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So, a colleague in senior position confides in me today saying they they have been put on anti depressants. Ok I say (I really don’t know what to say as I’m usually quite blunt at work and didn’t expect it). I’m the person someone talks to if they want advice on either something corporate or what bike to buy. I don’t really know anything about depression, meds or phycology. My usual response would be talk to HR, they will get you support from a professional that knows what they are talking about.
I don’t want to appear totally heartless so asked how they were feeling and just thought I’d listen while being very clear that I wasn’t a professional and had no idea what I was talking about. Anyway, turns out the person went to their GP, said they were feeling upset and anxious after being in a sporting accident a while back (I guess the sport element is what prompted chat to me). One appointment with GP, no discussion with a shrink or the persons family and they are put on meds. Obviously I am casual observer and don’t know the ins / outs other than to say, on face of it the person has always seemed of good character and very professional.
Is that not a little extreme to put them straight onto drugs? Seems very much like using a sledgehammer to crack a nut. Thought maybe people here may have some insight into how these things work? As I say, I know what I don’t know. But from a quick chat potentially the GP isn’t actually much better than me. I would have thought at least some kind of mental evaluation / discussion with family and tests before drugs? I didn’t say any of this out loud. Conversation just drifted back to work and bikes.
I would have thought at least some kind of mental evaluation / discussion with family and tests before drugs?
They have 10 mins per patient and a backlog months long....
The wait list for therapy on the NHS is over a year long in most regions.
Plus, nothing actually wrong with anti-depressants if they work for you (12 14 years on Citalopram here).
Iirc Citalopram is one of the most commonly prescribed drugs. For me it just took the edge off my worst symptoms and allowed me to be "more normal" while working through the issues - very much like how ibuprofen lets you carry on while healing a physical injury.
And outward appearances mean nothing when it comes to mental illness - some depressed people can put on a really convincing "I'm OK" act, until they aren't.
some kind of mental evaluation
GPs have a standard assessment for depression, a few questions which take a couple of minutes to run through at most.
Seems very much like using a sledgehammer to crack a nut.
If only they were. First option drugs are likely to be SSRIs and they do work for some, but the stats say they are on a par with placebo in terms of effectiveness. However, they are (relatively) harmless and don't interact too much with peoples' other meds, so a doc can be doing something immediately while perhaps referring for a talking therapy, or ordering a set of blood tests to look for a physical cause behind the patient feeling down.
Recently SSRIs have had another big study questioning their usefulness, questioning whether a bad mix of brain chemicals is the reason for low mood, but I wouldn't write them off completely. When you have a headache we often reach for paracetamol to sort it, but don't think for a moment that the sore head was caused by a lack of paracetemol in the brain.
From what I understand most big corps are getting better with mental challenges. If the person asked the co directly or GP referred I’m sure the co would have covered cost of first batch of therapy sessions. I get there is potentially an embarrassment / fear factor coming out to management.
I’m not for / against drugs as I don’t have the knowledge to have an opinion. It’s just the process / speed here that shocked me. Literally 10 min apt > drugs. I would have thought chat to therapist / family first and get their support.
Anyway, just someone on the side lines. Prob worth gaining some knowledge as I’m sure it won’t be the first time at work or out that it comes up.
If the tablets help then why not? You wouldn’t question if they’d gone in with an infected wound and were given antibiotics straight away. Chat to family for their approval? What if it’s family issues that are causing the illness?
OP. You say you know not much about the subject and yet propose this is a bit extreme?
The ‘senior colleague’ visited a medical professional who prescribed a product that should help your colleague.
Would you think it extreme if your colleague had broken their leg and had surgery to fix it?
Get real.
Iirc Citalopram is one of the most commonly prescribed drugs. For me it just took the edge off my worst symptoms and allowed me to be “more normal” while working through the issues – very much like how ibuprofen lets you carry on while healing a physical injury.
And outward appearances mean nothing when it comes to mental illness – some depressed people can put on a really convincing “I’m OK” act, until they aren’t.
some kind of mental evaluation
GPs have a standard assessment for depression, a few questions which take a couple of minutes to run through at most
This is an excellent answer, I couldn't put it better myself.
