GP refuses to prescribe anti depressants for DD

[Ssmiler]

My DD 20 has had some level of mental health issue for a number of years now.

She has had difficult friendships through school and has been badly treated / bullied by her “best friend” all her life. In her final school year I had a call from her head of year saying that she was concerned about her mental health. She hid it well but she had spells of not sleeping and general sadness. Also she does not cope well with even minor life inconveniences. Nor with change -eg the first couple of weeks after coming home from uni are always horrendous, as are the first few weeks after going back.

When she started uni she was great in the first year but again is back to these relatively frequent bad spells now through second year. She has tried counselling and CBT, she has a full schedule with her course so always gets up in the mornings, she goes to the gym at least 5 times a week and has good and kind friends and flat mates. But still she is getting these spells which are affecting her ability to engage in and enjoy life.

She is an introvert and hates speaking on the phone but finally plucked up courage early feb to phone and ask for a gp appointment. She was called by someone who said she had to do six weeks of on line group CBT. She has done it before but agreed as it was the only thing offered.

Towards the end of that she rang again and asked this time to speak to a GP. Explained this has been going on for more than four years, she’s done the talking therapies and does all the right things for self help. She said that after years of resisting meds she feels that she needs something to help her deal with the ups and downs of life as she just struggles so much.

The GP gave her a long lecture about the risks of anti depressants, hoe they’re “impossible to get off” and so it would be a big issue in the future if she got pregnant as the baby could be harmed…! Etc etc you get the drift

He was speaking to someone who had ALWAYS said she never wanted anti depressants, who will do anything to avoid speaking on the phone - especially to a stranger. But yet she had got so desperate she had phoned and asked for medication. That call literally plummeted her into a bad phase as she feels now there’s no help available and this is going to be her life going forward.

He arranged another call for a months time. I’ve no idea what to advise her. By her own admission she’s not good at advocating for herself and will never stand up to anyone who treats her badly - and will certainly not challenge an older person in their profession.

The next call is during her Easter break so I could be with her. Is that an option? If so what could I say? Any advice? Sorry this is so long

I would advise your daughter to call again now and ask to speak to another GP. Sounds like that one was terrible. In my experience of going to the GP with someone who had mental health problems, they need to hear it from the patient themselves. Maybe you could spend some time supporting your daughter to make the call, what she will say etc.

She sounds like she's been as proactive as she can be, she needs a GP she can trust to help her through the next bit of her treatment. Good luck, I hope she manages to get the help she needs.

I would echo the previous poster. First thing to do is make another appointment with a different GP. Ask for a female GP maybe?

I'm a female GP, do lots of mental health. Antidepressants in this age group rarely work and are generally felt to carry more risks than benefits, specifically an increased risk of suicidal ideation. Obviously I haven't met your daughter so this can't be individual medical advice but from your description she doesn't sound to have depression serious enough that the benefits of antideps would outweigh the risks. She's keeping up with her course, getting up regularly, going to the gym etc.

The real problem is that the provision of talking therapies on the NHS is abysmal (usually 6-8 sessions of CBT and that's it) and she may need longer.

What the GP said about addiction to antideps/use in pregnancy is BS, but that doesn't mean they are necessarily the right thing at this age.

Has your DD considered that she might be autistic. Vastly under diagnosed in girls - they being excellent at masking the difficulties autism can cause them day to day. There are things that as a mother of autistic girls - stand out as possibly autistic symptoms. Eg that change is difficult, she's introverted, was bullied by her best friend and that she struggles to speak on the phone. The reason I suggest this is that if she is autistic CBT - unless delivered by a practitioner who's an expert in autism and even then - CBT is usually inappropriate for autistic people and doesn't work.

Get a different gp or pay to get a diagnosis for clinical depression from a private psychiatrist. That's what I did with 16 year old dd because camhs was so overwhelmed . She is an adult though and another gp can prescribe.

@urrrgh46

Has your DD considered that she might be autistic. Vastly under diagnosed in girls - they being excellent at masking the difficulties autism can cause them day to day. There are things that as a mother of autistic girls - stand out as possibly autistic symptoms. Eg that change is difficult, she's introverted, was bullied by her best friend and that she struggles to speak on the phone. The reason I suggest this is that if she is autistic CBT - unless delivered by a practitioner who's an expert in autism and even then - CBT is usually inappropriate for autistic people and doesn't work.

I also thought the same thing when I read the OP. Definitely worth looking into. You can search Autism Quotient online and you will find the questionnaire often used by professionals. It will give you / your DD an idea.

(I'm an Autistic Mum with a DD going through diagnosis by the way)

Get a different gp or pay to get a diagnosis for clinical depression from a private psychiatrist.

This. Even if the GP had said with just cause that ADs would likely be ineffective (and there's no indication in OP's post that this was mentioned as a factor at all), it doesn't excuse the rest of the nonsense and the utter lack of help. "I can't do X but why don't we try Y or I could refer you to Z who knows more about this" is what patients need and look for. At this point though, doing whatever you can to move forwards with getting help is probably more important than dwelling on the outcome of the call.

