General Practice and depression
A range of professionals can help people with depression. For many people their GP (general practitioner) is the first port of call when seeking help. GPs can prescribe medication, refer you to primary care counselling and psychology services or to a psychiatrist, sign you off work, and some have good counselling skills.
GPs vary greatly in their abilities to help people with depression. People who thought that they had a good GP often said that they had been lucky. Highly regarded GPs had one or more of the following qualities'
- They recognised and acknowledged the experience of depression, and so helped patients feel that their distress was legitimate and they were not alone
- They demonstrated an understanding of what it felt like to be depressed. For instance, one man was surprised his GP (in his fifties) knew what being a depressed teenager was like!
Describes a GP who demonstrated caring and confidentiality, as well as acknowledging what it...
I'd never made an appointment to see the doctor off my own back, I'd never phoned up and said, "Can I see my doctor?", probably would never have gone to see him if it weren't for my mum making the appointment. Interesting isn't it.
So that was helpful, and he was a kind of, I suppose before he'd always seemed a sort of, kind of rather you know, a figure of authority to go with all the other ones. Then when he starts to talk to you, then you sort of you realise, God this man in his fifties knows what it's like to be sixteen, talks to a lot of sixteen-year-olds, knows what it feels like to feel shit. And lots of people have felt the way I feel, and that really helps. And it sounds trite but it's true. He was a good GP, he was a good GP.
- They connected at a human level with their patients. For instance, one woman said her doctor “makes you feel that it's you he wants to see, never mind the other people waiting… He knows exactly who you are and what you've gone through”
- They demonstrated a high level of availability and care. Some showed care by being very proactive in encouraging severely depressed patients to make and attend appointments
Says he appreciates how his GP provided him with his direct number for use in an emergency. ...
It is somebody I feel I can talk to, and it is someone who can provide help as opposed to some sort of anonymous phone number that you can phone. This was someone specific who I know and I trust and you know, if I am at my absolute worst I have entire faith that, that he could do something to sort me out. And to, to have that was very important and another great source of strength and actually still is.
GP rings up to encourage her to make and attend a GP appointment when she is depressed, as well...
And so she is on the phone ringing me and she is encouraging me to talk, to go to her because I haven't tended to go, only ever go to her in crisis. I've never gone at the beginning or the middle stage. I'm usually in a great crisis to have to go and see her. And she's been trying' she has been trying all these years I have been seeing her, to educate me, to go before the crisis.
You know, 'Why don't you, you've been feeling this way for six months and it's just got worse and worse, why didn't you come before?' And you know, 'Come and see me next week.' You know, 'You never come, I'll sit and listen.' You know, she is a human being, she has made mistakes and that's fine because she is a human being and I know she's a human being because she talks to me like, like I'm a human being and she's a human being. She is always fully present always as a person. She's never standoffish or looking at her watch and thinking, you know about the next patient. Never.
- They reassured patients that they would recover in time, but not immediately
- They listened and made an effort to understand the perspective of patients, even when there were conflicting accounts of the patient's behaviour
His GP has demonstrated she understands how he feels, even though his dad does not.
But certainly Dr [name] my GP, she, as I say, she has been very helpful, and knows how I feel as I say and sort of says, "Well you've just got to sort of battle on with it really", and sort of - that's it. And like my dad says to her, "Oooh well you know", cos he's sort of frustrated that I'm not getting anywhere as I say, and she says to him, "Well you know you've got to be patient [father's name]." She says to him, "Because you know [participant's name] will take it one step at a time with how he's feeling." Which, you know I do, or I try to. And sort of that, that's it really.
- They gave priority to patients with depression, providing additional time for candid discussion that seemed relatively unrushed
- They encourage patients with chronic depression to become informed and then treat them like 'expert patients' - i.e. people with a long-term health problem who can understand and manage their own condition themselves (see Expert Patient Programme)
- They referred patients to specialists when they could not manage the depression on their own
- They explained about the possible side effects of medication and involved the patient in decisions about their care
People had problems, however, even with very helpful GPs. Being on very familiar terms with a GP can make it harder for some people to discuss difficult issues, such as feelings of despair and suicide. For instance, one female health professional initially pretended she was coping (her GP was also a friend) before her facade crumbled. Some people with depression can find it difficult to deal with the extra attention of a caring GP. And it was thought that even very good GPs can wait too long to refer people to a psychiatrist. Along with the delay in medication taking effect, the time taken for referral can mean many months of distress.
Wanted her GP (who was also a friend) to notice her problem, but was worried that if she told him...
