Antidepressants; a GP ponders the urban myths…

I’m writing this blog purely as a GP who, every day, sees patients who take antidepressants. So these are my thoughts, based on experience, as well as evidence.

I also see patients every day who should consider taking antidepressants, because they clearly have all the signs and symptoms of significant clinical depression, anxiety, obsessive compulsive disorder or social phobia. Up to one in three of my consultations is for a mental health problem, and I suspect most of these people have finally come to see a doctor because they have reached a crisis point, or no longer know how to cope. They do not come lightly, and I understand that. They will often have already tried sensible measures, though we usually discuss those anyway, such as minimising alcohol or drug use, better sleep and eating routines, and exercise.

I always suggest counselling or other talking therapies, though again, many have had unsuccessful experiences of these. I will probably mention giving them another go…a different approach or technique perhaps?

But finally we come to medication, always approaching the subject gently, knowing that everyone comes with preconceptions and concerns.

“But they’re addictive”

“I don’t want to feel like a failure, needing medication”

“They’ll make me fat”

“They’ll make my acne worse”

“My parents won’t approve”

“I’ll be on them forever”


I have heard all of these, and many more, hundreds of times in the 15 years I’ve been a GP.

And it takes time and patience to pick my way through the concerns, which are mainly based on hearsay/myth (especially because they are NOT addictive or dependency inducing, and only one specific antidepressant is classically associated with possible weight gain. They have no effect on acne!).


But it’s worth the time, and listening to the concerns, because often a patient will then agree that it might be worth ‘giving them a go’, and that there is little to lose by trying them. Side effects are usually minimal for most people, especially if started at a half or low dose, and we always like to review how things are going at 2-3 weeks. And then when they have given them a go, and they return 4-6 weeks later, I have lost count of the number of people, but it is the vast majority, who have noticed an improvement, and as time goes on, at 8-12 weeks, say “I wish I’d tried these sooner”.


So all I would say is this; if you’re struggling and unsure about medication, then talk to a GP, sooner rather than later, and discuss your concerns, so we can see if antidepressants might help you too. And if they’re not right for you, we will still support you, and meet with you, to discuss other options and therapies.

You are not alone, and we are here to help.


A&E in Crisis- what can I do?

We are all aware of recent reports in the media about Emergency Departments (previously called A&E) being overstretched. One of the many reasons that this is happening is due to the inappropriate use of the Emergency Departments by patients accessing healthcare. This is a timely reminder of what to do when you are unwell so that we can allow Emergency Departments to treat those people who need them most.

Across the country, approximately 47 per cent of people attending an Emergency Departments could have received the same service via their GP, by telephoning NHS 111 or by calling in at an NHS walk-in centre, minor injuries unit or urgent care centre.

Be prepared

The best way to avoid falling ill is to stay healthy by eating a balanced diet, getting some exercise, drinking sensibly and knowing your limits


Self-care is perfect if your condition is something you will be able to treat at home – in fact, home is the best place for you. A big part of your recovery from these minor ailments is to rest and drink plenty of fluids. You can plan ahead by stocking up on some healthcare essentials – paracetamol, indigestion remedies and plasters for example. You can find all these at your local pharmacy.

Use the NHS symptom checker to help you identify your condition.

If you have sickness and diarrhoea don’t go to your GP surgery or hospital, as you may spread this to others. Drink plenty of fluids and call your GP practice if you have concerns. The best way to prevent this spreading is hand washing with soap and warm water.

NHS 111

NHS 111 has been introduced across England and Wales to make it easier for you to access local NHS healthcare services. It is open 24 hours a day, every day of the year and is free to call from your landline or mobile phone.

You should call 111 if

  • You need medical help fast but it’s not a 999 emergency.
  • You think you need to go to A&E or need another NHS urgent care service.
  • You don’t know who to call or you don’t have a GP to call.
  • You need health or medical information, or reassurance about what to do next.

For less urgent health needs, contact your GP or local pharmacist in the usual way.

