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

However the NHS don’t want to put in the leg work, and they don’t want to risk it.

I think it is less a situation of not wanting to do the leg work and more about structure. The NHS has a focus on doctors and nurses - there are relatively few psychologists and in many areas psychotherapists and counsellors are not valued or prioritized.

So if most MH staff are medical model trained, they are going to go towards medications.

As for risk - yep, the whole NHS runs scared. But look at what happens when something bad happens.

agree on protecting the title. Also not sure MH nurses are best placed to use therapy. One toldme that I had not been having therapy because it did not have homework. While it did not formally have homework i def made changes and have maintained these by talking about patterns that did not seem helpful.

Yes I thought that was odd

GPs prescribe too many antidepressants and yet I am cross because my GP did not prescribe me an antidepressant!

This is true. I had two psychiatrists. One literally knew nothing but medication. Frankly they were awful they didn’t listen at all. I felt they considered me a case to be ‘managed’ rather than I could recover.

The other psychiatrist was great. She was really thoughtful and holistic really.

I had to fight for a psychologist and luckily got one. He was really important in my recovery. It’s funny you say they are underrated by professionals. The first thing all the patients said to me when I was sectioned was you need to try to get a psychologist. Patients valued them highly and considered them gold dust.

What lifestyle advice is going to replace the medication for my schizoaffective disorder?

Are all people with schizophrenia & schizoaffective having meds replaced with this advice & therapy.

The biggest cause of cancer are lifestyle choices & factors - can we delay cancer treatment & offer lifestyle advice first - if they fail to comply they don't get the chemo?

I do appreciate it was orriginally an AD. However, I am primarily concerned about physical pain disturbing sleep and then worsening mh my surgeon, gastro and crisis team all felt approproiate way to mannage symptms but HP immediately jumped to another AD which is known to worsen symptoms i have just felt script was written before they spoke to me.

Sleep, stress management, trigger recognition and management, exercise like yoga, mindfulness like meditation, mood management, talking therapy, cbt, it’s a lot of work. But the brain is plastic and having been one of the rare individuals who went to the edge. It’s possible to train the brain to recognise the ledge and go back.

The first thing all the patients said to me when I was sectioned was you need to try to get a psychologist. Patients valued them highly and considered them gold dust.

oh, for sure. I trained in the US, where everyone, psychotherapists, counsellors and psychologists all do the same basic training, and then take specialist classes for what they want to do. When I moved back to the UK, I really struggled to find an equivalent role to what I had in the US, so did a training here. It was eye opening. I was in the school of nursing - wtf? Nursing and psychology are very different disciplines, and one does not necessarily set you up for the other.

Dont get me wrong, I have supervised a lot of people who have switched from nursing into therapy and been great. But also seen a lot who are appalling, who really see it as nursing with worksheets and really put people off therapy.

The training structure in this country is too much influenced by different bodies who lobby for their own members, and not enough overseen by an impartial body. So I do think there are more really crappy practitioners out there.

I would like to see the HPC license all mental health professionals with common expectations for training and knowledge.

As for psychiatrists - they are not trained therapists. Some get additional training. But many do not. And I find in the NHS they feel like they walk on water - I was used to a much more team spirit collaborative approach before I moved back to the UK.

I love my ADs. Just wish I'd taken them sooner. I know that's not the same for everyone, but they have been life changing for me. So glad my GP prescribed them.

Has anyone read Fragile Minds by Bella Jackson? Frankly terrifying on mh reccording and meds. Patients were reported to have pritty normal reactions to staff behaviiur. This was reported as symptomatic of the.condition and suggest increasing tranquilisers to the point iof falls.

Evidence rather grey on what? I’m certain they saved my life. I don’t need any more evidence than that to say confidently that they save lives.

glad they helped. On an individual level its impossible to know if it was the tablets active ingredients or taking a tablet to help. In studies around 45% of people improve with sugar pills. The evidence is also stronger in more severe depression.

Any of them could have prescribed it then could they not? And/ or written to the GP stating ‘please prescribe amitriptyline’. Depending on the reason for being under a crisis team GP might be reluctant to prescribe a drug known to be lethal in overdose. Either way amitriptyline is hardly a holistic lifestyle option suggestion. It’s just another drug.

