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"Citalopram will save you from suicide" - my doctor
Hi guys, I hope you are all well today.
Today I went to see my doctor because of my low mood. It took an awful lot on my part to go to the doctor's and open up about how I really felt inside - not that I got much opportunity to open up. Below is an approximation of how the appointment went including most of the key things hat were said.
Can anybody tell me if what I experienced is a standard response from a doctor - or should she have done more?
From my point of view I felt that the doctor should have probed more, asked more questions and shown more concern. Not because I am hung up on getting concern from people - but because surely, as a doctor, she should realise that there could be other hidden things which I am not opening up about and she should know that there could be a million hidden reasons for why I feel the way I do. I repeatedly asked for some further professional help but felt fobbed off.
How does she know that I didn't undergo some traumatic thing in the past which I need resolving, how does she know that I was not begging for help before I go and top myself or shoot a family? (I am not going to do that by the way, just saying she does not know that) She just kept pushing the anti-depressants. I actually felt worse when I came out than when I went in. What I mean is, if I did plan on doing something serious to myself or someone else then I doubt I would have told her in a 5 minute conversation. I felt as though I was crying out for help and got sent packing.
Anyway, here is the appointment...
Dr: How can I help you today?
Me: Im’not enjoying myself.
Dr: How do you mean?
Me: In life, in general, I’m having a bad time.
Dr: (puzzled expression)
Me: Most days I don’t want to be alive.
Dr: Have you had thoughts of harming yourself?
Me: Well, it’s not quite like that, it’s more like I just would rather be dead – as in, I would probably be better off not
living, it wouldn’t be as hard to cope – I just don’t know how I would get there.
Dr: Have you made any plans along those lines?
Me: (thinking)
Dr: You know, like have you decided on hanging or...
Me: No, not as such. Well sort of. It’s difficult to explain. I just feel low enough every day to be thinking it’s the best way out – and it’s been getting worse and more often.
Dr: Ok, well it’s good that you’re not planning it in your head. How long have you felt like this?
Me: Well, it’s been getting worse for the last month at least but I would say there has not been a time in the last 12 months or 2 years where I have not felt down or depressed – it’s as though it has taken a different turn though more recently.
Dr: Last time I saw you you were trying t o come off Tramadol – are you off that now?
Me: I’m down from six or eight per day to two per day at the moment but have not stopped completely.
Dr: I think that could be what is making you feel so down then because coming off those tablets will have an effect on you.
Me: It could be partly to do with that – I have felt a lot more emotional and sometimes really angry. I am a calm person usually but I have been finding it hard to not get angry and upset about things. However, before I started the Tramadol I was a couple of months into a course of Citalapram because of depression. I came straight off the Citalapram though within a week of being given Tramadol, I’m now starting to feel the way I used to feel before I went onto Tramadol.
Dr: And was the Citalopram helping?
Me: It’s difficult to say because just at the time they would have been hopefully kicking in I also had to stop taking them because of the pain killers.
Dr: Ok well it could be worth trying the Citalaopram again now and see how you get on.
Me: Ok. I want to explain a bit more too about the effect it’s having on me.
Dr: (waiting)
Me: I can’t sleep. I toss and turn at night. Sometimes all night. Other times I over sleep. I never want to get up and face the day. I can’t concentrate on things. I feel shaky. I shake my arms and hands and legs – quite often at night. Even when I am still, inside it feels like I am exploding – like my blood is Lucozade. Like I am fizzing inside. I lie there, even at 3am and feel like I need to run a marathon, but at the same time I’m lethargic and unmotivated. It feels like agony.
Dr: Ok.
Me: I don’t enjoy anything, or socialise. More or less never. I’m just low. This isn’t just the last month it’s a couple of years, and also in the past. Just until recently I was burying it inside.
Dr: Ok, so I think the best plan is to try you on a low dose of Citalopram, that’s the first port of call really. Would you mind filling in this form though first?
(Dr gives me a form with the standard depression questions on it. There are 10 questions and I answer 5 out of 5 for 7 of them. 4 out of 5 for two and 2 out of 5 for one question (Do you move around a lot?) Then I give the form back)
Dr: I looks like you may be suffering from moderate to severe depression given your answers so I definitely think it’s worth trying the Citalopram and then coming back to see me in a couple of weeks.
Me: Ok, I am happy to try those. Is there somebody I can talk to though? I really feel as though I need some help.
Dr: There are charities out there who you can get in touch with if you are feeling down. (Dr writes down the name of a local charity where volunteers give of their time and passes it to me.) You can look them up on the internet and get the number, just give them a call. They are based in the town centre. There is also the Samaritans if you just need to talk to someone at some point.