GP surgeries

Your GP surgery should be your first port of call for non-urgent, on-going illnesses or injuries. Using a GP saves time as they know your medical history. Many GPs are open longer hours now – including early morning, late evenings and Saturdays and offer emergency appointments for urgent cases. You can also see a GP outside of usual opening hours. Just call your GP surgery as usual and a recorded message will tell you how to contact the out of hours GP service.


You can be treated by health professionals at your local pharmacy. Pharmacists can give advice on treating minor ailments like coughs and colds, give sexual health and contraception advice and provide treatments for minor ailments.

Walk-in Centres

NHS Walk-in Centres offer convenient access to health advice, information and first aid. You can walk in 7 days a week. Professional nurses run the centres which are available for all patients whether they are registered with a GP surgery or not.
The service is for the treatment of any minor illness or minor injury. This includes sexual health concerns, emergency contraception, wound management, travel health and smoking cessation. Procedures such as suturing and clip removals can also be performed.

Bristol City Walk-in Centre
Broadmead Medical Centre
59 Broadmead
Telephone: 0117 954 9828
Above Boots
More details about Broadmead Medical Centre

Minor Injuries Units

Your nearest minor injuries unit can help with a number of urgent minor injuries. You don’t need to make an appointment.

Southmead Minor Injuries Unit
Gate 35, Level 0
Brunel building
Southmead Hospital
Southmead Road
BS10 5NB

More details about Southmead Minor Injuries Unit

South Bristol Urgent Care Centre
South Bristol NHS Community Hospital
Hengrove Promenade, Hengrove, Whitchurch Lane Bristol BS14 0DE  
Sat nav postcode: BS14 0DB
Telephone: 0117 342 9692
Open 7 days a week, 8am to 8pm
More details about South Bristol Urgent Care Centre

Emergency Departments

Emergency departments provide urgent treatment for serious, life-threatening conditions. You should travel to A&E yourself if you can but if someone is too ill, for example if they have collapsed or can’t breathe, dial 999 for an ambulance. The most seriously ill patients will be seen before those with less urgent conditions. This means some people have to wait for several hours for treatment, or they may be redirected to a GP, walk-in centre or a minor injuries unit.

Bristol Royal Infirmary A&E Department
Upper Maudlin Street, Bristol BS2 8HW
More information about Bristol Royal Infirmary Emergency Department


Bristol Eye Hospital Emergency Department
Lower Maudlin Street, Bristol BS1 2LX Telephone: 0117 342 4613
Open 8.30am – 5pm seven days a week Call before you visit. They may be able to offer you advice over the telephone.

More information about Bristol Eye Hospital Emergency Department


Medical students and mental health

The view from the Faculty Support Office;

Medical students present with a range of conditions, both mental and physical in all years of the programme.

Some of the mental health conditions that our students currently present with are Generalised Anxiety Disorders, Eating disorders, Asperger’s, OCD, Bipolar disorder, Depression and PTSD.

Some of the physical health conditions that we are currently supporting are diabetes, epilepsy, prosthesis, arthritis, CFS, restricted mobility, hearing and sight impairment, asthma, MS and temporary disabilities such as fractures and musculoskeletal injuries etc.

We also have a number of students with Specific Learning Difficulties such as dyslexia, dyspraxia and dyscalculia.

These conditions range from mild through to moderate and severe.  Affected students develop a relationship with our pastoral team and receive regular personal support ongoing throughout the programme and also during periods of crisis.  Emma, the Faculty Student Advisor is in regular communication with individual students, to ensure mental and physical wellbeing, especially those who are particularly vulnerable or at risk.

Students disclosing a health condition or disability in their application, or for the first time after the start of the programme, are offered an opportunity to meet with a member of the pastoral support team.  Emma then often liaises with the Disability and Health Panel and Occupational Health and Disability Services teams in order to discuss support measures.

