Antidepressants

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.

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 ‘The community Mental Health Team’, ‘Getting to the doctor-seeking help for depression’ and our Depression website). 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. 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’. 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’. 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’ 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’. 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 antidepressant use’ and ‘Antidepressants: finding information’).

Last reviewed June 2016.