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[racjen]

Bramble, I'm afraid I don't share your confidence and trust in doctors. I've just had the experience of being visited at home by the Crisis Team because my hormonal anxiety had got so bad I was feeling suicidal. Was prescribed an anti-depressant despite telling them I have a history of bad reactions to anti-depressants, then when the inevitable bad reaction occurred I was prescribed pregabalin, an anti-anxiety drug, with no warning whatsoever that this is very similar to an anti-depressant and can also cause suicidal thoughts. Given my previous history I'm shocked and angry that a trained psychiatrist could prescribe in such an irresponsible manner. In my experience the Crisis Team can do little more than prescribe endless drugs - if those don't suit all they do is pass you on to the Depression and Anxiety Service for possible counselling, which then involves another 4 weeks wait for an initial assessment and god knows how long for actual treatment.

[bramble]

Racjen - at least you were visited at home by the Crisis team in a timely fashion. I think that it is a very good service. I know for a fact that Pregabalin can be very effective in treating anxiety and they probably prescribed it as it is not at all similar to the normal ADS that are on offer. And it appears to have a lot fewer side effects than the normal ADS as well. I think you will find that any mind-altering medication can induce suicidal thoughts but only in a very very few cases. The Crisis team would have been very aware of your background and in their opinion and experience, this was their drug of choice for your situation.
The only other way to go is the non-medication route which is CBT, Mindfulness, exercise, good eating etc. etc. , all of which puts you in for the long haul. 

Bramble

[CLKD]

Time to ditch the Psychiatrist perhaps?  Time isn't on my side when depression strikes  I have been known to go and sit in the Waiting Room where I feel safe.  Fortunately, medication has in the main, helped.  Also I don't suffer 'hormonal' depression as I was well into treatment by the time menopause arrived, don't know how much difference that has made 4 me.

[Dancinggirl]

The treatment of depression and mental health generally is a very difficult issue - like so many things, the treatment needs to be tailored - there is only so much drugs can do and, as with so many treatments, nothing works instantly. It must be very difficult to assess what should be offered first with treatment, as everyone will be different.

My original thoughts for this thread were less to do with treating non hormonal depression, anxiety or mental issues but more about my concern that ADs/SSRIs seem to be used for such a wide range of health issues, especially for menopause symptoms,  and patients often seem to be in the dark as to why they are put on these drugs and what the effects might be.
Yes, time with the GP is short, so explanations not always possible, but surely pre prepared print outs with reasons for prescribing an AD/SSRI stating the benefits and side effects, clearly set out, would help reduce a lot of confusion and anxiety.  If an AD/SSRI is prescribed to someone with meno hot flushes, then this leaflet should explain why the patient has been prescribed this instead of HRT (which should be the front line treatment).

Bramble, I do take your point that we need to trust our doctors but all too often they do prescribe the wrong things, pharmacists often have to pick up on this. If patients are not fully informed, then how can they report back about whether things are working or not.  So often, people will complain about side effects with drugs and just think they have to put with this - if they go back to the doctor they could probably be given something different that could suit them better. This happens a lot with HRT, as we hear from women who post on this forum.

The overuse of ADs/SSRIs really has to be looked at - how many people become dependent on these drugs and what are the long term consequences DGx

[CLKD]

One doesn't become dependant upon ADs/SSRIs as they would do with Valium etc..  Also it really is up to patients to make more queries.  In 8 years not one patient asked what 'routine blood tests' entailed?!? ........... I was a medical secretary.  I think that patients in general need to go to the GP, discuss, go home and ponder.  But many people who don't visit the GP often still have an attitude that they know more than the patient  .  If the GP says, he/she must be correct!

I wonder who is considering that there is, actually, an over-use of medication for mental health issues?

[Bring me Sunshine]

Certainly not the manufacturers of the ADs/SSRIs trying not to be sceptical because I know that they can be life savers.  Someone is making a lot of money from the over-use of these medications.  Sadly in a 10 min appointment with waiting lists high for nhs talking therapy the dr has to make a call on whether ADs etc would help whilst waiting for therapy to start.