The Faculty holds a Disability and Health panel on a monthly basis in order to consider the support requirements of students.  Previously, some of the alternative arrangements and ‘reasonable adjustments’ that have been put in place to assist students in continuing with their studies are: extra time in examinations, a separate room for examinations, specialist equipment for examinations, placements local to personal therapeutic appointments, adjustment to unit timetable within an academic year to accommodate personal need and on programme support.

Emma also works with students by simply providing a listening ear when students’ health or personal problems get them down.  This is a confidential service, unless there is a requirement to share information to ensure student and patient safety.  This can often be part of a student’s network of support that may prevent a deterioration.  Advice is also given on absence and extenuating circumstances procedures and the GMC requirement for medical students to address their own health issues.

Lastly, short periods away from the programme, or an entire academic year, is a support measure that is often agreed.  It is very common for students to suspend studies in order to address health issues without the pressure of academic study.

For support contact



A word from our friendly local addiction specialist dr

Hello there, a brief update from my world as an Addiction Psychiatrist.


There have been big changes to how NHS services are providing support to people with alcohol and drug problems in Bristol over the last year. We are now providing services as part of ROADS (Recovery Orientated Alcohol and Drugs Service). This is a partnership between organisations in Bristol and aims to provide a seamless service so that when a person contacts ROADS they should not notice that the element of support they need can be provided by one of 5 different organisations. The aim being that all providers focus on the care provided rather than being passed between different organisations.


One of the big aims for ROADS was to improving the numbers of people receiving treatment for alcohol problems. Alcohol is the substance that causes the most harm in the UK but it has not had equivalent resources as traditional services focused on illicit drug treatment. There is no distinction between alcohol and drug services now in terms of funding and where people are seen. This is particularly important for young people as many more young people die or come to harm as a result of alcohol problems than for all other substances put together. We have seen a massive increase in the numbers of people referred for alcohol problems, in fact this has been such a success we are struggling to meet the extra demand which has exceeded our expectations.


We are still closely monitoring changes in patterns of substance use locally and nationally. An important area is Novel Psychoactive Substances (NPS), sometimes called ‘club drugs’ or ‘legal highs’. Although these substances are often less harmful than alcohol or other more traditional drugs, there are new substances emerging to exploit legal loop-holes which are often more harmful that substances that have just been made illegal. Also we are seeing problems as drugs are not being sold correctly. For example we have several people running into problems, and some deaths nationally, with substances sold as MDMA/ecstasy which in fact contain other more harmful substances such as PMA or PMMA. This is particularly a problem as people take a substance they think is MDMA but think it’s week so take more and then overdose on these more harmful substances.


Best wishes for Christmas and the New Year, stay safe, and be respectful of any substances that you put into your body,


Dr Tim

Why Mo? The stats, the stigma and the human side

  • Average life expectancy for men in the UK is almost 4 years less than for women
  • Men have 14% higher risk of developing cancer than women and 37% higher risk of dying from it
  • Every hour one man dies from prostate cancer in the UK (accounts for 13% of all male cancer deaths)
  • Testicular cancer is the most common cancer in young men aged 25-49 years old
  • 1/8 men are diagnosed with a mental disorder
  • 75% of deaths by suicide, are men
  • Highest suicide rate is among men aged 30-44

… and some key barriers to doing something about these issues…

  • Lack of awareness and understanding of the health issues men face
  • Men not openly discussing their health and how they’re feeling
  • Reluctance to take action when men don’t feel physical or mentally well
  • Men engaging in risky activities that threaten their health
  • Stigmas surrounding mental health

…so Movember aims to do something about these by raising awareness and encouraging open discussion and taking action, in addition to raising considerable funds for research and treatment.

The response from all walks of life is impressive and within the University there is some great involvement, MOtivated by many things…

Amber Bartlett is a second year French & German student and will be running in the Movember 10k in Bristol on 15th November:

  • How did you first hear about Movember?

