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[Dancinggirl]

HI All

Of course there is a place for ADs/SSRIs but I , like many others, am extremely worried that GPs rush to prescribe these as a first line treatment, without fully informing the patient of the side effects or fully assessing whether this is the right route to take. It's the old fashioned approach of ‘let's cosh them, to keep them quiet'. 

As a short term trial to help someone get over a difficult time wit true depression, crippling anxiety or for pain management, then fine, but how many people are sent away with a prescription for an AD having been given the full implications explained to them? Initial side effects can be severe, withdrawal symptoms take many weeks or months and I am particularly worried about the long term effects for those that find they become dependent on these drugs?

I know that the right SSRI can be very helpful for those poor women who can't take HRT for health reasons but isn't it about time they did some research to find some other alternatives.

I was prescribed Prozac in my mid 30s (going through very difficult time with my son being diagnosed with developmental problems) but my local pharmacist was very responsible and, knowing I had small children, told me he thought it unwise for me to take them due to the side effects - I was doing busy school runs carrying both my children and friends children to and from various schools and he said I might not be fit to drive.  HE printed out the leaflet separately and advised I read it very carefully before considering taking the Prozac. I opted not to take the Prozac and stuck with the counselling - I will be eternally grateful to that pharmacist. 
I was then advised, last year, to try Amitriptyline (just the lowest dose of 10mg) to ease pain in my lower back, hips and sciatica. It did reduce the nerve pain but, by week three, I was a hyper wreck, with a horrid dry mouth and awful headaches - it took 3-4 weeks for these side effects to wear off when I stopped them.  I was on the lowest dose so I dread to think what is would be like to come off a higher dose!!!!!
In the end I paid to see a rheumatologist privately, I had a scan and X Ray and the problem was identified - he gave me a steroid injection in my spine which has worked wonders (injection took 10 mins).  It will never be perfect as I have deterioration of L3-L4 vertebrae but the GP should have referred me, not dished out drugs that were just to keep me quiet. I now know what the problem is and I can manage it better - if it gets worse again I know I can have another injection that will relieve the pain for quite some time and won't give me side effects. Why did I have to pay for the appropriate treatment???

I know ADS/SSRIs are trial and error, before you find something that works well for you, and for many people they are a life line, BUT - the GPs really must explain why they prescribe them and what effects they may have both short and long term. 
RANT OVER. DG x

[Just]

Hello Dancinggirl, I agree it is time better alternatives are found and used. Everyone has different experiences and these medicines work well for lots of people but can also have horrible side effects and withdrawal.
The pharmacist you saw sounds excellent.
I took the lowest dose of Amitriptyline as it was recommended for vestibular migraine (one of it's more common uses now that there are newer antidepressants). I persevered for 10 days but it made me feel worse and the withdrawal was terrible. I know these types of medicines sometimes make you worse initially and then help but I couldn't tolerate the side effects long enough to find out!
It will be interesting to read everyone's comments.

[MIS71MUM]

With the NHS as it is, I can see this happening more often. There isn't the money to sort out or investigate the cause. Mental health budgets have been hit very hard. Counselling on the NHS is nigh on impossible to get.
Also GP's in the main are ill informed on HRT so AD's will commonly be prescribed rather than them trying to spend time getting your doseage right.

As for AD's, well the side effects are extreme and when I took them in my 30's, it took me years to get off them.
Also on my case too, it was the pharmacy who explained the side effects.

[CLKD]

Good thread!!

In the 1980s I was too ill to be told of the possibility of side-effects, but the nausea which was impossible 4 me to continue with each AD, was awful as well as other issues.  Eventually my GP found a medication which really did help. 

It's most medications, not many are fully explained.  I 'had to' start Statins in Oct [long story short] but the GP didn't know how they actually work  .  When I worked in the NHS in the 1970s not ONE patient asked what the 'routine blood tests' involved, what the Consultant was looking for ...... they went off, had the bloods taken, came back 2 weeks later for the results .......

Take Omeprazole - should be for short-term i.e. 3-4 months use, not long term.  They can cause more problems than they solve but how many are told 

How many are warned about any problems that may occur with progesterone?

