{thought i knew my mind like the back of my hand}

[kaberett]

Content notes for mental illness and medical gatekeeping.

I've just had my mandated regular appointment with my GP, who insists on talking to me once a month before she'll give me the antidepressants I've been stable on for two years, four weeks' worth at a time.

I lie to her about my mental health. My counsellor thinks this is a sensible thing to do. I realised today that the biggest source of anxiety in my life at the moment isn't the obvious stuff - my transfer report coming up; spending the next two weeks pretty solidly in work; the ongoing Relationship Situation - and it's not even Everyone Is Secretly Dead. It's the complete lack of faith in my competency to manage my mental health, and the complete unwillingness to grant me any agency.

This time round, I told her I wanted to try going back down to my summer dose (30mg citalopram daily), but I'd like to be prescribed some extra 40s so I can put myself back up immediately if I need to. She nodded and smiled and... wrote me a scrip for 30s only.

And then she started talking about putting me down to 20, as though that is something we should be aiming for. (She started the appointment by asking how I was, then saying she assumed worse, because [gesturing to my chair]. At least this time I managed to say that no, actually, I was doing better than the last occasion she'd seen me - I am well enough that I can get my chair up and down the stairs to my front door. Her commenting erroneously and unhelpfully on my chair use is becoming a pattern.)

I feel so disempowered about this entire interaction that I don't even know how to express it. I nearly took diazepam today to deal with the appointment. That is what I mean when I say that medical appointments about my mental health are currently one of the biggest stressors in my life. (In contrast, my appointments with my counsellor deal with actual trauma - and I look forward to them and leave them feeling better.)


I think part of the reason I'm such a mess about this is that I am, independently, doing some pretty intense work. I've just talked about having learned to trust myself (), especially with respect to my mental health and the ways in which my subconscious uses it to get me to pay attention. In particular, I'm starting to explore the possibility that my longstanding mental illness - I've been obviously clinically depressed for at least ten years - is an extension of this: an indication that I was in unsafe situations and my brain desperately wanted me out.

That can't be the whole of the story: my depression is really obviously progestin-mediated. As such, even though I think I'm the safest I've ever been (I certainly feel that way), I want to be very, very careful in experimenting with this, and I want my partners & family to be willing and able to help monitor me without detriment to themselves.

And I need to have control. I need to be able to bump my dosage back up without having to interact with telephones and appointment systems and medical professionals - especially given that my current GP practice apparently has a policy that any GP who hasn't previously interacted with you should refuse to do urgent mental health prescriptions, and hand you back to your main GP. (Meanwhile, they're very definite that I'm complicated enough that I should consistently see one person.)

I have two weeks of 40s left, which will get me through this next fortnight (). I have a prescription in front of me for a month's worth of 30s. I have enough spares at home (the existence of which I have carefully not told my current GP about) that I am just-about okay if I need to bump back up to 40 at this point, because I'm seeing her again on the 12th of May - but I am scared of what eroding that stash will mean for me, given this practice's reluctance to let me have any flexibility or autonomy whatsoever.

They similarly do not know about my tiny and dwindling stash of temazepam (I am down to one tablet) because they would freak, in despite of the fact that I have used all of ~6 tablets over the past ~15 months.

My GP goes on maternity leave four days after our next appointment. A month after that I see another GP at the practice. If they, too, are this controlling, I guess I have to deal with finding somewhere else to go.

Comments

[kaberett]

Concrete positive action: just e-mailed my counsellor asking about setting up our next session.

[hilarita]

Yay!

[hilarita]

She *What*? Um. OK, when I reduce MH meds, my GP explicitly ensures that I have enough so that I can go straight back up to a higher dose should I need to do that. (There's an understanding that if it's slightly bad, I can just mention it at the next monthly appointment, but if it's very bad, I should see her ASAP.) And at the moment, she's waiting to see whether I want to reduce my dose. Or not. It's completely within my control, because, y'know, competent adult.
It does piss me off that a lot of medical professionals assume that you can't observe your own symptoms accurately. Because, um, we're people that Notice Shit. (And even when I'm sick as hell, my observations are ace. It's my interpretation/reaction/weird shit that's not at home to Being Well.)

(Also, totally alongside not telling GP everything. There's a world of difference between 'symptom I'm keeping an eye on', or 'natural stress given that $foo has happened' and 'I need to alert you to bad shit going down that isn't being handled elsewhere and you need to know about it'.)
And understand about stresses at seeing GP. I still fucking hate it, even though it's mostly not that bad now, and so forth. (I've been with this GP for 8 years, now.) But long waits, and worries about medication control still freak me the fuck out.