I first heard about Movember while in Goldney Hall in my first year at University. A few of the guys from different blocks decided to enter as a team for Movember and grow some impressive tashes. One of my flatmates also started it but he looked so creepy with his tash he caved and shaved it off before the end of the month!

  • Why did you get involved this year?

I had been wanted to move on from 5ks runs to a 10k for a while and considered doing one whilst on my Year Abroad last year but chickened out due to too much eating and too little exercise! Sadly towards the end of my Year Abroad my Dad’s uncle passed away after a long battle with prostate cancer so when I was researching 10ks in Bristol I thought this would be a good way to commemorate his fight.

  • What can Mo Sistas do to help out this Movember?

Just because we lack the physical ability to grow a moustache doesn’t mean we can’t support the cause. Whether that means signing up for a run, sponsoring a Mo Bro or Mo Sista or just talking to people about Movember it’s all important in raising the profile of this fantastic cause.

Check out Amber’s progress at


Seb Rodrigues, a first year Economics & Management student, has got involved in Movember for the first time and is currently the leading fundraiser in the University:

  • How did you first hear about Movember?

Through word of mouth really, quite a long time ago. I think it was in Year 8, when I wondered why my schoolteachers all started looking like they were from the 70s.

  • Why did you get involved this year?

I went to a boarding school where they didn’t take too kindly to any form of facial hair. People had asked about Movember but we were never able to do it – so thought I’d start straight away in my first year of ‘freedom’.

  • Any fundraising tips for your fellow Movember participants?

Shamelessly abuse your contacts and keep doing so – post a pleading Facebook status to your friends, ask your parents, ask your friends’ parents; and, obviously, ask them all to ask their friends. Most of us are on student budgets, but donating a pint’s value won’t be too much hardship; for us though, it massively adds up.

See how Seb is MO-ing at

Psoriasis week 1-8 November 2014.

Psoriasis is a skin condition which can flare up at certain times, and tends to be life long, but can be improved and controlled. It happens because the skin cell turnover is faster in some areas of the skin than others, causing patches and ‘plaques’.

It can take several forms or distributions, large ‘plaques’, small ‘guttate’ patches (like raindrop splatter pattern), ‘flexural’ creases, nail indentations, like pin pricks, and ‘pustular’, often on the soles of the feet, and palms of the hands.

About 1 in 50 people get psoriasis at some point in their lives.

It most commonly starts between ages 15-30, or after 40. It is more common in white people, and in smokers.

It tends to get worse with stress, sore throat streptococcal infections, skin trauma/ scratching, certain medications, hormonal changes, sunburn (though a little sunlight can be helpful),  and alcohol.

Addressing these factors will help with controlling flare ups, and the condition can be treated with a variety of prescribed creams and ointments. These need to be used with care and by following instructions about application carefully.

Moisturising is vital, and should be a lifelong habit. Certain creams can also be used as soap substitutes. Check with your GP.

Vitamin D based treatments are the cornerstone of treatment, aiming to decrease the rate of skin cell turnover, and smooth the skin.

Specific scalp treatments are also available.

Steroid treatment creams also work, but should not be used for >4 weeks at a time.

Dithranol is a specific topical treatment for plaques, but can stain fabric, and skin!

Severe psoriasis can be referred to a dermatologist, and more potent treatments used, including light or ‘photo’- therapy.

In some cases people can develop joint problems associated with psoriasis.


Here at SHS we are very keen to help address these issues, and understand just how frustrating and challenging dealing with a chronic skin condition can be, so please book a routine appointment with a GP to discuss any worries you may have about your psoriasis.


Here are some helpful resources too;  (under 21s)



Movember is all about bringing back the moustache or ‘Mo’ for the month of November.

It’s about having a bit of fun and putting a spotlight on men’s health, which doesn’t always get the attention it deserves.

It is for awareness of men’s health in general, but in  particular; prostate cancer, testicular cancer and mental health.

