A-Z

Antidepressants

Antidepressants: The GP

GPs are usually the first point of contact for people seeking help for mental health issues. Often people find it difficult to talk openly about mental or emotional distress, and many put off seeking help until they reach a crisis point.
 

Lucy X accepted that she needed help and talking about it...

Lucy X accepted that she needed help and talking about it...

Age at interview: 21
Sex: Female
Age at diagnosis: 15
SHOW TEXT VERSION
PRINT TRANSCRIPT
What a lot of people don’t understand is going to the doctors the first time and explaining is just like, I mean the first time I did it I just like, I think I just cried for ten minutes and didn’t say anything and then you know it all slowly sort of came out. And then it’s just such a like as you said... you’re at your lowest and it’s like a complete oh it’s such a big thing and especially if you’re like myself you kept it very to myself to suddenly have to be like this is what’s happening was, I mean that would be another thing for people you know health professionals to realise what a big step someone has made when they originally turn up. I mean one they’ve accepted it personally which is a huge thing and accepted they need help and now they’re coming to find it. But they also have to open up to probably someone who is a complete stranger it’s like yes it’s a huge thing to like you know to maybe have a bit more respect and understanding for how big a thing that really is for people.
Whilst it was a big step to seek help, it could be a relief having a diagnosis and knowing that treatment was available. Treatment options vary according to the medical history, severity and type of symptoms. Sometimes the GP will refer a person for counselling or a brief psychological intervention (talking therapy) before thinking about prescribing an antidepressant. People with moderate or severe depression may be prescribed an antidepressant as well as referral for a therapeutic service. GPs may also refer on to more specialist mental health services (see also ‘Community mental health team, ‘Getting to the doctor-seeking help for depression and our Depression section).
 

Andrew was relieved when his doctor diagnosed depression...

Andrew was relieved when his doctor diagnosed depression...

Age at interview: 50
Sex: Male
Age at diagnosis: 49
SHOW TEXT VERSION
PRINT TRANSCRIPT
I was enormously encouraged that he didn’t just say here’s some tablets go away and take them, think about it. And he gave me a couple of websites to look at to just looking at possible side effects and how it might work and that sort of thing. so that gave me enormous encouragement with him as a doctor I have to say that he was actually thinking about me and what was best for me. and then I came home and talked to my wife about it and it was about November, October or November and I remember thinking the doctor said the first month on this treatment can be pretty grim or not, you know it can highlight some of the worst aspects of, of the depression, it can be a problem. and I remember thinking Christmas was coming up and I was feeling awful and I didn’t want to mess up Christmas and so I thought if I start now with the tablets, if I’m lucky I’ll get the month or six weeks in of not feeling so good and they might actually start to kick in the benefit for Christmas. And I just thought with the children around I came to the conclusion I didn’t want to waste any time and I’d spent enough time feeling, you know, unwell and if they could provide, if there was a treatment that could help then I would go on it.
People usually wanted to know whether there were other options, to be involved in choices about their treatment and to know what to expect from taking an antidepressant.
 

Catherine feels that doctors should realise that a patient may...

Catherine feels that doctors should realise that a patient may...

Age at interview: 41
Sex: Female
Age at diagnosis: 14
SHOW TEXT VERSION
PRINT TRANSCRIPT
There is a fear I think from doctors where somebody is going to say no because a doctor is offering you something, you politely, because there is a well of people who have already made that decision, I’ve spoken to people myself who are adamant they don’t ever want to take antidepressants and I think they’ve got to be prepared for that, they’ve got to be prepared for all responses, not just the yes I will and just hand out a prescription or yes I will can I have more information but no I’d rather not and I think it’s about, you know you must spend that extra five or ten minutes giving, you know, saying to the person are there any questions you’d like to ask me about this medication I’m about to prescribe to you, this is what it’s about.
If an antidepressant is prescribed there should be regular follow up contact with the GP so that he or she can monitor and review the medicines. People are also encouraged to see the GP if they felt troubled by side effects, if symptoms change or worsen, or to discuss the possibility of stopping treatment.
 
Experiences with GPs varied. Some went for regular appointments after they started on an antidepressant, but others said they rarely saw the GP once they were receiving a regular repeat prescription, especially when they had been taking the antidepressant over a period of time.
 