Me: I meant can you refer me to somebody for therapy or counselling?
Dr: The thing is, if I refer you to the mental health team they will most likely just send you back and ask for you to be referred on to one of the charities.
Me: Oh. It’s just that I am really struggling to cope every day and I can’t carry on. I’m having problems in my relationships with my family and my girlfriend that I can’t deal with and I have had issues going back for years that I want to sort out and need help with.
Dr: Have you got access to the internet at home?
Me: Yes.
Dr: You could look up CBT, that may help you. Have you heard of it?
Me: Yes, I know about CBT.
Dr: The thing is it’s probably about you having to change the way you think about things if you want to get better.
Me: I understand that, yes. And I have read a fair amount about CBT not long ago. I am really struggling though to deal with things and think seeing somebody professionally could help. I am falling apart inside.
Dr: What we will do is start you on the Citalopram and you can come back in two weeks time and see how things are going.
Me: Ok. What days are you here?
Dr: I’m only in on Fridays. Here is your prescription ohhhkayyyy?
Me: Ok thanks, take care. Bye.
Sorry about the long post. Hope you managed to stick with it.
Does anyone have some advice which could help?
Do you think I should go back? See someone else?
I'm a bit lost.
Today I went to see my doctor because of my low mood. It took an awful lot on my part to go to the doctor's and open up about how I really felt inside - not that I got much opportunity to open up. Below is an approximation of how the appointment went including most of the key things hat were said.
Can anybody tell me if what I experienced is a standard response from a doctor - or should she have done more?
From my point of view I felt that the doctor should have probed more, asked more questions and shown more concern. Not because I am hung up on getting concern from people - but because surely, as a doctor, she should realise that there could be other hidden things which I am not opening up about and she should know that there could be a million hidden reasons for why I feel the way I do. I repeatedly asked for some further professional help but felt fobbed off.
How does she know that I didn't undergo some traumatic thing in the past which I need resolving, how does she know that I was not begging for help before I go and top myself or shoot a family? (I am not going to do that by the way, just saying she does not know that) She just kept pushing the anti-depressants. I actually felt worse when I came out than when I went in. What I mean is, if I did plan on doing something serious to myself or someone else then I doubt I would have told her in a 5 minute conversation. I felt as though I was crying out for help and got sent packing.
Anyway, here is the appointment...
Dr: How can I help you today?
Me: Im’not enjoying myself.
Dr: How do you mean?
Me: In life, in general, I’m having a bad time.
Dr: (puzzled expression)
Me: Most days I don’t want to be alive.
Dr: Have you had thoughts of harming yourself?
Me: Well, it’s not quite like that, it’s more like I just would rather be dead – as in, I would probably be better off not
living, it wouldn’t be as hard to cope – I just don’t know how I would get there.
Dr: Have you made any plans along those lines?
Me: (thinking)
Dr: You know, like have you decided on hanging or...
Me: No, not as such. Well sort of. It’s difficult to explain. I just feel low enough every day to be thinking it’s the best way out – and it’s been getting worse and more often.
Dr: Ok, well it’s good that you’re not planning it in your head. How long have you felt like this?
Me: Well, it’s been getting worse for the last month at least but I would say there has not been a time in the last 12 months or 2 years where I have not felt down or depressed – it’s as though it has taken a different turn though more recently.
Dr: Last time I saw you you were trying t o come off Tramadol – are you off that now?
Me: I’m down from six or eight per day to two per day at the moment but have not stopped completely.
Dr: I think that could be what is making you feel so down then because coming off those tablets will have an effect on you.
Me: It could be partly to do with that – I have felt a lot more emotional and sometimes really angry. I am a calm person usually but I have been finding it hard to not get angry and upset about things. However, before I started the Tramadol I was a couple of months into a course of Citalapram because of depression. I came straight off the Citalapram though within a week of being given Tramadol, I’m now starting to feel the way I used to feel before I went onto Tramadol.
Dr: And was the Citalopram helping?
Me: It’s difficult to say because just at the time they would have been hopefully kicking in I also had to stop taking them because of the pain killers.
Dr: Ok well it could be worth trying the Citalaopram again now and see how you get on.
Me: Ok. I want to explain a bit more too about the effect it’s having on me.
Dr: (waiting)
Me: I can’t sleep. I toss and turn at night. Sometimes all night. Other times I over sleep. I never want to get up and face the day. I can’t concentrate on things. I feel shaky. I shake my arms and hands and legs – quite often at night. Even when I am still, inside it feels like I am exploding – like my blood is Lucozade. Like I am fizzing inside. I lie there, even at 3am and feel like I need to run a marathon, but at the same time I’m lethargic and unmotivated. It feels like agony.