That’s really interesting. Thank you for sharing. Hopefully this improves here.

Yes they could and still may do depending how things gobble u. Self harm risk is not a concern but the suggested neds are in light of other symptomds. It was honestly more about the innmediate offer of meds withoutcany obvious aaassessment m or reading other letters.

YANBU - in my early 20s I went to the GP explaining I felt tired all the time and had for a long time! GP said he thought I was depressed and prescribed AD. I took them and couldn’t get out of bed all week - so I stopped. After years of blood tests not showing anything, a dr listened to me saying about the pressure around my eyes and sent me to ENT - polyps! Different person after surgery.

i think AD can support people with MH illness however doctors need to be more accountable for leaving people on them forever! They do not follow up or care or support people to come off them. Withdrawals can be horrendous and when it’s a struggle, they increase meds or add new ones in - starting the whole reduction and withdrawal process again and it can feel impossible.

I hope one day we look back and it’s unbelievable that this ever happened.

I hope so. The HPC were lining up to take this on about 15 years ago. But then government priorities changed and it got dropped. At about the same time that investment in MH started to be eroded. I hope it gets picked up again.

A lot of people train in therapy now because it is the only way they will get a band 7 role in the NHS. And the NHS favours OTs and nurses for this type of training and role. So you get a nasty little cycle going on.

It really needs better oversight and government regulation. Not to say that even with that it will all be great- there will still be crap therapists. But a lot of the really poor people will be weeded out.

Yes, talking therapies may be just as efficacious for some people, @Catatedog - but they are NOT easily available, and most people will have to wait months, or even years to get therapy - so maybe ADs are sensible to help people survive until therapy becomes available. And if it’s going to take ages to get therapy, and ADs are going to be as effective as the therapy, why is it bad for the GP to prescribe the thing that the patient can start immediately, when the alternative is making them wait, suffering with their mental health all the while, until therapy is available?

Do you really think depression is just feeling a bit negative and is not a real mental health problem? Do you really think people are faking it when they 'claim' they are depressed?

I’ve had this, was useless. My depression comes from having fuck all practical support with disabled children including no school or childcare. No one can prescribe be a Mary Poppins so ADs had to do.

i have done talking therapy and home start and multiple other things but what I actually need is a break form the constant stress and overstimulation.

Exactly! Not just an antidepressant, one of the worst for adverse effects etc - TBH I can't think of a single patient who has been helped by a tricyclic.

This describes a lot of the patients I see. It's rubbish. But I can't prescribe a break, or a holiday, or more money, or the control over your life that you need. So we give antidepressants, which help a bit. It's not ideal.

I would suspect that’s because you asked for an antidepressant so the GP surmised that you wanted one and that you would not be pleased to receive lifestyle advice (as indeed the majority of people are not I’m afraid)

I think that is the case nowadays as the waiting list for therapy is so long... they have to be seen to do something other than send you on your way with leaflets.

Of course, if you don't think ADs will actually help, then you are free to not get the prescription filled.

And some people are depressed due to Shit Life Syndrome. Practical help is what is needed with that, but your GP can't pay your bills for you.

Hallelujah - I’m cured. My life long depression due to bullying, anxiety and low self esteem has totally vanished because I pegged the laundry out, @TheGentleButFirmMadonna.

Oh wait - it didn’t cure me. Work didn’t cure me. Walking the dog on a sunny day didn’t cure me. Sadly therapy didn’t cure me.

If I come off my ADs, I become deeply, darkly depressed, and start thinking about killing myself. At best, I hope not to wake up each morning. Even on the ADs, I’m not that great - but at least I can see some point in my existence.

And how do I know this? Because I listened to people who said that I shouldn’t rely on ADs, and decided I could come off them, because I was feeling better. Spoiler alert - I was not fucking better. Each time I tried to come off the medication, I ended up sliding into deep depression. I am now on a combination of 2 different ones, and I am going to take them for the rest of my life. I am not willing to take the risk of coming off them, and feeling suicidal again.