Sounds like you did the right thing re a very tricky conversation. I think you most likely judged it just right, they just needed someone to talk to, and you most likely came across as just the sort of sensible, trustworthy person they wanted to talk to. Sounds like they picked well, as you did exactly what they needed- listen.
Maybe it’s not, hence the question. I’m not trying to create controversy and have stated clearly I’m not pro or anti drugs, just develop more of an understanding myself so I can be of better support if someone comes to ask me something similar again, maybe support this person better if they come my way again. Already learnt a lot just reading the above comments, thanks all.
Yes, maybe it is the family causing troubles. Again, good point I hadn’t thought of. On the surface to me everything looked good.
The drugs are a stop-gap and for some people they work and become part of the solution, for others they don't. I can only speak from my experience but they made me completely numb to the world, in a very bad way indeed. No thought of consequences for my actions etc, very scary indeed. But I know others who have found them to be a lifeline and have been the foundation for them getting back on the right track so I don't dismiss them at all.
I don’t want to appear totally heartless so asked how they were feeling and just thought I’d listen while being very clear that I wasn’t a professional and had no idea what I was talking about.
That's the best thing you could have done, just the act of them unloading onto you is enough to help them through the day. There's no need to give them answers or solutions, just understanding them is enough.
And outward appearances mean nothing when it comes to mental illness – some depressed people can put on a really convincing “I’m OK” act, until they aren’t.
That's what happened to me: one day I was coping, the next I wasn't. It was genuinely a switch with me, when it clicked I had the full-on shakes, headaches, hypertension and nausea. Took months to flick it back the other way and I'm still working through the repercussions now, more than 7 years on. It has fought me a few times, flicking back and forth, the pandemic really hasn't helped and when they say there's a Mental Health Timebomb ticking away right now I fully believe them.
Rightly or wrongly drugs are the easiest course of action. Personally I think it's on the wrong end of the spectrum, but from my experience of talking to people it can be years of trying different combinations of drugs before being referred to an actual expert in the field.
I cannot really comment on the drugs side of things, but do keep up those chats and checking in. You may well be the only person they've told about it all.
Depression is a strange one. Some people swear by CBT or talking therapies. I’ve suffered with serious depression for most of my adult life. Been close to doing something stupid and irreversible a few times. Always resisted taking drugs and tried all sorts from self medicating (not advisable), talking to a shrink to CBT.
Depression always came back. Had a full and Frank conversation with my GP. Some people just can’t produce certain chemicals in the correct doses. Think I’m firmly in that camp. Been on 40mg citalopram for eight years now. Leaves me feeling numb and unable to experience the happy end of the emotional spectrum. Equally I don’t experience the extreme and frankly dangerous low side either.
Tried coming off a couple of years ago and it didn’t go well. I became very low quickly and was in a bad place. Then again as soon as I came off Covid happened, I lost a close friend, caught Covid, suffered with long Covid and had a dickhead drive their car in to the house.
I’m very good at hiding it though. Work colleagues and some friends wouldn’t have a clue. I’d love to come off the drugs one day and regular exercise, good sleep and diet do help.
NICE clinical guidelines for Depression
NB Bear in mind that the local GP will know exactly how many months the waiting list for counseling is - probably over 12 post Covid....
Which in practice means they can either offer drugs or 10 mins worth of sympathy.
Some people just can’t produce certain chemicals in the correct doses.
No one actually knows how SSRIs work. Years ago they developed a SSRE - Reuptake enhancer (Tianeptine) which, if the Serotonin theory holds, would make people more depressed. It didn't - had the same effect as SSRIs! It's doing something, just no one is exactly sure what or how.....
https://pubmed.ncbi.nlm.nih.gov/16008321/
I know I’m better on them than not despite the down sides (no pun intended). Sometimes worry about long term effects.
Citalopram is bloody awful for me - made me super numb to everything and claustrophobic.
I'm currently on Mirtazapine and it works well. Helps getting to sleep (a bit too much to begin with) and I can exercise just fine. Sex drive has evaporated, though - but it wasn't really there when I was in the pits of despair anyway.
