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The traditional view is that GPs are rubbish at diagnosing it. Frankly, I blame the patients, many of whom are as enthusiastic as they are inaccurate self-diagnosers. Thus: “Doc, I think it’s flu/RSI/ necrotising fasciitis” are likely to be met with, respectively: “It’s a cold/sprained wrist/ time you stopped reading the papers.”
And so it is with clinical depression. The patient who confidently announces, “I’m depressed, doctor” — which comes with an implied, “And I want you to sort it out” — almost certainly isn’t.
And I can’t. Because these individuals are usually just unhappy and, while I might sit and nod sympathetically about their neighbours/boss/ spouse-from-hell, I can’t offer any constructive help over and above whatever therapeutic benefit those sympathetic nods provide.
The truly depressed, on the other hand, feel so hopeless and helpless that they have no idea what’s wrong and make no therapeutic demands.
They tiptoe around the problem, preferring to complain of feeling tired, or dizzy, or out of sorts. And as these symptoms have a mind-boggling number of causes, perhaps it’s no surprise that we GPs end up weeping, too.
So, if you think that you genuinely need treatment for depression, don’t complain of feeling depressed. But don’t pussyfoot around with confusing, vague symptoms, either. Your best pitch is a misty-eyed “I’m feeling low, doctor”. And if he doesn’t take the bait, try pointing out that you’re particularly fed up with the cost of over-the-counter St John’s wort.
But the really bad news is that diagnosis is no longer the difficult bit; treatment is. According to a recent paper in the BMJ (British Medical Journal), the current first- choice antidepressants — SSRIs, which include the likes of Prozac and Seroxat — are apparently no better than a placebo. This is like discovering that Father Christmas doesn’t exist: those bloody psychiatrists have been making it up all along.
But we GPs have smelt a pharmacological rat for a while, according to the findings of a new and fortuitously timed survey by the Mental Health Foundation. It reveals that only 37 per cent of female GPs would prescribe patients an antidepressant as first-line treatment.
Admittedly, 61 per cent of their male colleagues still trust the happy pills, but this is a relatively low figure given the no-time, no-nonsense, no-fluff style of the average male GP.
If not pills, then what?
The non-drug approach of spring-cleaning your lifestyle consistently fails to convince my patients. By the time you’ve bitten the bullet and booked an appointment, you can bet that you’ll want more for your depression than advice to cut down on the booze, take up jogging and join a book club.
There’s always counselling, of course. Cynics view this as the last resort of the therapeutically spent and no better than being wrapped in a cardy and offered tea. It’s also probably quicker to get this at your nan’s — and you get cake, too.
Then there’s psychological treatments, such as cognitive behavioural therapy. These are fine except that the likely wait for treatment would tip the average depressive over the edge.
There is, at least, some light at the end of this dark, therapeutic tunnel. A light box, in fact. It works for sad, light-deprived Scandinavians, so why not us? And there’s anecdotal evidence within the medical profession that it’s effective. Radiologists — who stare all day at brightly lit X-ray boxes — always have a cheery smile. Whereas proctologists — squinting endlessly into brown bottom-holes — are miserable as sin. So you heard it here first: we need light boxes on prescription.
You may laugh. In which case, you don’t need treatment anyway.
Dr Copperfield is an Essex GP. He also writes for Doctor magazine
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