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

Agree ideal would be both. This thread has allowed me to see it is both physical and mh conditions that i think like this for. Someone who eats 10 pies a day should be gyuided with dietetic and exercise guidance rather than just meds.

super pleased you have been offered meds that work for you!

This. Without my laundry list of meds including antipsychotics, mood stabilisers and antidepressants I'd be fucking dead.

Thanks for this post. I struggled with depression for years. Fortunately for me, I had none of the complicating life factors like the ones you see in your patients.

I ate well, exercised regularly, but the only difference it made was in people’s perception that I was somehow exaggerating my symptoms.

anti- depressants were a game changer for me- and I’d echo what your patients said. I avoided them for so long because of the stigma, but they sorted me out. I’ve been off them for years now, so it’s not a lifetime thing.

How about 'Pull yourself together'? That's always worked for me!

Well I havent read the whole thread OP but its much more nuanced than your OP which people probably have already pointed out

You do need to be in a fit state emotionally and mentally to be able to take advantage of therapies, so sometimes people need meds to get them to that point

On the other hand GPs dont have much else in the treatment armoury, long waiting lists etc even if available. CBT is usually offered but that is not only ineffective for lots of people but is usually only 6 sessions, it cant touch the sides and I think its not that useful for people who are ND

Therapy is also not a fix all that its often made out to be on here, like as if you have therapy and then its all ok, some people cant respond, some people dont hvae the emotional insight, some people dont have the intelligence or cognitive functioning to manage therapies. The quality of therapists are really varied too, you can swap about for years trying to get one thats right and the NHS doesnt have that option for us.

Sometimes poor MH is simply like any other illness and needs chemical or physiological intervention and drugs is what keeps someone on an even keel

Sometimes its solely a lifestyle change thats needed but perhaps someone needs medication to get the motivation to exercise or lose weight or move house or job or any number of those changes that are needed.

I think meds are a really positive thing personally but I do also think that society needs to be structured in a more emotionally healthy way.

They usually tell you to start the meds and come back in 6 weeks. Then they can start talking you through lifestyle stuff. If someone is sitting there in crisis asking for help and they get told "eat better and walk more" it's not going to actually help them in anyway. The meds help get you into a better mindset ready for further help at the 6 week mark.

It's not a perfect system and many people don't engage with it properly or don't go back, or can't get an appointment, or see a different GP who didn't know exactly what was happening. We do need an overhaul of our MH system as it's failing many people right now.

But the issue isn't the meds themselves.

I don’t really understand the point you are trying to make OP. Your posts don’t make sense to me.

Therapy is probably a better option for some people with mild depression but it’s not readily available for GP’s to prescribe. I would say a bigger issue than starting people on antidepressants is leaving people on them for years and years without review.

i do think the problem is in part the meds. I am not convinced that handing meds to all and then reviewing in 6 weeks is appropriate. It only takes a couple of minutes which can be done outside the appointment to assess severity of condition and inst thead everone offered meds with follow up in 6 weeks.
also really glib talk of coping strategies. Would be interested in how much training they get nd why the rapid increaase

Or my late fathers wonderful advice “ just pull yourself together “ 🙄

Social prescribing is an empty buzz phrase to put responsibility back on patients who dont have the means or resources or treatments they need.

You do know that amitryptiline is an antidepressant? One which is very heavy on side effects and dangerous in OD.

@RobertaFirmino …..totally incorrect. It is not about ‘brain chemistry’ or ‘neurotranmitters’ I’m afraid.

Let’s just say patient A comes in to GP. History of depression/anxiety/panic attacks.

Your answer is there’s a pill for that?
The OP is 100% correct in their comment about pushing meds.
A GP does not have the time, nor knowledge, nor access to fundamental services, practices or therapies that could help.
They would prescribe medication to help patient A ‘deal’ with the worst symptoms, whilst healing nothing.

I’d like to know about your knowledge of mental health, illnesses and the like.
Patient A was abused very badly during childhood, young adulthood and only just survived for many years. Not fulfilling any potential.
Patient A has no access to nutritional food, safe housing, and is carrying a brain injury due to the abuse endured over a lifetime. Highly probable CPTSD.
A pill does not heal.
Patient A has endured horrific cruelty, abuse, etc and it’s akin to living in a war zone.

