Paul Galloway wrote:
>
> [log in to unmask] wrote:
>
> > In any event what I am saying is simply that we come across cases in
> > which clients have too readily been put on an anti-depressant regime
> > which has then "coloured" their lives.
>
> Hopefully ! The aim of treatment is usually to put some colour back into
> lives
> variously described as "black, grey, hopeless, futile, not worth living"
But don't forget the blues (favourite music and footie team).
> Yes it is ! We accept (and are saddened) that cock-ups happen, but
> you're extrapolating from your caseload to make assertions (general)
and you...
> about the treatment of depression suggesting there are (generally)
> better ways to treat it than drugs (what had you in mind by the way ?).
No I am not necessaruily saying depression should be treated differently
but what many people think of as, and some doctors treat as,
"depression", may be just negative thinking, tiredness, low self esteem
syndrome caused by underlying problems with their lives that may be
helped by trying out a few lifestyle ideas FIRST, eg for money/business
problems, closing/liquidating a dying business/going bankrupt sooner
rather than later when inevitable often can lift the burden of perceived
"depression" because it is then out in the open and the debts are lifted
and positive action is being taken. Similarly if caused by marital
probelms, maybe bringing teh marriage to an end is the answer rather
than soldiering on in a life that makes the patient "depressed"
(certainly the case for victims of marital violence who often enter the
ranks of the "depressed"). Exercise is an excellent mood uplifter. For
the elderly, it may often be lack of social contact through all their
friends dying off , changed by joining clubs etc to widen their social
circle.
Now of course all this is not the sort of advice doctors would feel they
have trained and studied to spend their time giving. Far easier to put
these patients into a medical classification system and prescribe from
the relevant section of MIMS. Obviously the failed business problem and
the marriage problem are for referral to other professions but at least
it would help to flag the possibility of positive action. Maybe the
answer is that, as I know some doctors are doing, such patients be first
dealt with through in-surgery anxiety clinics. A nurse I know has set
up a number of these in Merseyside surgeries with great success.
> Reading between the lines though, you do seem to subscribe to the common
> misconception (common that is to patients and lawyers acting for them)
> that consultant care (in this case for depression) is superior to that
> of the GP.
>
> Let's leave aside the uncertainty and difficulty of deciding where the
> blurred cutoff is between 'feeling low', 'GML' (General Misery of Life)
> and a making formal diagnosis of depression.
But that incidentally is really all that my point was about.
>The medical treatment of
> depressive illness is a good example of a disease where the GP is far
> more expert than most consultant psychiatrists.
Which GP are you referring to?
> I don't say this out of
> arrogance but because we probably only refer about 10% of cases to
> psychiatry and so the specialist gets a skewed selection of the 'worst'
> cases on which to base their experience. I think it was Fry (he of the
> general practice hall of fame) who said that 'The specialist roams the
> zoo cages, but the GP stalks the jungle and sees disease in it's >natural habitat.'
Yes, and it is the caging itself of wild animals that turn them into the
depressive/psychotic animals we see in every zoo. So why not help
people to sort themselves out in the jungle.
> An important part of our job is to keep patients out of the clutches of
> specialists, where the great majority would fare worse than they do
> under the primary care.
>
Yes, but putting people on SSRIs, for example, and messing around with
their serotonin levels (that have served them OK previously) , will
often increase the risk that eventually they will end up in the
psychiatrist's chair.
> Depression is under diagnosed
How do we know? Because people commonly say they're depressed?
> Remember your experience of medical cock-ups, and justified and
> un-justified patient grievances is the lens through which you view the
> medical profession, and is itself "coloured".
>
Yes, but I am not making any observation as to numbers of extent of the
problem, simply saying that experience shows the problem exists.
> P.S. I would be delighted to provide you with the references to the
> studies which you require, including evidence that depression is
> generally undertreated, and with professional interperetation of the
> evidence into lay terms.
>
> My fees for such work are in line with those charged by our local
> solicitor for checking over our 'Practice Agreement' i.e. £150 per hour
> plus VAT :-)
Hell. They charge more than I do! This is making me depressed. Can
anyone e-mail me a Prozac prescription quick.
Graham Ross
ALeRT
http://www.alertuk.com
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