The appearance of new hair on a gentleman’s or ‘Mo Bro’s’ face will be like a walking-talking billboard, promoting the health message. The moustache is a way of generating conversations, awareness and of raising funds for men’s health.


The rules of Movember:-

1)      Sign up at Each ‘Mo Bro’ must begin on 1st November with a fresh, clean shaven face.

2)      Grow and groom a moustache for the 30 days of November

3)      NO fake moustache NO beards NO goatees. That’s cheating!

4)      Use the facial hair to stimulate conversation and raise funds for men’s health

5)      You must conduct yourself like a true gentleman!


It is well known that men visit GP’s and other health professionals less frequently than women, and the average life expectancy for men is on average 4 years less than for women. The reasons for this are numerous and complex but include:-

  • Men being unwilling to discuss their health, or how they feel.
  • Stigma around mental health in particular
  • Men feeling they ‘need to be tough and get on with it’
  • Reluctance to ask for help unless feeling unwell physically
  • Lack of understanding and awareness of men’s health issues.


Movember facts:-

  • Started in Australia in 2003
  • Over 100 million people have grown a moustache worldwide due to Movember
  • Raises in excess of 75 Million US Dollars equivalent each year, worldwide
  • Facial hair grows at around ½ inch a month
  • The world’s longest moustache is over 14 feet long
  • Over 99% of testicular cancers and most prostate cancers can be cured if caught early

Together we can make a difference as well as having some fun over the month of Movember. Please think about joining in and encouraging others.

Bring on facial hair cultivation and create a dodgy Mo!



International Students; blog Autumn 2014.

Almost 20% of the 2.34 million students in the UK are from overseas. At the Students’ Health Service, we and the NHS are here to help you with your health concerns, and worries.  Whether you are feeling physically or emotionally unwell, we will try to improve your situation, and allow you to continue with your academic work.

We have a lot of experience dealing with students from all over the world, and are familiar with a wide variety of health and cultural issues that may arise. We are open minded and non judgmental. We want you to feel able to talk to our doctors and nurses if you are worried. We know that English may not be your first language, or that your symptoms may be treated differently in your home country, or that certain conditions are not discussed openly in some places, but we will do our very best to support you and help you to feel better. Sometimes we have to refer you to other teams for help and treatment, ranging from hospital specialists, to psychiatrists, to the Students’ Counselling Service. All of these people are there to support you to, and most are free of charge.

For more details of any possible costs at hospital treatment level, please see our information on the website


It may be helpful to understand a little more about how our service works, so here are the basics;

  • Everyone in the UK should see a Primary Care professional (General Practitioner/ GP or nurse) before deciding whether or not to refer to a specialist. We have a ‘gate keeper’ role.
  • Therefore when you have a health problem, the first team you will deal with will be us, and our receptionists will ask you the ‘nature’ of the problem (no need for details), just to ensure you see the right person in our team
  • Primary Care in the UK deals with 90% of health problems, with only the rare few requiring a hospital team at all.
  • Many of our nurses can prescribe, eg for contraception, sexual health, travel, asthma, minor infections etc.
  • Only use Accident and Emergency departments for EMERGENCIES please!
  • If we are closed then phone ‘111’ to get advice about the nearest Primary Care (walk in) centre, or other options, eg dentists
  • Phoning ‘999’ is for life and death emergencies only
  • We are not dentists, and we cannot prescribe for dental infections etc
  • We are not opticians, and so if you need help with glasses/ eyesight issues, please find a local optician
  • We can refer for psychological support, but you can self refer at our Office for physiotherapy/ podiatry/ LIFT psychology  (all free of charge)
  • For Student Counselling Service go straight to their website
  • For blood tests you must see a GP first, to arrange and order the correct tests.


We hope this will help you to access health care as and when you need it, but if you are not sure then please do ask our reception team, and they can advise you of what we do and don’t do, or check our website.


We look forward to meeting you and helping to make your stay in Bristol as successful and healthy as possible!


Health Advice for the Returning Traveller; When to see the GP?

