessRailwayStation

Unless you think prescribing medication is always the right decision for every patient presenting with mental distress?

So doctors aren't in control of their own prescribing decisions now? You do realise they have to follow certain protocols and guidelines when prescribing these medications?

Of course they’re in control of their own prescribing decisions! That doesn’t mean they make the right decision every time though. You said yourself upthread that they’re not skilled in every aspect of mental health so mistakes are inevitable.

It definitely wasn’t the right decision for my DD.

Not everybody is your DD.

@BarrowInFurnessRailwayStation

It definitely wasn’t the right decision for my DD.

Not everybody is your DD.

No shit. And neither is prescribing SSRIs the right decision for everyone.

You need to get past this anti medication mindset just because they didn’t suit your daughter. Many people, including young people, benefit from them. I don't think you're helping the OP.

There's no point talking to you.

OP, I hope your son finds them helpful and he can start to recover.

Having a child with anxiety, I have spent a great deal of time reading on this subject and speaking with her doctors. We have taken her to private child psychiatrists with excellent reputations. The gold standard of treatment is considered a short dose of medication in combination with therapy. Especially when they are young, it helps the brain reset. Allowing the anxiety to continue is actually teaching the brain to be in an anxious state. Interrupting that pattern as young as possible can make a big difference.

My own child was able to do a very short course of medication combined with CBT. She stayed on slightly longer than originally planned because Covid hit and the doctors decided that they should not risk taking anyone off anxiety meds in the beginning of the pandemic, but once we knew she was handling the stress of it, she stopped the meds and has been doing great without them.

@BarrowInFurnessRailwayStation

You need to get past this anti medication mindset just because they didn’t suit your daughter. Many people, including young people, benefit from them. I don't think you're helping the OP.

What “anti-medication mindset”?

My DD is on medication for depression, as I explained upthread. Just the right medication and not the “blunt instrument” one you’re saying is the best the NHS can offer.

@Mumofone200

Warmduscher Are there tests for dopamine and seratonin levels? I’d prefer if he would consider taking bloods to see what the deficiency is before committing to medication. I know he’s an adult but he’s still my child and very much dependent on me financially emotionally etc I have a right to guide him

Not available to GP's there aren't. And I have never seen them done in NHS psychiatry either. You have no idea what was actually said in the appointment by either party. What discussion was had or what suggestions made. You are only hearing what your son has chosen to tell you. You cannot make judgements on that basis.

@BarrowInFurnessRailwayStation

YANBU but unfortunately so many people are hooked on ssri pills as GP'S dole them out like smarties.... But don't care about the long term impact, or the reliance, and really the avoidance of actually dealing with the nitty gritty of mental health to be able to find a path and sort out life as the alternative. That's too expensive an option.... And the anti depressants make pharmaceuticals lots and lots of money.

Absolute crap.

This is BS. Ugh. And they are not addictive!