Dr: Ok.
Me: I don’t enjoy anything, or socialise. More or less never. I’m just low. This isn’t just the last month it’s a couple of years, and also in the past. Just until recently I was burying it inside.
Dr: Ok, so I think the best plan is to try you on a low dose of Citalopram, that’s the first port of call really. Would you mind filling in this form though first?
(Dr gives me a form with the standard depression questions on it. There are 10 questions and I answer 5 out of 5 for 7 of them. 4 out of 5 for two and 2 out of 5 for one question (Do you move around a lot?) Then I give the form back)
Dr: I looks like you may be suffering from moderate to severe depression given your answers so I definitely think it’s worth trying the Citalopram and then coming back to see me in a couple of weeks.
Me: Ok, I am happy to try those. Is there somebody I can talk to though? I really feel as though I need some help.
Dr: There are charities out there who you can get in touch with if you are feeling down. (Dr writes down the name of a local charity where volunteers give of their time and passes it to me.) You can look them up on the internet and get the number, just give them a call. They are based in the town centre. There is also the Samaritans if you just need to talk to someone at some point.
Me: I meant can you refer me to somebody for therapy or counselling?
Dr: The thing is, if I refer you to the mental health team they will most likely just send you back and ask for you to be referred on to one of the charities.
Me: Oh. It’s just that I am really struggling to cope every day and I can’t carry on. I’m having problems in my relationships with my family and my girlfriend that I can’t deal with and I have had issues going back for years that I want to sort out and need help with.
Dr: Have you got access to the internet at home?
Me: Yes.
Dr: You could look up CBT, that may help you. Have you heard of it?
Me: Yes, I know about CBT.
Dr: The thing is it’s probably about you having to change the way you think about things if you want to get better.
Me: I understand that, yes. And I have read a fair amount about CBT not long ago. I am really struggling though to deal with things and think seeing somebody professionally could help. I am falling apart inside.
Dr: What we will do is start you on the Citalopram and you can come back in two weeks time and see how things are going.
Me: Ok. What days are you here?
Dr: I’m only in on Fridays. Here is your prescription ohhhkayyyy?
Me: Ok thanks, take care. Bye.
Sorry about the long post. Hope you managed to stick with it.
Does anyone have some advice which could help?
Do you think I should go back? See someone else?
I'm a bit lost.
hi i would definatly see a different doctor. you need to see a psychiatrist beacuse they specialise in this field and they know more about the different kinds of medication. thats what i did. also you need to see a psycologist beacuse they will help you with the skills you need to learn to get better and they can also help you work through your thoughts and put the bad ones in to prospective. just go to a gp and ask for a referal.
Probably best if you can go private for counselling or psychotherapy - the NHS list for counselling are very long - over 8 months at the moment. Take the citalopram. Look on the internet for counsellors/therapists in your area. Sometimes you have to make the first move to get yourself sorted out rather than relying on the NHS and other people.
The doctor has done basically what most doctors do. They tend to not go into great details with you. They tend to leave that to the counselling. I have been suffering with depression and anxiety for over 4 years now and am on my second stint of counselling sessions. I still get the same reaction as what you had from the GP's and so merely state to them the basics that they need to report in my notes and that's it. I had a GP the other day that clearly did not understand the mentality of someone with depression and so came across quite rude, abrupt and horrible to be honest. I just tend not to let it bother me and as long as they note what they need to I don't really care.
I have self referred to the counselling near me on both occasions and have not had any obstructions from GP's. I am in Wales. The first time I contacted the Counselling Service myself and they then informed my GP of the sessions, but this time as I had done it before the GP was happy to refer me as I stated that it did seem to help for a few months however I think I need more.
Good luck
I have self referred to the counselling near me on both occasions and have not had any obstructions from GP's. I am in Wales. The first time I contacted the Counselling Service myself and they then informed my GP of the sessions, but this time as I had done it before the GP was happy to refer me as I stated that it did seem to help for a few months however I think I need more.
Good luck
What kind of doctor did you go to? You seem to be looking for a more thorough psych eval, which you should get from a psychiatrist. That really is the best way to go when addressing these kinds of issues. Howver, if this is the first or second time you've addressed this concern, and this doc is your family doc...I think she performed a pretty good evaluation. I know this is not what you want to hear...but hear me out....
