To think gps push meds too easily for mh

[Catatedog]

while I appreciate Ads are really helpful for some ppl i feel gps push these before lifestyle advice and they know psychological therapy access is poor

Amitriptyline is an antidepressant.

That sounds as though you think you have more clinical expertise than the GP.

I am really glad ADs help you. I appreciate they both save lives and vastly improve the quality of others lives. Hpowever, as with all meds have sideaffects.

I do speak from experience including crisis team and a private psych involvement. The psych was much more inclined to give say melatonin for sleep, and a few tablets for stressful sittuations whereas GP did not feel to have the time to adress more wholistically.
It was not a critacism of individuals who take or gps who prescribe. More it feels a sticking plaster that can be too easily offered when talking therapies alone or in combination, treatmemt for physical conditions, some work flexibility or social support would be more helpful.

It doesn't matter how simple the advice can be about lifestyle changes. When I was really depressed, it was a struggle to get out of the dark back room in my house, which for some reason was where I spent most of my time. The idea of pegging out washing, going for a walk or phoning someone for a chat would have been completely beyond me. It wasn't until the antidepressants kicked in that I started to realise how caged in I'd been by depression. It was like being in a prison and I could see no way out.

Yes. I think Google might be the bane of some GP's lives.

It probably depends on the gp. Years ago (90s) a friend went to the gp and was told to do more exercise and get outside more in the first instance.
Also in the 90s I went to the gp with stress and the gp was heading towards talking about anti depressants.

The worry now is that GPs seem to have very little inclination to speak to you. So its possible that writing out a prescription is the easiest way.

I think time is the problem rather than inclination.

I obviously dont have more clinical experties than the GP. They had not read the letters from psychologists etc. A friend was seen by the crisis team who prescribed a week of zopiclone and made specific suggestions to the GP on what to try. Their report from their gp appointment is that the gp told them not to take as adictive and did not prescribe the AD the crisis team dr, presumably a psych suggested. They were put on sertriline as first line treatment but eventually after monthsmore time off work were put on ad psych reccomended and after 4 weeks felt strong enough to start phasing back

I don’t know why more people don’t try it, honestly. Just stop being depressed. Hang the washing out.

All research suggests that mental health problems are not caused by any shortage or difference in levels of neuro transmitters .
A convenient idea for big pharmacy, but completely unfounded.

I absolutely agree OP. These medications are handed out with minimal investigation into the necessity and virtually no consideration for the long term impact.

I've found the reverse to be fair - I've got a period of severe depression going on at the moment - normally I have really good coping strategies and support networks going on to deal with the depression-anxiety tag team that work shifts on my mental health and I can keep going through stuff that would fell a lot of people (you've got to have fucking amazing strategies to work successfully full time in a people-heavy job as an autistic and do well with it!) so when I go to the GP saying I'm struggling and need help - I need medication-type help to get me over a hump and to maintain myself in a head-space that I can deploy all my usual coping strategies and maintain stability.

They've really pushed the talking therapies - which I don't want to go via their provider anyway at present because I can access this via my own work systems and also because I've had talking therapy before and I was actually using all the strategies they worked with me on anyway!

I'll admit I'm unusual in that I do have incredibly good insight, and a great awareness of my "OK you need to do something" internal threshold being breached so I'm good at avoiding crisis in that regard - but at the point I went - it was meds I needed.

I don’t think they really have any other options. You can lead a horse to water as they say. They can tell patients about life style choices but they can’t police them.

Why not try yoga or a hot cocoa before bed to see if it will help with your sleep issues?

You don’t need meds when you could just make lifestyle changes.

I wonder if that could be because they’re safe and effective?

The point of meds is to help reduce symptoms enough that you can implement all that lifestyle stuff. It's to get you out the rut enough to start.

Fully agree ads and a sign off fit note are quick. In early 2000s I witnessed a very simmilar thing. Too people had aparent die. One GP took time to workk throgh what needed signed off work for 3 weeks a few sleeping tablets for a couple of really stressful events and a supportive note to work arround flexibility. The other fit notes repetedly signed off with out seeing a GP. Four months in depressed not working poor sleep patterns. Prescribed ADs. Then eventually lost job. Made things worse. It probably took 5 years for them to get their life back on track. I wonder what would have happened had they been ablble to be offered more support signposting to things like AtW mh services and charity talking support.

But thats not always the case is it? Not to mention the implications for some job applications etc.

Some people, yes, but there are a surprising number of people who dont seem to know. And GPs are doctors, so they think in terms of medications.

Well said 👏

Anti depressants have a poor evidence base
In terms of positive impact for mild to moderate depression.

They also have side effects and can be difficult to withdraw from.
For severe depression and crisis they can of course be live changing or even saving.
But these reasons would not be the basis of most decisions to prescribe.

I think GPs are really stuck between a rock and a hard place , they are time and resource poor and patients may often seek a prescription as a sign that something has been done for them.
The percentage rise in prescription of ADs is quite breathtaking. Many children now on these drugs too.
It can't be a good thing overall

Do GPs generally actually assess where people are in that rutt though? I also dont think its fair to assume people know things that may help. Middle class educated people may do but others may need to feel heard and see some small changes they can make b

If you had an infected wound, would you accept antibiotics for it? Or would you try lifestyle changes first? Like bathing it more often, or just pretending it doesn't exist?

I have schizoaffective disorder and medication means the difference between living a near normal life & being permanently sectioned.

Why so much hate for psychiatric medication? Someone with heart disease, high cholesterol or diabetes don't face the same stigma.

Why shouldn't a GP prescribe an affordable life changing & life saving medication without insisting on 'lifestyle advice' first. Why not both?

Honestly if I had an infected wound i would first try bathing in salt water, honey silver that sort of thing. If i felt systemically unwell or it was getting worse despite these measures then medical treatment including oralle or iv antibiotics surgery etc.

I think i have unfairly targetted ads though. In private hospitals or hospicis things like jheat packspositioning are used for pain. Dietrary changes like prune juice for constipation. It seems quicker for nhs to give tablets for these things.