Patient A along with others would love some answers.

I have struggled my whole life with depression. IME most GPs have been sympathetic and want to help - but realistically prescribing ADs is all they can do. There was a time when they could refer you to the practice counsellor, but I don't think anybody has these any more.

My beef is with adult mental health services, which are stretched to threadbare and provide very little. There are CBT courses (useful but not always sufficient) and emergency services for the suicidal, and almost nothing in between.

The Government's fantasy that all these chronically depressed people just need to go back to work is a joke in the context of the vast unmet need for mental health services in this country.

'It only takes a couple of minutes... to assess the severity' also sounds like 'glib talk' to me though.

Is the evidence not rather grey on this?

In a nutshell.

I have actually spoke to gps about this through some work i was doing around mental health. And the reply was the same we dont know what else to do people are coming suicidal, completely overwhelmed by life and struggling to function. We can explain to them to self refer to talking therapies but wait lists are long and can take months/ years so the only thing we can do is offer anti depressants to try to help in the mean time. None of them wanted to be prescribing anti depressants the way they where but they had nothing else to offer.

I'm very much a supporter of the importance of getting outdoors each day and exercising. However, for a lot of people, that is not always possible. We all have to get to and from work, and the length of the journey, or physical ability, might rule out cycling for instance (which would give you both exercise and a bit of outdoors time). Our hours are so long sometimes that exercising when home, or before work, is also not possible.

In the winter, daylight hours are so short that for women, it's not always safe to get outside before or after work, or even alone at the weekend during daylight hours for a walk through the local woods etc.

So people are having to go down the medication route because they can't access the holistic routes.

I can assure you that hospice care is not relying on heat packs for pain control.

OK some people might use them but generally the patients I see need proper drugs.

I do meet people who insist on not having them as they don't believe in them/want to embrace their spiritual journey/various other reasons. However to date all of them have been very happy to have proper drugs that actually work eventually.

Often it's a combination of everything that helps people- but ADs can give them enough a start to them make some lifestyle changes, or out into practice other skills they've been told about but haven't had the energy/motivation to change.

Antidepressants are used for other illnesses other than depression. I have crippling OCD and a disassociation disorder and I’m prescribed an SSRI, it saved my life.

I can’t stand the whole “lifestyle changes” brigade. It’s like telling someone who is deaf to listen harder.

First of all I will point out that ADs have been life changing - if not even life saving - for me.

I got them during lockdown. It was as simple as a phonecall, the call took 4 minutes. They checked on me a month later, all was good and I was starting to feel a little better, and ever since then they've just approved the repeat prescription every month.

So I've been on them for more than 4 years now.

And they were ridiculously easy to get hold of. In the first phonecall they mentioned talking therapy and asked if it was something I would be interested in. I said possibly, but I found the thought quite overwhelming at the moment so maybe when the meds had kicked in a little.

It was never mentioned again and, as I say, I've been left alone for 4 years now. This includes swapping GPs - my new one has never even met me, and still just signs off on the meds.

Many years ago, I was beating myself up for not being able to make the CBT I'd been taught work. I was suicidal at the time. A kind psychiatrist pointed out that CBT was for mild to moderate depression, not what I had. And I think this is true for many. Online CBT used to start with a questionnaire that asked if you had suicidal thoughts, and if you did, it couldn't proceed. So what are the GPs to do? Not a wonder they are prescribing ADs because often by the time a patient gets to them they are where I was. Too ill for talking therapy.

Yes massively. The same compound that treats depression to treat anxiety and stress.

Mental health is not mental illness.

They need to be properly funded to have enough time with people. Until then research yourself so you have an idea of what may help

Thank you for mentioning pies. I'm guessing you are anti weight loss injections for similar reasons?

If someone is severely depressed, telling them to get exercise and social contact probably isn't going to be enough.

If someone is severely overweight, telling them to eat fewer pies probably isn't going to be enough.

Both conditions (depression and overweight) are physiologically complex, and we don't fully understand them. The drugs work for many.