In the GPs' chair...little alternative to pills for our depressed patients.

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In the GPs' chair

There's little alternative to pills for our depressed patients. Where do they, and we, go for support?

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Kandela

The Guardian, Wednesday 13 April 2011

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Doctors' surgeries have become a last resort for patients meant to be supported by other public services. Photograph: Alamy

Long before the trials of coalition government, Nick Clegg warned that Britain had become a "Prozac nation" with a record number of prescriptions for antidepressants being issued to patients who faced long waits for counselling. And last week it was revealed that during the past five years there has been a 43% increase in antidepressants use.

I have worked in general practice for 35 years, running a progressive practice in a pleasant suburban town. I have seen many changes in prescribing and patient care, and I must admit I've contributed to those millions of prescriptions for antidepressants. That's not because I'm influenced by the pharmaceutical industry's marketing ploys but because in many of the cases I encounter, prescribing antidepressants is more or less inevitable. In fact, they are often the only remedy available to help patients suffering from a short-term mental health crisis, regardless of what the pundits say.

General practice has become the dumping ground for all kinds of problems usually dealt with by public service agencies. Take the call I had recently from one agency about a patient who was exposing himself to female shoppers in a local car park. Or the suicidal young woman who ran up thousands of pounds of debt on credit cards and, when reality caught up with her, came to ask for "something" to help her cope with the impending court action.

And what about the man who lost the will to live after the death of his wife of 50 years? He should have been referred for bereavement counselling, but their policy is to allow some time to elapse first. What alternatives do I have as a GP but to prescribe something to help him manage his grief? These are not invented examples; they are real, and they put me in a difficult position.

There are those, including some politicians, who now accuse us of failing to explore other methods of support, such as counselling, as an alternative. If they sat at my desk and dealt with an average of 45 patients a day, as I do, they would not be so simplistic.

Not long ago a young woman came to see me in a depressed state because of a relationship problem. She was crying, unable to sleep and not coping at work. Her request for counselling was reasonable. A few weeks earlier a local mental health unit had sent GPs a flyer about the establishment of a new "rapid" service, which seemed ideal for what was needed. But when I attempted to contact the unit the phone number given was wrong, and it took nearly 20 minutes to get the correct one and speak to the secretary there – all this with the patient sitting in front of me sobbing and my waiting-room overflowing.

I was asked to send an urgent referral by fax, which I did, and then told the patient to go home and wait for the call from the unit. Two weeks later she returned to tell me that nobody had been in touch. She was much calmer – not because time had elapsed but because a GP in a nearby town saw her while she was staying with her parents and prescribed tablets. We are still waiting for her "rapid" counselling appointment.

An increasing number of people who come to see me are suffering with personal, emotional – and more recently financial – problems that all have health implications. Every one of them wants an answer and expects a quick fix.

Contrary to what the public is told the system is not coping with the high and varied demands from patients. I don't blame patients but governments and politicians in general who, for cheap and short-term electoral gain, give people false hope of solutions that GPs are unable to provide quickly or without support from other agencies. GPs have no magic cure, and some crack up, like their patients, and quit or retire early; but most will continue to prescribe silently.