Personally, from my standpoint, as a nurse, I think your doctor was pretty thorough and seemed to spend a good deal of time with you (your post was long, that was quite a conversation, even if it didn't take a LONG time). Thing is, doctors aren't mind readers, if you wanted to discuss something more specific with her, you should have said so. It seemed like you were waiting for her to ask specific questions, some times we just have to come out and say what's on our minds. She was info gathering, which is a big part of a doc's assessment, especially when dealing with more emotional issues. Unlike with a physical complaint, an emotional one is subjective, and requires the doctor to have a different assessment approach, and many times that is a lot of questions. Again, if this was a PCP, she was right on target, IMO.
Also, I agree whole heartedly with your doc about the Ultram possibly being the culprit here, especially if you dont have a long history of depression. Ultram basically acts in many ways the same way an opiate would, and when tapering off, many patients report a lot of emotional side effects, like depression and anxiety. The good news is, that will resolve, but the bad news is, it will take time. Even if you were completely tapered off, it may take several months before that emotional fog and depression starts to lift. The chemicals in your brain have to readjust. If you were on the Ultram for any extended period of time (and it sounds like your dose was awfully high), the "happiness" and sense of well being would have largely been attributed to the Ultram. The Celexa will help a lot with that, but with any SSRI, that also takes time. You may even require more dosage increases of the Celexa down the line, which is why this process takes patience (which is hard to have when you are feeling so lousy).
In my opinion, your doctor really seemed to cover most of the bases, including giving you the depression questionaire, which is commonly used by medical professionals to help assess depressive symptoms. She referred you to some charities to seek out some counselling, which, maybe you should give that a try? It seems to me that she is asking you to give that a try (along with the Celexa and Ultram consideration) before getting more aggressive with a referral to a mental health provider, which, depending on how many times you have seen THIS doctor for this complaint, seems pretty fair. If this is the first time you've approached this complaint with this doctor, I don't think it is unreasonable to at least try some of these suggestions, even if you feel you need more interventions at this point. You may be pleasantly surprised at the outcome.
When we're feeling badly, we want answers NOW, and want action TODAY. We DO have to learn that this is a long process that requires patience, and willingness on our part to at least try different appraoches that the doctor is asking.
I'm sorry you left there feeling like you did, but perhaps you aren't being entirely fair here. It isn't uncommon for us to have MUCH bigger expectations when we seek help for these kinds of problems. If this is the first or second time you've discussed this with her, at least try the first course of action that she recommended, and then at your follow up appt, without a doubt, make it clear that you want to try something more aggressive, ask for a referral to a psych and a therapsit. Come right out and say how you feel, whether it be that you feel you aren't being taken seriously, or are being dismissed, whatever the case may be. But for now, give yourself some time, and remember that INDEED the Ultram could be a HUGE contributing factor, and if that is the case, the only thing you can do for that is give it time, as hard as it is.
I'm not in any way trying to be rude, I'm only giving you my honest opinion on how I see it and hopefully giving you some things to think about. It's so hard when we're feeling so awful. We reach out and expect a much more dramatic reaction, when truth is, that's just not usually how it happens. Some of my best docs had the bed side manner of a slug. I realized after time that it was my family and friends who needed to have the caring and emotional response, and while I would have appreciated more warmth from my doctors, if they get me feeling better based on their recommendations, then that's okay. I just honestly think one of the biggest reasons you were left feeling the way you did was because your expectations did not meet up with how it went down. That is not saying that there wasn't some very valuable advice given to you by your doctor.
You can always come here and vent, we know how hard this can be...you're among people who understand. Hang in there!!
Personally, from my standpoint, as a nurse, I think your doctor was pretty thorough and seemed to spend a good deal of time with you (your post was long, that was quite a conversation, even if it didn't take a LONG time). Thing is, doctors aren't mind readers, if you wanted to discuss something more specific with her, you should have said so. It seemed like you were waiting for her to ask specific questions, some times we just have to come out and say what's on our minds. She was info gathering, which is a big part of a doc's assessment, especially when dealing with more emotional issues. Unlike with a physical complaint, an emotional one is subjective, and requires the doctor to have a different assessment approach, and many times that is a lot of questions. Again, if this was a PCP, she was right on target, IMO.
Also, I agree whole heartedly with your doc about the Ultram possibly being the culprit here, especially if you dont have a long history of depression. Ultram basically acts in many ways the same way an opiate would, and when tapering off, many patients report a lot of emotional side effects, like depression and anxiety. The good news is, that will resolve, but the bad news is, it will take time. Even if you were completely tapered off, it may take several months before that emotional fog and depression starts to lift. The chemicals in your brain have to readjust. If you were on the Ultram for any extended period of time (and it sounds like your dose was awfully high), the "happiness" and sense of well being would have largely been attributed to the Ultram. The Celexa will help a lot with that, but with any SSRI, that also takes time. You may even require more dosage increases of the Celexa down the line, which is why this process takes patience (which is hard to have when you are feeling so lousy).