[racjen]

I completely agree with you DancingGirl - over my peri and now sudden menopausal period, I've been prescribed 7 different ADs for anxiety, and all have caused such severe reactions I've been unable to persevere beyond a week or so. And when I say severe reactions I mean black depression, zombie-like stupor, fantasising about suicide - the last one (sertraline) had me taking out the new pack of stanley knife blades I had upstairs and testing them for sharpness, mainly because I'd surrendered my stash of éxit' drugs to the crisis team. And yet they still tried to persuade me to try another one. And then suggested pregabalin, which I later discovered by googling has all the same warnings as ADs about suicidal ideation etc. Again I found my pharmacist far more helpful for advice than the psychiatrist who prescribed. MAkes me SO angry.

[dahliagirl]

I had one sertraline once 

I couldn't string a sentence together and I was like a hen on a hot brick.

I went to bed, thinking I wouldn't sleep, then crashed out, but was woken by getting too hot - then I just kept getting hotter and hotter, until I went all sweaty and cooled down.  It was like a really scary hot flush.  I didn't got back to sleep after that.

I was told I should have carried on taking them for two weeks    I don't think I would have been able to look after my children like that. Anyway, I got a counselling appointment the next day, which was more what I needed.

[Bring me Sunshine]

I certainly agree.  I think gps treat the symptons not the cause.  Often people do need to talk through their issues without any drugs whatsoever.   The sad thing is they get 10 minutes to assess the patient which is not enough and it is so easy to dish out a prescription for anti depressants.

However, anti depressants can be life savers.

But there are none that I know of that act fast like we need them to.  No cruely they make you feel so much worse at the beginning, increased suicidal thoughts, tired, dry mouth, sickness, worse than you were before you started taking them.

It is no wonder people have to quit them but sometimes you do have to persevere my friends, when I was prescribed them in 1987 after losing my mum the year before, my then husband put them down the toilet.  It took me till 1998 and a major loss in my life before I took them again due to a breakdown.  They took around 3 months to start working, a life time when you feel worse than you did before taking  them.  I so wish there was a fast working one, I never found one.  But I do know that they can save lifes but are not the answer for everyone xx

[Dancinggirl]

Bring me Sunshine
Yes, they certainly can be a life saver or at least really helpful but only if you are truly in a bad mental state or have severe nerve pain.
Unfortunately ADs/SSRIs are often simply an easier and cheaper way to get the patient of the door. I believe it is irresponsible and actually negligent that patients are not fully informed about side effects and risks - especially if they truly need these drugs to save their lives. To simply trust that a patient will read and fully understand the leaflet and is not enough.
As you rightly point out, it can take a long time for them to work and they can make you feel so much worse for quite some time. I actually think there are drugs that can be taken to help over the initial problems but are rarely offered.
I do think there needs to be a big review on the use of ADs/SSRIs, especially when it comes to treating menopausal women. DG x

[dahliagirl]

From what I understand from someone being referred to a mental health crisis team, they do counselling and assessment before prescribing anything, so that they can prescribe the right thing (if needed). (this was a particularly good team - I know that other places are not so good).

So it is puzzling how someone can still go to the GP for HRT and be given ADs instead.  There are the NICE menopause guidelines to follow as well.

[CLKD]

I'm afraid that had I been offered counselling prior to appropriate anti-depressant medication in the 1980s, I wouldn't be sitting here now.  Also, how long does 1 have to wait B4 counselling sessions become available?  In the 1990s it was 18 months  .

My GP was so concerned about my mental state in Feb. 1990 that he arranged for a Psychiatrist to visit me at home.  The problem was she bought a trainee with her, I wasn't well enough to say 'no' as they landed on my doorstep  .  That was really un-professional!

One has to realise too that none of us know what ladies present in surgery with.  If they go in weepy and complaining of depression what's a GP to do?  Unless the lady has associated anxiety and low mood with hormones ............ and admits to such.  Then discussion should take place about the options, HRT/ADs or .........

