GP won't prescribe anti-depressants for 17-year old

[SionnNess]

My daughter is 17, she has very low moods and anxiety. She has a history of self-harm for around 4 years. She is still punching herself in the face, and scratching herself. She took an overdose 2 years ago. She was diagnosed with autism around 3 years ago. She was referred to CAMHS after the autism diagnosis, but was discharged pretty quickly without being seen. She doesn't walk to talk to anyone. Been to the GP when she was 16 and she was prescribed propanolol for her anxiety. Didn't really make much difference. Went to the GP yesterday hoping for some medication, but again was told 'no'. They want her to talk to someone as first line of treatment, but again she has refused. So they have referred her back to CAMHS. They asked if I was ok with this, but obviously not, what else can I do? I told them I would wait until she is 18 is 3 months and come back. Not ideal. But they said, even then she might not be prescribed anti-depressants. I really dont know what to do to help her. She will talk to me occasionally, but always says she doesn't know what causes the low moods, and that she still thinks about suicide. I have recently been taking fluoxetine due to a rough period in my life, and I cannot explain how much I think this has benefited. I wish they would let her try it. If she wont talk to anyone, what other options do we have? Anyone else been in a similar situation?

Gp’s tend not to prescribe to under 18’s as NICE guidelines state talking therapies must be tried first.

Although I understand that it must be frustrating, it could be a good thing that your GP won't just wave the problem away with a prescription for ADs. They don't always help, and your DD's case is complicated by her autism and the fact that she is under 18. The GP may not think it is appropriate for their practice, rather than a specialist, to prescribe. I think GPs are becoming more sensitive to the fact that ADs don't always help, and that they can in some circumstances cause harm.

I think you need to try and persuade your daughter to participate in therapy, so that she can take it from there, with pills at a later date if appropriate.

Just for comparison, my son, at the same age, and also autistic, did take anti-depressants briefly. They didn't help him, and he became convinced that they had caused a sexual dysfunction that persisted after he stopped taking them.

Is she in school or college?
Does she get any fresh air or able to have little walks?
My DD was desperately poorly at 14-15 and only managed to turn a corner by not going to school and then starting to have little walks every day. She really wanted anti-depressants but she wouldn't even see a doctor, let alone a counsellor.

Honestly? Try and go private. I wish I had. Sometimes medication is needed and you can’t force someone to open up. Especially people with things like Autism. In my experience girls with ASD tend to very shy and reserved making talking therapy even harder for them.

Why isn’t she willing to try talking someone first?

I went to the GP for anxiety and depression this year and they wouldn’t prescribe ADs. My notes say “minor mood observation” which I feel completely shit about. I was told to self refer to talking therapies, which has been ok but not wildly effective so far. I am a grown adult, I think they don’t want to prescribe ADs any more. So I struggle on while all my friends get help.

This may not be fair, but it’s how I feel.

I'm autistic too but in my 50s. I have just been diagnosed with ADHD. I feel so much calmer on ADHD meds. Just wondering if it could be that?

Thanks everyone. I don't blame the GP and understand that they are just following guidelines, but its really hard when she just isn't capable of opening up. I do believe this is due to her autism. She just feels like life is rubbish, no amount of talking is going to help her out of that. She does go to college and she goes to the gym with me or her friend, and we also go long walks together. She has good and bad days. But I just wanted to even out those bad days, and help her feel she doesn't need to hurt herself or to think she is better off gone. It hurts me to see her hurting so much. I have resisted getting medication all my life, and I finally did it this year for myself. That is why i know it really does work, and I just wanted to let her have that opportunity to try it. It may not be for everyone, but at least I could say i tried for her...

Depending on where you live, your GP might be able to get prescribing advice from a CAMHS psychiatrist if that's an option, however... two things.

Some doctors don't like prescribing until 20s, so you might still be waiting after she turns 18. I spoke with a GP this week who wanted advice on prescribing for a 19 year old, and noted that she didn't prescribe to under 22,usually.

Then there's a curiosity in your comment above,
no amount of talking is going to help her out of that.

Why not? Sure, counselling won't change it, but autistic girls either LOVE CBT or hate it, and those who hate it will usually do really well in child psychotherapy. The children for whom talking to the right kind of therapist doesn't help, are very few.

GPs can't prescribe ADs to under 18s. It has to be through a psychiatrist. They should always be used alongside talking therapy. You could go private as the waiting times for CAMHS is usually long.

This is not true. GPs absolutely can prescribe, but because they aren't experts, many are uncomfortable and prefer a psychiatrist to either advise them, or do it for them.

This is what I have always been told by CAMHS and my own GP. Even when in crisis and seeing a locum on new years eve, he told us that he wasn't able to prescribe anything due to my child's age.

There might be odd local arrangements (our psychiatrists are contracted to stop prescribing at 17, and GPs are expexted to do it) but there isn't a national rule, and GPs can prescribe. The only caveat is you're not supposed to operate outside your competence.

We had to go private; DD wasn’t capable of talking therapies without just the very lowest dose of Prozac.

Can I ask about the financial side of that? Seriously considering it for DD.