It’s the time of year again when all our backpacking students return from the four corners of the world. Some will be arriving for the first time in Bristol, as international students of course, and many of you will have been traipsing through the jungles/ beaches and villages of the world’s most remote places, possibly even to Coca-cola free zones!

Unfortunately, even if you did everything right, had every last jab, and took all your malaria pills, you may still be at risk of post-travelling illness, so here is a quick summary of what to watch for and what to act on;

  • Tell the nurse/ doctor exactly where you have been, and dates
  • Tell them if you worked in ‘at risk’ environments, eg in a hospital/ clinic
  • Most illnesses will be common conditions like pneumonia/ fungal skin rashes
  • Be honest about malaria tablet history and compliance
  • Report any treatment tried or taken overseas
  • Fever is a common symptom requiring medical attention in returning travellers, especially if it is accompanied by; rash/ jaundice/ breathing difficulties/ bruising/ persistent vomiting/ altered conscious level or paralysis (the latter are extremely rare with only 0.3% of unwell travellers ever requiring hospital admission).
  • Malaria commonly presents with fever, chills, sweats, headaches, muscle pains, nausea and vomiting.
  • Jaundice (yellowing of the skin, and whites of the eyes) can indicate Hepatitis, most commonly type A, from infected food and water.
  • Arbovirus infections (Dengue, West Nile and Chikungunya fevers) are the main cause of viral fevers in returning travellers, and tend to have short incubation periods, typically less than two weeks .ie you will show symptoms within 2 weeks of being infected.
  • Diarrhoea is extremely common in travellers, and those who develop three or more loose stools in an eight-hour period, especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools, may benefit from antibiotics.
  • Prolonged, severe diarrhoea with blood should be reviewed by a GP.
  • Skin rashes are very common, and should be reviewed by your GP if not settling, or if associated with fever.
  • The vast majority of travellers’ infections have a short incubation period, meaning that symptoms will start within 10 days or less from infection. The notable exceptions are schistosomiasis (bilharzia)/ malaria/ TB/yellow fever, and Q fever.



Therefore, if you continue to feel unwell despite being home, and eating and drinking normally for you, then please come and see one of the GPs. You may also find it useful to look at the following;




Cough it up! When your cough needs a doctor…

It’s the beginning of the new academic year and all you can hear is coughing. Lecture theatres full of students hacking away, and the same in your flatmate’s room, or the shared lounge. Well don’t worry it’s common, and rarely anything to worry about.

It is normal for a cough to last up to 3 weeks, and 10-20% of the population have a chronic cough, ie one lasting more than 8 weeks.

Coughing is a reflex, clearing your throat of irritants and mucus, so asking your GP or nurse to ‘make it stop’ is fairly futile, but some things can dampen the reflex a little, such as honey and lemon juice in hot water. With a dry cough, pholcodine linctus can be helpful. But most cough medicines are a waste of money and therefore we never recommend them. Dextromethorphan is also a possible medication that can suppress the reflex, in certain ‘over the counter’ remedies, so ask your pharmacist for guidance.


When to see the nurse or doctor then (several Student Health nurses are trained to listen to chests, so can help you sort this out too)?

See us if your cough has lasted more than 3 weeks, or if you are short of breath, or coughing up blood. Also, if you have chest pain, recurrent fevers/ night sweats or unexplained weight loss.


Coughing up green mucus/ sputum is not in itself a reason to worry, as this can happen with viral and bacterial infections. Only bacterial ones may need antibiotics.The symptoms mentioned above are a more helpful guide as to when to get a check up.

Being a smoker or asthmatic may make you more prone to infections, so do mention this when you see us.

We can help you to quit smoking should you decide to take this fantastic step for your wellbeing, and we have a specialist asthma nurse for our asthma sufferers, so do book in with her for regular reviews.

Coughing is common, and in our student population rarely anything to worry about. Try the pharmacy first if you can, and see us if you are worried.