On Sun, 25 Aug 1996 12:01:32 +0100, [log in to unmask] wrote:
>> antidepressants aren't sometimes prescribed inappropriately
>
>What, never?
Actually my sentence reads "It's NOT that
antidepressants aren't sometimes prescribed inappropriately"
Note the double negative - isn't grammar tricky :-)
>
>I would be delighted to read a study confirming your claim to gross
>underdiagnosis.
>
Try this for a start:
Unrecognised depression in general practice.
Freeling P; Rao BM; Paykel ES; Sireling LI; Burton RH
Source
Br Med J (Clin Res Ed), 290: 6485, 1985 Jun 22, 1880-3
There is plenty of research on this subject and it all gives similar
answers.
>
>You are not seriously disagreeing with me are you that if a
>non-depressed patient (but one feeling "low") walks into his GP and
>tells him he thinks he is depressed and wants to be put on tablets that
>he would NEVER be given them?
>
Of course not. One of the fundamental points here is that there isn't
a lab. test for depression. The diagnosis depends on collating a
number of symptoms which are all open to interpretation, so a
diagnosis of depression is always someone's opinion. If in doubt most
doctors would err on the side of giving antidepressants, although not
usually in the first consultation. If you are right you may save a
life. If you are wrong little or no harm is done.
>>
>
>But there are better ways to help those patienst cope with such traumas
>and so avoid suicide.
Yes there better ways of helping people cope with such traumas if they
are NOT depressed. However if they ARE clinically depressed then this
needs proper treatment. Cognitive psychotherapy is as effective as
antidepressants in milder cases, but takes longer and is impossible in
the very severely depressed. In an ideal world patients would have
both, but in practice cognitive therapy is rarely available on the NHS
and this situation is unlikely to change. Hence for most depressed
patients antidepressants are the best choice.
>The dangers of GPs putting patients on
>anti-depressants is that they do not have the time to be with the
>patient sufficiently when they go on the drugs and to educate the
>patients sufficiently about what they will experience should the drugs
>precipitate a drug induced akathesia itself leading to suicidal
>ideation.
Akathisia (this is how it is really spelt) is a side effect of
antipsychotic drugs (as opposed to antidepressants) and has been a
problem in schizophrenic patients. It has not been reported in
tricyclic antidepressants. There have been a few case reports in
patients receiving the newer SSRIs but I don't know anyone who has
ever seen it happen.
If I get depressed I want an understanding doctor and I want
antidepressants!
Dr David Evans
Cardiff
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