I was one who had every faith in my doctor who had seen me through bereavements/infertility failures/marriage break ups she was wonderful and a short term use of ADs/SSRIs would always sort me out.

Sadly when depression returned at the start of 2017 for no reason her reasoning was to treat it with ADs/SSRIs and you can see why due to my history.  I must add that I was on sertraline at the time when the depression returned, that had never happpened before.

Not once was menopause mentioned(I hadnt a clue about the menopause as mum had died young etc...and no one I knew had been through it or if they had, talked about it).  Then followed a year from hell on many different AD's  and referral to a physchiatrist.  Nothing worked and they labelled me "treatment resistant" in between this I was asking for a blood test because I had started reading things and I was 51.  The blood test was denied a few times and I was about to go private when they consented and the oestrodiol level was 137.  I was then told I was post menopausal.

My gp was a lady of around 60 but not once did she consider the menopause could be the reason for the depression and anxiety.  So I agree that more awareness is needed by gps on this subject.  It wasnt till I finally saw someone from a menopause clinic who said no amount of anti depressants would cure "hormonal depression".  Oestrogen or a combination of the 2 was needed.

It was a long hard journey but the physchiatrist and dr did say that they had learned a lot from it and I hope they take this forward for anyone else who is in my position.

I see that menopause cafes are springing up around the country perhaps that is the way forward.  To arm women with more information before they see the gp.

[racjen]

Bramble I have to say that I find your complete faith in doctors a bit worrying, if not naive. My GP took four goes to get my initial HRT prescription right (by that I mean that every time I went to collect it it wasn't what we'd agreed and I'd have to go back and point out her mistake). When I reacted to sertraline with worsening depression I was told by the guy from the Crisis Team to double the dose, because he simply didn't listen to what I was saying; worse thing he could have suggested as I went on to develop suicidal ideation. The Crisis Team psychiatrist then tried to persuade me to take yet more ADs, before suggesting pregabalin. And I had to research it myself to find out that it too can cause suicidal thoughts. My pharmacist actually advised me not to take it as I'm clearly one of the tiny percentage who reacts badly to brain-altering drugs, but shouldn't the doctors be taking that seriously? My faith in the medical profession has been severely shaken...

[CLKD]

Doctors should learn to listen  or make more time, like suggesting that a patient who obviously needs more discussion, to make a double appt.?  The whole system could help itself if they listened!!

I have been fortunate.  Having worked in the NHS I wouldn't take any crap.  If my GP didn't give me what I required I would make an appt. a few days later, "I wasn't listening last time, could we go through it again".  That opened up routes, obviously I didn't know what he had told the previous patient or if he had been up all night ........

Or I by-passed the GP and saw the Practice Nurse.  I don't believe in going backwards and forwards unless I have tried to build a working relationship.  I do think that younger GPs might be on track with modern techniques in medicine but won't consider menopause. It surprises me that female GPs of a 'certain' age don't cotton on, nor males who have women of that age 

Make that List, Take that List!

[Bring me Sunshine]

Yes I agree Racjen & CKLD.  You have to do a little research at home and go in with it.  Also make sure the doctor you are seeing is more switched on to menopause/depression etc...Dont demand a referral to a specialist straight away but certainly if you are not getting anywhere.  Perhaps gps need to extend appt times for certain ailments and consider working weekends??  Sorry if any drs are on this forum!!

[CLKD]

They shouldn't need to work weekends if the system were set up properly.  Ours already begin at 7.30 two mornings a week and do 2 late nights until 8.00 p.m.  They have a couple of hours on a Sat. for people who work in the week ....... which means support staff have to attend too.  However, I never feel rushed in my appt.s, last year the GP was 35 mins. late and apologised but obviously there was a crisis somewhere down the line.