Anti-depressants have their place, say GPs

Byron Bay GP Rob Trigger said there was currently an epidemic of young people with depression and anti-depressants had a role to play in treating the problem. He said depression and mental health problems accounted for more than 50 per cent of health problems in young Australians.

His comments come following an article in The Northern Rivers Echo where a Lismore counsellor spoke of her concern at the number of young people she was seeing who were taking anti-depressants some as young as 13. She said these youngsters did not have chemical imbalances in the brain, but were just going through a hard time. She questioned whether the use of anti-depressants was really called for, or whether they were being used as a quick fix where counselling might be more appropriate. However, she said there werent a lot of options open to GPs, as counselling was not covered by Medicare.

Dr Trigger, project advisor for the Northern Rivers Division of General Practice youth health project said while he agreed there was a sentiment of truth to her arguments, he also felt there was another side to the story. He wanted to dispel what he perceived as the myth that anti-depressants were bad and wrong and would stuff you up.

However, he owned that prescribing anti-depressants for young people was a complex issue and a controversial one.

A lot of people think western medicine is evil because its all about the pharmaceutical industry and thats sad, he said. Theres good evidence to suggest that on occasion there is a role for anti-depressants in young people.

However, he said there was also a role for alternative remedies like hypericum (St Johns Wort) in treating depression, and there was a need to break down barriers between western and complementary medicines. He said GPs were sometimes unsure of how complementary medicines would interact with traditional medicines, and more education was needed.

He said in severe cases anti-depressants might be the only thing that worked used in combination with psychological therapies.

Ideally the decision about whether to prescribe anti-depressants would be made over a number of consultations and it was important that the young person be monitored while they took the drugs, he said.

Sometimes they wont respond to psychological therapies and if you add anti-depressants it will break the cycle so they are open to change, he said. It will lift them to the point where they are able to make some decisions lift themselves to get better.

Dr Trigger said there were now additional Medicare item numbers which were meant to encourage GPs to spend more time with young people presenting with mental health issues and to also do more follow up monitoring. In some cases this would require more education, which was not always feasible or of interest to GPs.

Meanwhile, as of yesterday (November 1) GPs can now refer patients for up to 12 psychologist sessions which qualify for Medicare rebates.

The most important thing GPs can do for young people is engage them and instill a sense of trust so they feel they can come back, he said. Young people are a vulnerable group. They dont have money and they dont have voting rights.

He said it was sad that many young people didnt use anti-depressants when they could, and this could lead to serious consequences for them, like getting kicked out of school. This only increased their sense of disconnectedness.

And disconnectedness is why young people are getting depressed, he said. Its because of the way our world has changed. Its the lack of connection, or sense of belonging, and the break down of families and community.

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