I'm surprised at the medical view that ADs (all of them? of every single class?) are considered ineffective and/or risky as old as 20, though. I know the cautions around children and adolescents, but understood the threshold for routine prescribing decisions to be 18....if the argument is that a 20yo's brain is still developing, at what point is it considered physiologically mature enough for ADs?

It's perfectly possible for someone to go through the motions of life while being profoundly depressed--major depression doesn't always mean taking to one's bed or refusing to see anyone. I won't go into details, but I've occasionally sat on the train typing a goodbye letter having gone through my morning routine just as usual.

Wow so many replies and so helpful. Thank you all so much for helping. I’m reading and rereading. I’m particularly noting that two of you have mentioned autism. Thank you. I have to admit that has literally never once crossed my mind but I’m now thinking maybe it should have? It’s definitely worth looking into and we will.

The one thing I will say is that for uni she went off alone a very long way from home, knew no one, lived alone in first year, made good friends found nice flatmates etc. I’m not saying she wasn’t nervous but it was her dream course, v hard to get into and she was excited. After a week she was so well settled I couldn’t believe it. That lasted a year.

Actually as I write that I wonder was it the living alone in first year that helped as she could be alone to decompress when needed? The issues started in second year - she lives with friends now. So maybe this positive experience in first year points more to autism rather than less?

Also @passport123 thank you for the GP perspective. That’s very helpful. I didn’t know that there were risks re suicide ideation etc - I guess that’s why I posted here - I don’t think I know anything much about any of this. What I did suspect though was that the gp was talking BS about a mythical future pregnancy being a reason to not consider AD.

But is it really the case that there are no “safer” AD that would be suitable for a 20 year old who truthfully has been battling on and off for so many years now? I will ask her though if he mentioned suicide ideation as a reason for not prescribing - maybe he did and she didn’t want to tell me that.

And finally @Doggirl thank you and I just want to say I’m sorry to hear that you’ve had such difficult times. That has really resonated with me as I have known someone very close who did all the right things like DD but was seriously depressed as it later transpired. So I agree with what you’re saying and I did suspect that her telling the GP that she was trying and doing all these “correct” things was what made him dismiss her so summarily.

But she is battling and she doesn’t want to keep having these ongoing difficulties - and the episodes are definitely more frequent now.

I think she needs to speak to a different GP. ADs are not the solution to everything but to just tell her she can't have them in case one day she gets pregnant (she's 20! She could be miserable for the next 10-15 years before that becomes relevant, if ever) and not offer any other solutions is unconscionable and sounds like one of the old-school types who believe everyone should just pull themselves together and get on with it.

Hi OP. This resonates with me. I’ve had anxiety since my teens. By my third year of uni, my anxiety had peaked to the point I needed anti-depressants and counselling. It got me over the worst of it.

As an adult I was diagnosed with ASD. Currently investigating the possibility I might have ADHD too. I found uni very difficult, being away from home, living in shared accommodation (so much noise and mess!). Understanding that I’m neuro-diverse has really helped me. I also work with routines. I have stuck to the walls of things I need to remember. I do certain jobs on the same day each week where possible. All of this helps me feel like I have some control! It’s worth doing some online assessments like the AQ mentioned above to see if it fits. Also have a look at Tania Marshall’s website about ASD in women.

I would definitely join in with your daughter’s appointment. You can advocate for her.

What I did suspect though was that the gp was talking BS about a mythical future pregnancy being a reason to not consider AD
@Ssmiler absolutely and raises concerns about how he would manage a pregnant women with depression or one who imminently wanted to TTc. Worth mentioning to the practice manager

By the way op my dd is 18 and is on sertraline . She was suicidal and so anxious she couldn't function . I know the dangers of any medication but I felt we had no choice . No one was helping us , camhs were shocking and we had to do something which was go private to get a diagnosis and therefore medication although gp is happy to prescribe now she is over 18! Don't give up !!!

@urrrgh46

Has your DD considered that she might be autistic. Vastly under diagnosed in girls - they being excellent at masking the difficulties autism can cause them day to day. There are things that as a mother of autistic girls - stand out as possibly autistic symptoms. Eg that change is difficult, she's introverted, was bullied by her best friend and that she struggles to speak on the phone. The reason I suggest this is that if she is autistic CBT - unless delivered by a practitioner who's an expert in autism and even then - CBT is usually inappropriate for autistic people and doesn't work.

I also came on here to say the same thing. I am autistic myself, diagnosed aged 40 and this resonated with me. An earlier diagnosis would’ve helped with my own earlier mental health issues

Thanks for your kind words Ssmiler. In my case the 'masking' dates back to childhood, being almost certainly down to parents who weren't really engaged and that I didn't feel I could share feelings etc. with. The way that you describe your daughter and what she's going through so fully in your post, seems she is more fortunate in her mum having her back!

Also echoing that "not coping well with change" raised flags with me re ASDnot sought diagnosis myself, but read plenty when thinking about what lay behind my problems. One of the issues with ASD is that high-functioning (Asperger's) women don't necessarily manifest the same as menin particular, stronger socialisation effects meaning they can even overcompensate on some social conventions. As a child I remember DM eye-rollingly telling me that when people ask "How are you?", they don't actually want to know about your health. It's not a stretch to imagine that if someone has learned that "I'm fine" is the expected response at every turn, they will have internalised that that's how they have to mask in living.