Some people had been seeing the same GP for many years and felt that it helped that he or she knew them well. Olivia Y described her doctor as ‘just a breath of fresh air, he’s wonderful ‘. Others said their GP was ‘brilliant’ or ‘amazing’. GP’s who listened, seemed to be generous with their time, treated them as an individual, provided information, discussed the available options, and involved them in making decisions about treatment were particularly appreciated. Andrew explained what mattered most to him about his GP when he was prescribed an antidepressant ‘I felt that if I’m going to go on the treatment that may affect my mind in some way, you know, I wanted to be able to trust the doctor and know that I was an individual to them’.
 

Emily thinks she may not have coped if she hadn’t felt able...

Emily thinks she may not have coped if she hadn’t felt able...

Age at interview: 28
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
I think the way my doctor went about it was very good. Just open discussions, you know, providing the options but asking how you felt. He asked me how I felt about each option, he took the time and he was, I was in there a long time, I dread to think how long I pushed back the appointments that day but he took the time to explain the different options and asked me how I felt about each one and so we could actually discuss openly. And it just, and I think because it was so important that, it was the first time I’d met him and he became such an important part of my life so quickly I don’t know how well I would have coped without knowing that I had that support and I could go in each session each appointment and not feel judged but literally give the facts this is how I’m doing and trusting the response.
Commonly people felt it was important that GP’s didn’t just hand out prescriptions. Stuart felt it was important that they should give people as much information and advice about other types of support as possible.
 
Lucy X summed up why she felt so confident about her GP ‘I was there for 45 minutes and I never felt like she was trying to push me out the door she just, you know, I really felt like she genuinely was there to do the best... it just felt like she cared’. Clare felt she mattered to her GP. ‘I had confidence in the person that was, that was giving them and I think that was important. I didn’t feel as though I was being fobbed off’. When Stephen was first prescribed antidepressants, talking to the GP had more impact than the fact he prescribed an antidepressant. ‘I was actually more relieved from the talk rather than having the tablets because she was just such a good doctor’. Stephen’s message to GP’s was ‘Whatever you do don’t just sit and say ‘oh I think this person’s got depression here’s a prescription’ - you actually have to get them to understand what’s wrong with them... so they understand why you’ve given them the tablets’.
 

Stephen is fully involved in decisions...

Stephen is fully involved in decisions...

Age at interview: 48
Sex: Male
Age at diagnosis: 44
SHOW TEXT VERSION
PRINT TRANSCRIPT
And have you always felt that you’ve been involved in the decisions about your treatment?
 
Yes because it’s usually me that does most of the talking.
 
Okay.
 
They come up with the prescription or the solution whatever but it’s me that’s telling them what the problem is and what I think I need etc. and then as I said we might discuss about going on to a higher dose so it’s often down to me. She might say ‘Oh I think you should double it,’ and I’ll be saying ‘Maybe not ....but if that’s what you thinks’ best I’ll do what you thinks’ best.’ Or I might say to her as happened in the last one, ‘I’m feeling a lot worse than I had done because of the extra pressure, could we discuss increasing the dose?’ and then she’ll say ‘yes’, so. I do think I’m very involved in it.
When Hannah decided to stop taking her antidepressants she found it encouraging to go for regular follow up appointments ‘coming off the antidepressants... just having that support from my GP, regular support... meant so much to me that they wanted to continue seeing me until they felt that I was getting better’. It’s important to ask questions when you see the GP, but some people said this can be difficult.
 
We also talked to some people who had less positive experiences with their GPs. Reasons for unhappiness included a lack of continuity, feeling that the GP handed out prescriptions for antidepressants too readily, didn’t spend enough time with patients, hadn’t provided enough information, consultations felt impersonal or dismissive, that the GP didn’t seem interested in their problems, or that they had felt unsupported after they had been prescribed antidepressants.
 
People often understood that there were limitations on the availability of talking therapies, which left GP’s with few options to offer patients other than a prescription. But Thomas felt cynical, ‘What GP’s have to give people with depression. Its tablets still. There is improved access to psychological therapies but it’s quite patchy’.
 
Melanie would have liked more continuity. ‘Because of the nature of the surgery that I have I think I see a different doctor every time so I’m not necessarily getting consistency... I feel like I’m having to start from the beginning with every different doctor that I see, it’s not as simple as just saying ‘how are you feeling?’ because I’m thinking… well you don’t know how I was feeling before’. Some people also said that appointments with the GP felt impersonal, like ‘a paper exercise’. Melanie reflected ‘every couple of months they do the little questionnaire, they give me a score and I don’t really think that there’s much else coming out of it other than that’.
 