[quirkytizzy]

I like your distinction about what to tell your gp. My ex boyfriend could never understand that there is a difference, and that we as mentally I'll folks often have a pretty good grasp of what those are, seeing as we are the ones living in our heads.

[such_heights]

Ughhhh, that's so terrible. Also also, I know we talked about this ages ago and then I never did the thing, but I still have that stash of citalopram that I have no use for which you're very welcome to, if that would help.

<333

[kaberett]

... actually yes please, that would make me a lot more relaxed about the current sitch. WE SHOULD HAVE TEA. xxx

[such_heights]

YES PLS

[jelazakazone]

It feels to me like you seeing this GP is self-sabotaging. I hate this idea that people with mental illness are unreliable. Or women are unreliable. Or whatever. Maybe you (general you, not you you) are unrealiable on one front, but that doesn't mean you shouldn't have access to what you need to take care of yourself. I am so frustrated for you and untonuggan. I am frustrated for everyone who is not white, cis, male, and privileged. Health care is hard enough without all this fuckery.

Also, I don't understand why it seems most people's/agencies' goals are dependence. My goal as a parent is independence for my kids. I have already told them they are moving out when they are 18 :D (DD2 asked, what if I don't want to move out until I'm 19?:) And then the other day she was telling me she was ready to go to college. LOL.)

I have many thoughts on this stuff. Also, some stuff related to keeping women by making them be responsible for their kids 24/7 which feels related to this stuff, but not terribly relevant here. <3

Also: hilarita said a bunch of stuff I was trying to get at more articulately than I did. *points up*

[shehasathree]

Grrrrr.

[alexseanchai]

Oh honey. *hugs?*

[kaberett]

thank you ♥ have since bimbled home in the sunshine reading Engraved on the Eye (Saladin Ahmed, collection of short stories) and made dinner and done the washing up and bimbled in the garden a bit, so I am much happier :-) next on my list: retreating to aforementioned garden with said book and a bowl of ice-cream...

[alexseanchai]

Yay happier! Book and ice cream sounds like marvelous plan.

[quirkytizzy]

Having control and an active role in your own treatment is vital to health and recovery. How could your doctor not recognize that? You need that for health on so many levels! And not having enough or the right dosage of meds is a good way to get crazier, she is not helping you. Just because you are mentally I'll does not mean you are incapable of caring for yourself.

CN your counslers write a letter of recommendation or something? This worries me greatly that your gp is discounting you, the patient, so greatly.

Oh man, I wish I'd saved my temapazan. I'd had a really bad reaction to it and flushed it after I dc'd last year. :(

[kaberett]

Heh, thank you for the thought. I don't get on with it brilliantly (cf the two-day hangover I only managed to shift through judicious use of my caffeine hypersensitivity last time I took some...) but it's really good to have around when I need it.

My counsellor's written a letter about what a responsible and self-aware patient I am already. Alas, alack ;_;

[(Anonymous)]

Posting anonymously cos public post and don't want this to be attribut able to me.

I don't have mental health problems (barring one phobia). I am however fat and therefore avoid my GP surgery as much as possible because it feels like the only advice they are interested in giving is about weight loss. Fortunately I am surprisingly well for a fat person and the only problem I have is with hayfever drugs, but that I've been able to work around via online GP services Bthink Lloyds Pharmacy, Dr Thom, Dr Fox etc.)

Keeping an NHS GP = important for various reasons, but I do wonder if it would be useful to have a private GP too. GPs as gatekeepers is hard.
Thinking about NHS services you can access the following without GP referral:
A&E
Sexual health services
Contraception
Dentists
Opticians
Some alcohol treatment services
Some TB services, particularly in London/other high incidence areas.
Maternity care
Some specialist services for homeless people
HIV services.
IAPT services
Physiotherapy in some areas of the country
Tavistock Centre in London for some counselling/ mental health things
And that's about it.

So, I'd say it's worthwhile getting sexual health/contraception advice from specialist services cos avoid ing GP interference where possible = useful and other than that worthwhile keeping an eye out for other services becoming self referral.

Other options are private GP for mental health problems, trying to come off medication you don't have a reliable supply of or obtain ing the medication otherwise than by prescription which is at least dodgy and depending on the drugs worse than that.

[kaberett]

Coming off the ADs isn't a realistic option (file under Reasons I Will Die Rapidly And Messily If I Survive The Apocalypse).

In the first instance I've actually had a poke around NHS choices this afternoon and established what some of my other options local-GP-wise are; I might get in touch with some of them over the next few weeks...

[(Anonymous)]

[same anonymous person as previous anon comment in this thread]

Different NHS GP != bad idea.

Other thought - do you have any contact with your uni's Occupational Health services? They might know local GP practices and know who is good/bad with mental health/complex health problems.