I'd advise pressing the therapy; I did and got a useful series of CBT sessions.
Sometimes worry about long term effects.
Me too, 14+ years and counting. But, you have to die from something in the end, may as well be happier up to that point!
Sorry to derail the OP. I wouldn’t say I’m happier, just calmer. Don’t really feel happy to the degree I used to. Have a sort of restricted emotional range. Probably not making sense, but you’ll probably know what I mean if you’re fourteen years in.
OP, first things first, you did good. That your colleague felt able to speak to you about it speaks volumes for how you are perceived at work, just listening can be a massive help.
When I keeled over (2007) the drugs were a lifeline, the promise of something kicking in to help reverse my slide over the edge until I could get back on my feet was a great comfort. Been on them pretty much ever since, trying to get off them has never gone well, and now I don't aspire to. Citalopram kept me level, reduced the downs but also no ups, Mirtazapine had no discernible effect, Fluoxitine seems to be my best match, limits the severity of the low mood, but lets me enjoy life in the meantime. Others mileage may vary.
My problems started after a (sports) head injury, did your colleague clatter his head or has the injury had a more subtle effect? Realisation of mortality/ aging/ not being very good at something you love doing can be a reet downer.
Prescribing antidepressants has been proven to increase profits for drug companies.
Would that not apply to prescribing any drugs? The article doesn’t even mention profits for drug companies but is worth reading any way.
Already been said really, but GP will have asked questions to establish nature of the problem and most crucially, whether they are a risk to themselves or others.
The first time I sought help from the GP a few years back I was offered meds but refused, but agreed to try them a month or so later. Was on them for two years, off for two, back on them this year - 30mg Citalopram. It's taken the edge off and calmed me down while I get support and counselling to deal with the wider issues.
As my issues are triggered by work, I got signed off while the meds got to work - took 2-3 months to get the dose right. What has surprised me both times I've been on meds that because I've been fairly open that my health issues have been mental health, a huge number of friends, colleagues and more casual acquaintances have opened up about their experience of mental health struggles and treatments.
And it's often the ones you least expect it to be. We get real good at holding it together and hiding behind the mask until one day you just can't face it any more.
some depressed people can put on a really convincing “I’m OK” act, until they aren’t.
Never a truer statement made.
sillysilly
Full MemberIs that not a little extreme to put them straight onto drugs? Seems very much like using a sledgehammer to crack a nut.
Basically, no. They've probably been put on citalopram or similar, an ssri, which just increase the tweak the brain chemistry in an effort to improve mood. They're not at all personality changing, or "happy pills", and they tend to have fairly few side effects.
They're not sledgehammery at all sadly, they're just a little tweak. I tend to describe it as just reducing the difficulty level a tad.
Prescribing antidepressants has been proven to increase profits for drug companies.
Most antidepressants prescribed have lapsed so generic ones can be sold- so not exactly huge margins of profit to be made. Plus the NHS is able to use it's massive purchasing power to secure hefty discounts
Good on you for being someone there who was happy to listen to what your colleague was saying.
From what you have written it seems that both of you do not have much experience of SSRIs.
Mental health awareness has been increasing over the years, but some people are still unaware of what mental health problems can do to people. And why should they? There is a significant proportion of the UK population who do not suffer from them and most of their close contacts will not have suffered from them either.
On reflection I have had mental health problems for years. I was talking to my old flat mate from uni recently and he said that I was very depressed at times at uniand that was back in the early 90s.
The tablets can work for some people, but not everyone.
I have been on Sertaline for 7 years now and it keeps me just right. My eldest daughter and son are on them as well and they report positive experiences when trying to deal with anxiety. I wonder if there is a hereditary chemical imbalance in my brain that I have passed on to them?
Keep checking in with your colleague in the short term. If they start taking the tablets then they may start feeling some side effects quite soon. You can end up feeling worse before you get better.
