Seeing your GP

It is very common for people to go and see their GP with common mental health problems like anxiety or depression. We see two or three new cases of depression most days. We will take the history, try to build an impression of the patient and their life context. If needs be we will gather information from relatives as well (if the patient agrees) Sometimes the family is very helpful and sometimes the family is the problem for the patient. GPs are skilled at tuning into these emotionally charged scenarios and at getting enough information to work with whilst not being too intrusive. 

We will be trying to determine if we are dealing with reasonably severe depression or local life difficulties or both. Sometimes the diagnosis only emerges over a series of consultations. If we think the illness is severe enough, and been going on for long enough we will offer treatment.

- We may advise less alcohol and tobacco intake
- We may offer talking therapies, counselling, psychology and so on. Sadly these are underprovided on NHS and the problems have often resolved by the time the therapist gets round to seeing the patient.
- We may advise more exercise as a general measure.
- We may advise antidepressant medication
- It may become apparent to doctor and patient that a lifestyle change for example a new job would be very helpful. (I had one patient who had a full house of depression symptoms, whose symptoms went entirely when he got a new job)
- We will refer patients with severe symptoms to the hospital psychiatric services
- We will offer support and follow up to make sure the illness is responding to treatment.

We cannot:-
- Cure depression instantly
- Make patients with alcohol problems sober up
- Stop all suicides
- Make the world better for you- we live in the same world as you- and like you we too are trying to make some sense of it.
- Make your friends/family/workplace be nicer to you.
- What can happen next?

For some patients recognition of their depression is a relief
For some patients it is a shock, or a source of shame
For some patients the word depression is such a shock that they go away and come back in 2-4 weeks and tell me they have picked themselves off and are now getting on with life again.
Some patients have a fluctuating illness, good at some times, worse at others and come for treatment when it is getting worse.
Some patients actually have severe illness and need psychiatric help. They will be referred to a psychiatrist.
Most patients are treated within primary care and never need see a psychiatrist.
Some patients use St Johns Wort bought over the counter to good effect
Some patients find counselling very helpful.

Peter Davies, 24/07/2008
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