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Subject:

Re: antidepressants

From:

Margaret <[log in to unmask]>

Reply-To:

GP-UK <[log in to unmask]>

Date:

Sat, 28 Apr 2007 12:04:25 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (77 lines)

I don't have a set plan with any depressed patients and treat each one as an 
individual. I use a combination of antidepressants, supportive counselling, 
CBT, Human Givens Mindfulness and exercise on prescription and see them as 
needed.
Margaret

> Sorry came in late on this one. If they are bad when they first
> present I will review at 2 weeks. If not too bad then first review I
> will leave for 4 weeks, but also depends on the work situation. I
> generally persuade them they may need a month or so off, but if they
> are reluctant to do this I will see them at 2 weeks, and generally
> when they have been seen at 2 weeks they agree that works can actually
> do without them and that they are feeling a lot better although not
> 100%. I tned to stick with Citalopram more than anything as I have
> used it a lot and got excellent results, titrating up to 40mgs SLOWLY
> over 2 months if required (I have had patients with the jitters by
> foolishly me trying to increase too soon). I always warn them about
> possible GI side effects and that they will go if they persevere.
>
> At 1 month I generally find that some are doing very well. These I
> give a script for 2 months and then tell them I want a telephone
> review with them. I tell all patients at the onset that I will review
> them 2 monthly by telephone when they are improving. I also warn them
> that they will continue on the ADs for around 6 months, BUT if this
> takes them into the autumn or winter, then I will keep them on them
> until the spring. I NEVER stop ads beyond August - to many 'bounce
> back with depression. The non-repsonders at 4 weeks I see 2 weekly and
> titrate up by 10mgs each 2 weeks. Usually works well at the higher
> dose.
>
> As has been mentioned I NEVER put ADs on repeat and tell all patients
> that they are likely to get better. Increasingly I consider that the
> first review at 2 weeks does little apart from getting a feel that
> they may respond to Citalopram and I tyr and encourage them that if we
> are seeing any positive signs then we need to leave things a further
> 2-4 weeks. Despite what the books may say I do think SSRIs -
> especially Citalopram are effective in reactive depression and grief
> reactions. I am not a fan of counselling and often work hard to
> convince patients that I believe I can get them feeling a lot better
> on a 6 month course of ADs.
>
> Hope this helps.
>
> Paul
>
>
>
> On 26/04/07, Dr Skinner <[log in to unmask]> wrote:
>> I need the panel's advice, please.  What is current thinking on review
>> periods for depressed patients on medication (in the main of course, 
>> SSRIs)?
>> Clearly the answer to this might include the phrase "it depends on the
>> individual circumstances of the patient" but I am thinking of the stable
>> patient who perhaps has shown a good response to the medication and is
>> perhaps 2-4 months into the treatment - or perhaps someone who has been
>> taking an SSRI for many months or even years and is keen to continue.
>> 2-monthly scripts and reviews?  3-monthly?  6-monthly?  Does anyone have 
>> a
>> "norm" for this, or even a practice policy?  No need for long detailed
>> answers - I just want to get a feel for what others do.
>>
>>
>> Paul Skinner
>>
>
>
> -- 
> Best Wishes
>
> Paul Bromley
>
> www.floridaholidayvilla.biz
> Superb Villa in Orlando with own pool - Free Internet & International
> Phonecalls.
>
> 

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