I was told each time I changed ADs that it would take 10-14 days to kick in but fortunately, the various ADs that were suitable; in that I didn't feel sick so had to stop taking them; began to work within 3-5 days  .  Fortunately too, those prescribed have worked well for my organic depression - each for 5-10 years B4 the brain became used to the drug.  Over these years of course, new ADs have been offered to the market.

Prozac gave me the feeling that I was walking on 7" heels  and I knew after 3/4 days that if I took another pill, I wouldn't be getting out of bed the next day. This was the drug with apparently 'no side-effects'. 

My pre-menstrual depression was totally different to the on-going illness I suffered during the 1980s/90s.  That was more of an intense weepyness which went on and on and .........

I also have clinical depression which is eased by upping the dose of my AD for 5-7 days.  As long as a medication doesn't make me feel sick I have been able to cope. 

[Dancinggirl]

CKLD - your wonderful post really highlights my concerns.  If GPs can't do an appropriate assessment and take into account all aspects of what is going on with a patient, why do they prescribe ADs so readily, knowing these drugs could do more harm than good.  It is appalling that there aren't enough counsellors available. If you need counselling, you need it immediately!!!
It's not just more Wellwomen centres that are needed but proper mental health centres.  Perhaps every GP practise should have properly trained Wellwomen nurse practitioner and Mental health nurse practitioner.  These highly qualified nurses could offer longer sessions offering a more holistic approach - thereby linking the needs of the patient across both issues of hormones and mental health.
What about each GP practise offering up local support groups for women going through menopause (you could be assigned a meno buddy ) - a bit like the NCT which supports expectant and new mothers.   Prof Studd states in his recent article that, unfortunately, psychiatrists are very reluctant to see hormones as a cause for depression and anxiety.  Many of us would tell these psychiatrists that they are quite wrong. 
The NHS is not addressing the basic health needs of many women - would it not save time and money to treat women appropriately in the first place - not palm us off with ADs/SSRIs.

Sorry - still ranting.  DG x

[dahliagirl]

CKLD - the crisis team ring you and visit you at home - or outside the home or in the office.  The ones I met were very good - but like I said all areas are not the same.

[CLKD]

I had a dedicated psychiatric community nurse for a few years.  But the good old Government of the day made cut backs and that was when he was made redundant  .

I had a therapist who quoted some of the books that I had already read  and dismissed - because on paper it looked so easy to stop being floored by anxiety.  I could tell her which page she was on ........ she admitted that I did know more about anxiety than she did  .  That was after waiting 18 months for the therapy office to ring to see whether I still required sessions  .

Your idea is good Dancinggirl.  Sadly, as with geriatric services, mental health will always be 2nd bottom of the pile.   .   Neither gains requests by Drugs Companies for Research Grants in order to find out what exactly being geriatric or suffering with mental health issues actually entails.  I know someone who was a dedicated NHS Psychiatric Nurse who had to move into the private sector because there was no support from 'above' and working conditions were dangerous.

[bramble]

We would all like to live in an ideal world where doctors are excellent, have more time and where there will be a raft of services ready to step forward and back the GP up. However, it's not an ideal world and GPs are more overworked than ever, not only seeing patients face to face but dealing with the piles of admin work. We should be thankful that we have the NHS, albeit that it is creaking at the seams with more and more elderly people needing long term care. etc. The NHS is a victim to its own success really - the fact that they can successfully treat people who then live on a longer life and so add to the burden overall. 
As for making you aware of the side effects of the drugs they prescribe. They really don't have the time. I firmly believe that a doctor will prescribe to me the best drug for my given situation. It is up to me to read the leaflet, make myself fully aware of that drug, and then report back if I have problems. I have to take some responsibility for myself - I can only expect the doctor to discuss the medication in broad terms.

I think the NHS overall is doing a wonderful job.
Bramble

[CLKD]

They do the best in the main Bramble.  When I was very ill I didn't have the energy to read the information .......... now I recognise when my brain requires more support I feel enabled but it doesn't take long to go really down. 

If the Government of the day were to listen to sufferers with many different conditions we would all be better.