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.

 

Self Injury; a paradox…

It is a strange truth that people self harm to make themselves feel better.

Some people have a glass of wine after a bad experience, some eat a huge bag of crisps or a bar of chocolate. But some people cut themselves, or burn their skin, take an overdose, or punch a wall. All of these options are a human way of coping with stress, though not a healthy way.

Most days at Students’ Health Service we see male and female students who have recently harmed themselves. Our nurses are very sympathetic, brilliant at wound care and completely non judgmental. The GPs would like to help you too, and discover what’s behind the self injury and distress. We are not easily shocked and we have seen many unusual ways that students harm themselves, secondary to depression, anxiety, obsessive thoughts or psychosis.

Alcohol usually makes self harm more frequent, or the injury worse.

Nationally self harm is thought to affect about 5% of people, though this is likely to be an underestimate (Meltzer et al 2002). In a school survey 13% of young people aged 15/16 reported having self harmed at some time in their lives, and 7% in the previous year (Hawton et al 2002).

It is important to assess and treat those who self harm, as the behaviour is often related to an underlying mental health condition, which, if treated, may lead to improvement not just of the depression/ anxiety/ schizophrenia etc but also of the self injury.

If you would like help with self injury, or would like to talk about your mental health in general, please come and see us soon. Don’t forget that the Student Counselling service is also there to help, and the team is very experienced in supporting students with such issues.

 Other support in Bristol;

Contact the Self Injury Self Help Bristol organisation, who provide services for men and women with self injury issues. They run support groups, and also run workshops related to achieving good mental health in general.

Email; sishbristol@yahoo.co.uk

 Phone; 0117 927 9600

Or, Bristol Crisis Service for Women; 07788142 999

Runs a text support service for managing your self injury and emotional distress.