Suppose what you need is to be able to create a bigger stockpile of $relevant drugs, to allow more leeway, in case there are difficulties getting more. Can you plan for a strategic lie when you see her next ("no, not doing so well, would prefer to go back to 40mg, if possible")? Or, can she be persuaded to refer you to a psychiatrist [not sure if that's a useful idea or not - but she might be more willing to prescribe in a way that gives you greater control over the drugs if there's advice from a psychiatrist that that's OK to do for you]

You know about the rules on Emergency Supply of PoM (http://www.rpharms.com/non-member/emergency-supply-qrg.pdf)?

Arguably, what I'm suggesting here is irresponsible, but I take the view that lying is OK/a good thing when it is about survival (which includes, IMO, ensuring a reliable supply of anything essential to an individual).

[silveradept]

Can you request a new GP, spoons permitting? Because it sounds like this one is giving very clear signals that they don't give a fuck about you.

[barrelofrain]

Just commenting to say that I hear you about these stressors, and it is bullshit to have to do this kind of thing to get proper/accessible care.

[raze]

I have tried writing several responses to this, all of which have dissolved into rambling, inarticulate rage - but I'd be preaching to the choir, so instead: I'm very sorry that you had this experience and will be forced to struggle because of it. It isn't fair for a person to be given so little agency over something so personal and so important. *hugs,* and whatnot.

[kaberett]

*hugs* -- thank you; this response helps a lot. I think I've been falling into the trap of learned helplessness about this: the voices (including yours!) telling me that this is not actually a fair or reasonable situation are very, very helpful. (My mother, bless her, thinks that my negative reactions are a bit out-of-proportion, which... isn't helping; I love her dearly but.) So - thank you. xx

[dreamfracture.insanejournal.com]

She sounds like she is doing the exact opposite of helping. I don't really have any advice, I'm afraid, but I wish you the best of luck.

[forthwritten]

Oh, grim. I don't understand why some GPs think that the eventual goal is to come off antidepressants when some people just function better on them than off.

Good luck with finding a more understanding GP.

[shanaqui]

Well, my mother's a psychiatrist and she firmly believes that there are some people who are better on medication than off. At the same time, she advocates trying to come off the medication, or at least taper down the dose, because that provides flexibility for the future when you might need it again. Most medication has an upper limit on dosage. If you've tapered down while you felt better, you can always go back up; if you haven't, you might end up with nowhere to go. It's particularly pertinent in cases where there's only one medication that works -- I have that with my anti-anxiety medication.

So there is sensible reasoning there, but some GPs take that the wrong way and forget that the goal is to permanently manage the condition, not to permanently come off medication no matter what. And it really is frustrating when they take that attitude.

[forthwritten]

Yes, and my parents are both psychiatrists and I'm well aware that being on upper limits of antidepressants for long periods of time is undesirable for the reasons you describe, as well as side effects.

I've outlined exactly what I object to, viz. GPs with limited experience in managing complex, long-term mental health conditions making sweeping generalisations about how the people under their care should be using antidepressants, whether that patient experienced mild situational depression in response to an external stressor which has since been resolved or the long term mental health issues that kaberett is clearly adept at managing to the extent that they are aware of how much they can safely taper their dosage, when, and how.

[shanaqui]

I'm not sure how to read your tone there, but I'll just clarify that I don't know you or your experience with these issues at all, and was responding solely to "I don't understand why some GPs think that the eventual goal is to come off antidepressants when some people just function better on them than off" with my experience/knowledge in case it was useful to someone, whether that be you or not. I haven't seen a comment where you outlined exactly what you object to or what your level of knowledge is until this one.

Possibly I'm just jumping in where I'm not wanted, because it's an issue that I'm dealing with at the moment as I taper down from my meds and so it's something I'm thinking/talking about a fair bit.

[forthwritten]

Perhaps you should have made a separate comment rather than responded snippily to mine then.

[shanaqui]

I wasn't intending to be snippy in any way: I genuinely intended to discuss my experience/understanding of why GPs get the wrong end of the stick. I'm sorry that was unhelpful to you and unwanted, but I think you're the one being "snippy".

[shanaqui]

Wait what. Having any kind of longterm medication requires some degree of self-regulation to manage the condition -- I can get saying you're not supposed to go down on dosage without supervision, but having the space to adjust the dose upward to account for whatever factor (whether we're talking anxiety or ulcerative colitis) is just sense. (I mention anxiety and colitis, since both my friend with colitis and I are allowed to manage our own dosages to some extent, and have since we first went on the meds, let alone now we've had some experiencing in recognising and managing our symptoms.)

Grargh. Doctors.