Depression, Busy Doctors and Winnie-the-Pooh
Whenever I hear of busy doctors, I am reminded of the Bisy Backson.
If you haven’t left your childhood too far behind, you will probably know this comes from the Winnie-the-Pooh stories, specifically from the delightful book, The Tao of Pooh by Benjamin Hoff. When Rabbit went to visit Christopher Robin he found a note saying: ‘GON OUT. BACKSON. BISY. BACKSON. C.R’
Benjamin Hoff comments, ‘The Bisy Backson has practically no time at all, because he’s too busy wasting it by trying to save it.’
Now here’s an item I saw on the BBC online news (19 October 2016), so it must be true.
It’s about antidepressants.
A woman is shown in a film who says:
I was an absolute mess – wanting to take my life, like continually. I read the leaflet and I was getting exactly what it said I was getting – seizure-like symptoms where my muscles were kind of jolting around of their own accord and I felt disorientated and sick and had digestive problems and infections. I mean it’s really really extreme.
Subtitle: One in 11 British adults take antidepressants. But these pills can come with some serious side-effects.
Then we have a quote by Professor David Healy, who knows a thing or two about antidepressants – he wrote a book called Let Them Eat Prozac – and he says these pills can make many people’s problems worse:
One in four people become more anxious, rather than less. And they can become extraordinarily anxious, so that some people become very agitated and some go on from that to become suicidal.
After that, another patient, Darren, is shown. We are told he developed muscle spasms and a stammer when the dosage of his antidepressants was increased. The film shows him with violent shaking of his right arm. He says ‘I can stop it but if I do somewhere else goes’ and we can see his head and upper body start shaking.
On the other hand, Dr Sarah Jarvis, a GP in west London, says people can benefit from the right kind of antidepressant:
I think with people with severe depression, you may well need to try two or possibly three before you find one that does work. But for most people with severe depression we can find a medicine which will help them, and where the benefits will outweigh the risks.
The point of this news item is that ‘People who say their lives have been ruined by commonly prescribed antidepressants, known as SSRIs, are taking their case to Parliament on Wednesday.’
So we have opposing views from two experts on the value of antidepressants.
I think what underlies this difficult problem – do antidepressants do more harm than good? – is the concept of depression as a disease, like pneumonia or arthritis. As I have said in previous posts, depression is a symptom, not a diagnosis. What is going on with patients who are labelled as suffering from depression? It seems the common approach to mental distress is the same as with purely physical illnesses: take a history, do a physical examination if appropriate, possibly do some blood tests or an X-ray; then you can make a diagnosis and the treatment follows. For example, a patient comes with pain in the abdomen, it hurts more if the doctor presses at the lower right part, a blood test shows a raised white blood cell count, and a diagnosis of appendicitis is made; the treatment is to remove the appendix. Of course it may not be so simple as this and appendicitis can be difficult to diagnose. But how much more difficult it is with mental symptoms! The trouble, it seems to me, is that once a diagnostic label is attached the treatment that follows is a pill of one sort or another. This is a gross oversimplification.
What is going on in the mind of the patient who is diagnosed with depression? If given the opportunity in a supportive and non-judgemental setting, such patients almost invariably have plenty to say. The origin of the problem may go back to childhood, or be related to family, work or financial difficulties. A sympathetic ear can do much to ease such patients’ distress. The prescription of a so-called antidepressant can feel like a rejection: the ‘busy’ doctor – and why are doctors always busy? – doesn’t have time to go into all the patient’s troubles and issuing a script for a pill is often the quickest way to ‘dispose’ of the patient. Dispose is actually a medical term – rather unfortunate I think – for dealing with the problem that the patient brings to the doctor.
It reminds me of when I first started to work in general practice in London in the 1960s. Computers hadn’t been invented and records were kept in what were called Lloyd-George envelopes, named after the Liberal politician who was instrumental in introducing socialised medicine into Britain. They were cards about 5 x 7 inches where one could write the clinical notes: often the entry consisted of only two words, apart from the date: a symptom and a drug. For example: ‘Tonsillitis – penicillin’, or ‘Cough – Gee’s linctus’.
In some ways this approach hasn’t changed much, except these days we use computers: Depression – Prozac.
Text © Gabriel Symonds