Thursday, March 02, 2006

Depression

I read a post on another blog recently about doctors and depression. The gist of it was that visiting the doctor with depression ended in a prescription for prozac and no questions about feelings or causes. I found that very disappointing. I hope that's not how my patients feel when they present-- as so many now do-- with depression.

To fully understand what we are treating we need to know a little at least about feelings and causes. The only problen is, at initial presentation, talking about scary stuff like feelings, especially to Anglo-Saxons, tends to provoke tears and embarrasment, so many docs don't like to go there. Me I just make sure I have plenty of hankies on hand.

Two weeks in to treatment all talk of feelings and causes is modified by the invisible "prozac forcefield" that kicks in to push all the scary stuff away long enough for people to get better. So why are we so keen to prescribe pills anyway. After all, current guidelines would have us consider Cognitive Behavioural Therapy (CBT) for mild to moderate depression, even ahead of medication.

Well, here's the deal. Doctors like to fix things. It's what we spend our lives trying to do, though many on the receiving end of our ministrations might not appreciate that fact. We know that, for true depression, modern antidepressants work, and work much faster than the old ones used to, and they are actually pretty safe (unless you are an amrerican teenager at least). We also know that CBT, though invaluable, is often not accessible for many months (around 9 at present locally).

AND any GP who has been in practice any length of time knows of several patients who have declined meds and ended up seriously self harming, or dying as a result.

Its hard to talk about the important stuff in a 10 minute consultation, so I choose to overrun, and get nagged about my time management as a result. Others react to the pressures of the surgery differently, but we all mean well, and we all want to help make it better.

Really.

There's lot's more to say, but now's not the time so I'll post this and see what happens.

4 comments:

Maxwell Steer said...

Hi - Every time I upload to my blog I hit the Next Blog option, which gives a fascinating window on so many different worlds. Today I was taken to yours. I resonate strongly with what you write: I come from an entirely-medical family & am the black sheep who became a composer.
As a creative artist & as a person of faith I am no stranger to deep & sometimes perplexing experiences which, to s/o without these contextualising parameters would be disorienting.
As part of my eclectic life Im coordinator of the Ethics/Spirituality/Philosophy Field of the Big Green Gathering [http://www.big-green-gathering.com/index.html].
I would very much like to use this as an opportunity to propagate a mental health initiative (which we begun last year) of looking at the positive aspects of psychosis in the context of life progression with a variety of speakers, inc s/o from the Inst of Psych.
Would you be interested in speaking? There is a lot more I could say about the strategic significance of this if youre interested.
Sincerely
Maxwell Steer, Wiltshire, England http://msteer.co.uk/

Doctor Jest said...

Hi Maxwell.

Thanks for your comment.
I'm afraid my experiences with psychosis remain faily low level being a GP, but I wish you well in your endeavours.

Also, the world needs more black sheep.

pink said...

cbt -- cock and ball training, dr j?

oh, and knew i wasn't your only reader...

Doctor Jest said...

pink sorry no. just cognitive behavioural thingy, or a chat and a cup of tea if you prefer