Well I obviously' it all became too much and I felt myself sort of falling onto his desk weeping and he was quite taken aback. You know, "What's wrong?" and I... it all just started and it came out one thing after the other, how miserable I was feeling, and about, you know, how low I felt. And I couldn't bear to continue living like that any longer. And that my friend had insisted that I come in and talk to him and, and he was really good. He wanted to know why I hadn't spoken to him before and I said, "That I wanted, I wanted you to recognise that there was something not quite right, and you didn't."
Describes how she feels uncomfortable with the caring attention from her GP and so forgets things...
It was just unnerving having that amount of attention focused on me.
While many people we talked to had an adequate GP, some GPs were considered less skilled in helping depressed people. Some GPs were said to have trouble communicating with patients. One young woman felt patronised by her doctors. As one older man pointed out, some GPs had little understanding of depression, and in some pockets of the UK it was thought GP understanding of depression could be particularly limited. One female health professional felt that it is difficult to negotiate with GPs when you have depression because you lack confidence, and depression is not visible. She suggested bringing someone else to the consultation to support you, or writing everything down first.
Felt she was patronised and not listened to by GPs until they realised that she had attended an...
Like I'm not stupid, and I'd like to get something explained to me but nothing was ever explained to me until I was at University because then they go, 'Oh, what you are doing?' I'd say, 'I'm at University.' 'Really, where?' '[elite University name].' 'Oh, right, my daughter's there' and then they're suddenly, oh you're at [elite University name], right you're...
Part of the fraternity?
[It was like] You know, you might understand what I'm talking about because I'm so clever. Before that, it was like you were some sort of total moron, that you just didn't get listened to, you didn't get, you know it was as though what they were saying was, 'Well, it's just in your head, you know you don't really understand, I know better." And I know that they're really busy and I know that they don't have a lot of time, but I really felt that I got no help at all most of the time.
Explains that some members of support groups report 'pockets' where doctors are not very...
Now I've heard that once or twice. It may have changed, it may have changed Damien since I had it, but I've heard that once or twice from people, and I can only say how fortunate I am to have had the excellent support I had from my doctor'. For me the most important thing was sympathetic helpful people. Doctors in the first instance, who were prepared to accept what it was'
From my experience in the support group many people did not get sympathetic doctors in their life, and I think for some of them they were, thought they were malingerers or told to pull yourself together, everybody gets this sort of thing.
Suggests that people could bring someone else along to GP consultations, or write important...
You just have to prepare yourself that it's ok to feel like this. I'm not being a fraud. It really is that self belief. And it's really, really hard because if you are depressed anyway you have got such low self esteem that you feel a complete fool. And then'. In that case I guess it would be a good idea to take someone with you.
An advocate definitely that can speak up on your behalf. Or write it down, write it down before you get there as well. Write down what is debilitating, how you feel and stuff. For the actual daily appointment you might feel absolutely fine, and that's ok. It doesn't mean that you don't experience depression but the following day... you know you couldn't go to work or anything.
There were many stories about GPs who failed to recognise or diagnose depression. A number of people lived with depression for many years without receiving an adequate explanation from their GPs.
Explains how she presented to her GP with minor ailments, felt she was wasting his time, and was...
So you came away from these consultations feeling what?
Feeling there was something, feeling I was being a nuisance for going to the doctor. For saying there was something wrong with me when the doctor didn't think there was something wrong with me, for time wasting. I felt like I was just being a drain on my doctor.
I was given antidepressants at one point, I think it was Prozac, and I was on those for about eighteen months or so. But I was never given a particular explanation of what they were to do with, other than they might help - have a side-effect of weight loss. Well that's [laughs] I don't think that's a particularly good thing, but it helped me explain away why I was on antidepressants.
Even knowledgeable GPs could fail to communicate about depression in a manner that patients understood. For instance, one woman only found out she had an earlier diagnosis of depression during a subsequent episode.
She had not known that her doctor had treated her for depression in the past, nor that anxiety...
He had been the same doctor who had treated me when I'd had this post-natal depression thing when [Son's name] was born. And I think I must have seen him about my nerves on and off in between, but I've probably missed one or two things out where, you know, something had triggered me to become very over anxious. I remember having a row with a friend and that completely flattened me as well.
So I had seen him about that. So he said, "This is your depressive illness. I am going to give you some antidepressants." And I said, "But I don't feel depressed, I feel anxious". And he said, "No, it's two sides of the same coin," which again nobody had ever really explained to me. And he said, "We'll get you right. It might take a week or two". And it took five years.
Last reviewed September 2017.
Last updated October 2012.