Thank you to all who have responded, especially those with first hand experience. Massive learning curve and a quick Google either brings up generic NHS or conspiracy theory Daily Mail articles. A lot of good points made here that are much more helpful. No idea why I was one to get the full story but just seeing how many people are responding here, sure it won’t be the last time. Hopefully next time I am better prepared and can be more helpful. Scary to see how it effects people you think would never be…
Ah, never a less suitable user name. You sound like an awesome colleague.
Where I work we have mental health first aiders. Maybe something that you, or your organisation could consider. I don't know if they are well used, (quite rightly) but they are there and well known, which is one reason to be grateful I work for a caring and progressive employer.
Drugs are great to prevent people going over the edge and doing something silly.
Below that, where there is little to no real risk of self-inflicted mortality, all too often they're either happy pills where you believe you are being treated so mentally are on a better stage, or they get you high so you kind of avoid the bad stuff.
I used to have a GP who was a great proponent of distributing happy pills. We lived on a collection of sink estates where there wasn't mu h hope of getting out. Tony Blair's, "Education, education, education!" got quite a few unreasonably trapped people out.
If someone around you says they were put on meds, and they're staying in the same environment, chatting and doing things with them normally is good treatment. Looking for things to hold onto, or make changes that help escape the seeming "downwards spiral with no escape" are real helpful.
https://www.theguardian.com/society/commentisfree/2018/jul/19/drugs-alone-wont-fix-our-epidemic-of-depression
https://helpmestop.org.uk/addiction-help/prescription-drug-addiction/
some people end up taking antidepressants for years, and some for the rest of their lives.
My very limited experience is the GP will offer drugs as an option but not necessarily a solution. It seems like a very long process for some people to discover what works for them but anti depressants aren't treated as a last resort.
some people end up taking antidepressants for years, and some for the rest of their lives.
So similar to painkillers then? Some people are on them for ages while the underlying problems aren't fixed.
So similar to painkillers then? Some people are on them for ages while the underlying problems aren’t fixed.
Is that actually a bad thing though?
Painkillers cause all sorts of long term health problems, SSRIs none that I know of...
Most people will end up on drugs for life at some point eg Blood pressure medication, statins etc and in most cases the drugs increase their life span and number of active years....
I was on Nortriptyline not for depression but as a nerve blocker for a foot issue, I was on them for years but then decided to come off them. One of the first side effects I suffered was if I was bending down and stood up quickly I would go dizzy and almost fall over but what did it for me was the increased heart rate. What finally made me come off them was when I went for a run and got a 198bpm heart rate for a gentle jog and it felt like my heart was going to come out of my chest.
My heart rate is now thankfully back to normal but I still occasionally get dizzy issue standing up quickly.
I was also briefly on Amitriptyline but that just ****ed me up and I quickly came off them.
Mrs Lunge had similar, the Citalopram was one of the best things that happened to her. They gave her just enough clarity and stability to be able to work on the things that were ultimately causing the issues. She would not have been able to deal with those causes without the drugs.
Sounds like the doctor was spot on to me.
Nice one for listening, letting colleagues know why you're not working full beans is difficult, so possibly took some effort for them to confide in you? Anti depressants (fluoxetine = Prozac) helped me through very bad anxiety which then manifested itself into depression. My GP advised them and it took a couple of weeks before I could take the first one. The meds helped to sort out a very addled mind and get me back again, coupled with excellent counselling... Hope your colleague manages their way through issues with the right support.
Is that not a little extreme to put them straight onto drugs? Seems very much like using a sledgehammer to crack a nut. Thought maybe people here may have some insight into how these things work? As I say, I know what I don’t know. But from a quick chat potentially the GP isn’t actually much better than me. I would have thought at least some kind of mental evaluation / discussion with family and tests before drugs?
Your are a Doctor and I claim my £5....
MrP
^^ On this matter I don’t even have an MBeBay from the university of YouTube. Apologies if I’ve caused offence.
no offence caused here chap
good job for being a sounding board and providing some support
much of the above posts resonate with close family's experience of anti ds; they help, they don't fix the root cause all the time, other treatments are also good but none are as instantly available, drugs are right there and easily got, they can get you past a bad place and allow you to work on other problems, you may need to try a few different types before finding their best result.