Sonia sometimes felt that doctors didn’t listen, or involve her in decisions about her treatment. ‘there wouldn’t be a two way conversation about it; it would be very much a ‘you need to do this’ and I wasn’t prepared to do that so I didn’t tell anyone’
 

Greg feels that there are lots of pressures on GP’s. One doctor he saw was ‘amazing’ and spent time talking things through, but another one ‘just dished out pills’.

Greg feels that there are lots of pressures on GP’s. One doctor he saw was ‘amazing’ and spent time talking things through, but another one ‘just dished out pills’.

Age at interview: 34
Sex: Male
Age at diagnosis: 34
SHOW TEXT VERSION
PRINT TRANSCRIPT
I’m realistic enough to know that people who don’t have that much time, doctors don’t have that much time to sit down and speak to every patient and I was very lucky with one that he was an amazing doctor, he would always take his time over me whether that was personally, I think he was like that with everyone he would just take his time and he was amazing doctor and I’ve had another doctor who just dishes it out straight away and maybe he was under a lot more pressure, he had a lot more patients, so it’s hard to judge.
 
Yeah in an ideal world we should sit down with someone and talk to them for half an hour and find out why they want to take them and what the history is, whether that’s feasible, I can understand there’s probably pressures to see all these patients get these patients through the door . Yeah I think, you know, a conversation is the best thing for mental health issues alongside pharmaceuticals as well. I think pharmaceuticals alone are probably not great, and I think conversation alone possibly is not great as well. So it’s just whether there’s time for people to be able to converse with someone about their issues.
Clare, and others, were aware that these days GPs are much more open to discussing decisions in contrast to an old fashioned ‘doctor knows best’ approach. Some people reflected that GPs varied in their approach and theories about the treatment of depression. ‘I've had one doctor that's completely chemical imbalance and that's it, and one doctor that's completely, "No it's you, nothing to do with chemical imbalances’. Tim had been given conflicting advice about coming off antidepressants. ‘One said I should do it over six months and another said well you know half the dose for a month and then see how you are and if you’re fine then just stop... different approaches’. Lucy X felt it was down to luck as to whether your GP was good, bad or indifferent, and that it depended on the individual. ‘I think it can be quite hit and miss with what doctor you see if, you know, I’ve heard people who’ve really even struggled to get a doctor to believe in their depression seriously. And then they’ve gone to another doctor who... sort of straight on it, all the stuff get something sorted. Several people suggested GPs favoured certain antidepressants or had ‘favourites’ and some wondered if this was because some were cheaper than others.
 
Some GPs have more specialist knowledge, training, or interest in mental health than others. Sharon felt that typically GPs are ‘jack of all trades’ rather than specialists. Collette felt that her CPN (Community Psychiatric Nurse) knew much more about antidepressants than her GP ‘she [GP] doesn’t have the experience of mental health drugs whereas the CPN since, particularly since doing his nurse prescribers course does have the experience of the drugs and, you know, he sees the patients and he sees what side effects they have’.
 

Stuart reflects, ‘there are some GP’s who aren’t just not interested...

Stuart reflects, ‘there are some GP’s who aren’t just not interested...

Age at interview: 52
Sex: Male
SHOW TEXT VERSION
PRINT TRANSCRIPT
I think a lot varies depending on the interest of the GP, the GP who referred me to the psychiatrist she had a special interest in mental health that was her, her area and so for her I was an interesting case whereas for the average GP I’m just a, you know,’ this is someone whose suffered from depression all his life. I don’t have the tools to cure him’ you know, in the medical world, you know, we’re not at the state of knowledge where… there’s nothing any GP can give me that’s going to, that’s going to cure it.
 
So do you think the GP’s are whole, mainly focused on giving out cures for things rather than talking to people?
 
Well yes I mean that’s my, my feeling and that’s the, that’s the way the training traditionally is for GP’s and I, I know from talking to GP friends certainly, you know, that there are some GP’s who aren’t just not interested in mental health problems because it’s not a disease you can get hold of and fix. it’s so intangible and so difficult.
Simon, a GP, pointed out that health professionals may themselves have a history of depression; he felt that he could emphasise with his patients because of his own depression.
 
(See also ‘Messages for health professionals, ‘Being prescribed an antidepressant’, ‘Getting to the doctor-seeking help for depression’, ‘Reviewing medicine use’ and ‘Finding out more information about antidepressant medicines’).

Last reviewed June 2016.
 
donate
Previous Page
Next Page