"My story...mental health, depression, brain injury and NHS/GPs"

About: Bolton PCT

(as the patient),

I have been prescribed antidepressants (SSRIs) for the past 9 years stemming from a severe episode of 'depression' which resulted in being referred to a psychiatrist who decided to place me on an SSRI (sertraline) and I also had several sessions of CBT with a psychologist. I should add that I have suffered severe brain damage to my frontal lobes during my formative years, I was an adolescent at the time and it has completely ruined my life. Nevertheless, I wasn't ever assessed for any impairment and as far as the doctors were concerned repairing the structural damage to the skull was all they could do or would offer. So I was left completely in the dark about my consequential behavioural problems and cognitive impairment by the very people who were supposed to help. We're told that there's little that can be done anyway regarding brain damage, I'm inclined to believe that had I been offered the help of a therapist the outcome would have been better at the very least (if not more) from a coping point of view. That's my first axe to grind with the NHS.

After several years of being in the dark I was at breaking point and had to see the GP and having explained my brain injury and specifically my emotional/behavioural problems, at the tender age of 17 I was categorised by my GP as being 'depressed'.

I didn't think much about this diagnosis at the time, and not having been offered any treatment related to the brain injury I was completely ignorant as to my condition and just wanted to feel better (by the way, now I realise that I'm not stupid, deranged or anything, but simply brain-damaged (doctors note the difference)) so unsuprisingly I didn't want to quesition the GPs diagnosis, maybe it was just depression and all would be better after talk-therapy and some mind-altering drug, it was worth a try. Well, therapy really helped at least to get me out of the black-hole even if it was just a little talk and was probably formulaic, it felt for once that a medic actually cared to listen. Eventually, I was discharged after 1-2 years and so the GP was the primary care provider thereafter.

Because I continued to take antidepressants for the next several years, I would often have to see the GP as a matter of course before being prescribed. I had no objection to being seen by the GP, but my impression was that the GP was careless in his management of me, asking the same open-ended questions that didn't lead anywhere like 'how are you doing these days' to which my response was 'I'm ok' or 'I'm fine'. Admittedly, I have great difficulties talking to anyone and not least the GP who couldn't be more obvious in his lack of interest in my mental state. The objective of seeing me was clear, to tease out a few satisfactory words such that he could type something in his notebook. I never felt the doctor really cared about my response and I could have told him that the moon is made of green cheese and he'd note that down before handing me a prescription and obliging me to leave his room feeling flustered and patronised. Never, did my GP offer or suggest further therapy, suggest that I see a Psychiatrist (who first prescribed me antidepressants) again at some stage about the issue of long-term depression and antidepressants and whether they're a good thing in the long-term. There are some arguments to suggest they cause structural damage and actually contribute to the depression by forcing the body to counteract an unnatural state thereby shutting down the natural neurotransmitter production permanently. My GP never investigated other potentials factors like something as mundane as diabetes or thyroid problems or anything else. Surely ruling these out should be the first port of call for a GP? Interestingly, I've never been offered a general all-round health examination by my GP, presumably because they don't offer them, or because the onus is on the patient to complain and demand first before the GP reacts. Surely it should be the other way around? How can a patient especially with something as obscure as a mental health condition ever be expected to complain for things to get done? The way GPs act, they'd feel shameful to even so much as hint that they're not well. The fact is you have to complain (even fabricate) about health-matters in order for investigations to commence and that shouldn't ever be the case. Routine health checks (blood checks, examinations, questionnaires, etc. ) should be offered as a matter of inquest probably at least once a year. Why aren't they? I know in Japan they do this and I believe their health care is also public. It isn't being a hyperchondriac. The patient and doctor has a right to know the bigger picture and the patient shouldn't have to complain/demand/beg for doctors to inquire as is so often the case. The whole system is at fault.

Nine years later I'm still on antidepressants and the GP still asks the same pointless questions never inquiring further than to ask 'how are you doing? ' and 'what are you doing? ' before handing the prescription. Shame on me to think that he'd ever ask the hard questions or disclose some pertinent information like the potential for antidepressants to be harmful to long-term mental health leading to chronic untreatable depression. No, apparently, they have an excellent safety profile and SSRIs can be prescribed for 15 years. SSRIs have only been around 20 years I might add and hard evidence of long-term usage is therefore lacking. Finally and most unforgivably, absolutely no mention of the brain injury sustained and it's impact and effects in daily living. Managing the brain injury is simply not worth talking about as far as my GP's concerned. Talk of mundane mental health issues makes GPs prescription-happy however, if not inquisitive.

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