In my opinion, your doctor really seemed to cover most of the bases, including giving you the depression questionaire, which is commonly used by medical professionals to help assess depressive symptoms. She referred you to some charities to seek out some counselling, which, maybe you should give that a try? It seems to me that she is asking you to give that a try (along with the Celexa and Ultram consideration) before getting more aggressive with a referral to a mental health provider, which, depending on how many times you have seen THIS doctor for this complaint, seems pretty fair. If this is the first time you've approached this complaint with this doctor, I don't think it is unreasonable to at least try some of these suggestions, even if you feel you need more interventions at this point. You may be pleasantly surprised at the outcome.
When we're feeling badly, we want answers NOW, and want action TODAY. We DO have to learn that this is a long process that requires patience, and willingness on our part to at least try different appraoches that the doctor is asking.
I'm sorry you left there feeling like you did, but perhaps you aren't being entirely fair here. It isn't uncommon for us to have MUCH bigger expectations when we seek help for these kinds of problems. If this is the first or second time you've discussed this with her, at least try the first course of action that she recommended, and then at your follow up appt, without a doubt, make it clear that you want to try something more aggressive, ask for a referral to a psych and a therapsit. Come right out and say how you feel, whether it be that you feel you aren't being taken seriously, or are being dismissed, whatever the case may be. But for now, give yourself some time, and remember that INDEED the Ultram could be a HUGE contributing factor, and if that is the case, the only thing you can do for that is give it time, as hard as it is.
I'm not in any way trying to be rude, I'm only giving you my honest opinion on how I see it and hopefully giving you some things to think about. It's so hard when we're feeling so awful. We reach out and expect a much more dramatic reaction, when truth is, that's just not usually how it happens. Some of my best docs had the bed side manner of a slug. I realized after time that it was my family and friends who needed to have the caring and emotional response, and while I would have appreciated more warmth from my doctors, if they get me feeling better based on their recommendations, then that's okay. I just honestly think one of the biggest reasons you were left feeling the way you did was because your expectations did not meet up with how it went down. That is not saying that there wasn't some very valuable advice given to you by your doctor.
You can always come here and vent, we know how hard this can be...you're among people who understand. Hang in there!!
Definitely keep the appointment in two weeks. The doctor needs to know how you are doing on your meds. I am sure he/she also wants to check on your suicide ideation status. Follow the advice to contact the charity that does counseling - the number s/he gave you and try to get in before the appointment with the doctor so you can report about that too and it may give you a better case for a referral to a psychologist. However, some charities do have licensed therapists that are as good as a psychologist.
Hi, I live in UK too. Doctors only have 7 minutes to see each patient. In my doctor's practice there are understanding GPs and those I would never want to see again.
How long have you had depression and been on anti-depressants? Have you seen a psychiatrist, or any other help? You can ask a doctor to refer you, I think I have seen everyone who is supposed to help. Lots of counsellors, different psychiatrists, psychologist etc. I think you should go back and ask to see another doctor and insist you are referred. You are the patient, and the doctor should listen.
I know how frustrating it is to feel fobbed off, and not want to go to the doctor's again. I must admit I avoid it if I can. But you obviously need more support, so pluck up the courage to go again, and see what another doctor says. I remember telling a psychiatrist that I stored up pills in case I wanted to commit suicide, and he did not seem that concerned.
It is bad enough having depression without having to feel you are a nuisance at the doctors. The last one I saw made me feel very small, and it went over in my mind for days. I will never want to see him again.
Good luck, and be strong for yourself, and keep asking for more support until you get it.
Take care
How long have you had depression and been on anti-depressants? Have you seen a psychiatrist, or any other help? You can ask a doctor to refer you, I think I have seen everyone who is supposed to help. Lots of counsellors, different psychiatrists, psychologist etc. I think you should go back and ask to see another doctor and insist you are referred. You are the patient, and the doctor should listen.
I know how frustrating it is to feel fobbed off, and not want to go to the doctor's again. I must admit I avoid it if I can. But you obviously need more support, so pluck up the courage to go again, and see what another doctor says. I remember telling a psychiatrist that I stored up pills in case I wanted to commit suicide, and he did not seem that concerned.
It is bad enough having depression without having to feel you are a nuisance at the doctors. The last one I saw made me feel very small, and it went over in my mind for days. I will never want to see him again.
Good luck, and be strong for yourself, and keep asking for more support until you get it.
Take care
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