do people come across clients who refer to GPs not prescribing medication for various conditions, but especially depression, because the person is on a lot of medication, or they don't want the person to become dependent, or any other reasons... and is there some factor i should be aware of in terms of non-medical reasons why GPs would prefer not to prescribe...?

i ask because tribunals/ medical advisers frequently draw inferences from medication/treatment or lack thereof, and i'm not sure it is always as straightforward as painted...

In my experience there are several reasons why a GP may not be prescribing medication:

- the GP may consider that it is a sledgehammer to crack a nut for some forms of depression

- the GP may feel that counselling or CBT is more appropriate for certain types of depression (there is some evidence for this);

- the claimant may have tried various types of antidepressants and found the side-effects worse than the illness;

- the claimant may not want to take conventional medication (this is quite commmon) but prefer to use complementary therapies or herbal medicine such as St John's Wort which does ahve proven antidepressant value;

- the claimant may never have told the GP s/he feels depressed (not uncommon if GP is perceived as unsympathetic); or

- for some reason the treatemnt regime has fallen apart - GP doesn't know how bad claimant is, claimant may be so bad disengages from the system, GP has told patient to pull himself together and get a job (not always bad advice!).

The ones that worry me most aren't these. They are the ones who have been on the same antidepressant for 5 years, have never seen a psychiatrist, and are making no progress at all. Then you do wonder what the GP is up to.

There is a huge range of antidepressants on the market. all of them work slightly differently and all patients react differently to them. ie if one type is prescibed for 1 patient, it will work, but the same one cane be pescribed to another patient, it may not work for them.

Clinical trials have prooved this.

Not all GP's know this.

Pharmacists are in a much better position to advise uon the effect of different types of these drugs. (They do 3 years studying for a degree in pharmacology, GP's spend about a week studying it during a medical degree).

Also, many patients refuse to have treatment by taking drugs, because of the poor press these drugs have had in the past. They also may have poor insight into their condition (ie refuse to accept that they have a much of a problem, or there is not much that can be done for them or no one takes them seriously)

Another problem is that depression is classified medically as a mild to moderate mental health condition. This leads to a misconception that it is a mild or moderate medical condition. This is far from the case. Depression is probably the most dangerous mental health condition to an individual because this is the illness that leads to suicide.

Moderate depression is generally regarded as an illness that makes someone incapable of work (by those who understand what this term means).
The worst suicide risks (or so I have been told) are not the most depressed people, who have no energy and motivation and can't even summon up the effort to kill themselves. The dangerous time in treating depression is when the medication has acted well enough to improve motivation and remove apathy, but hasn't yet done anything to improve mood.

To those who think that it is demeaning to be told that an illness is psychogenic (which is NOT "imagination"), I owould say that I ahve known people who spent 16 consecutive weeks in hospital with depression: how often does that happen with a merely physical illness?!