i don't seem to have any luck with GPs. the ones i've liked have all been locums so have left the practice months later.
i saw a new gp today because the anti-depressents have been giving me severe headaches. she was beyond useless. first she searched online the drug i am currently taking even though she had a bnf infront of her! then she told me that most of the anti-depressents available to me are of the same 'family' (she was also very patronising, though that could just be my perception since i didnt like her) so would probably cause the same side effects. then she told me about one (i cant remember the name) in a different 'family' but asked how my blood count has been recently because this drug lowers your WBC! so i told her i thought it was fine but didnt she have it on the comupter in front of her? she then asked what i thought about taking this drug and i responded (politely) that i don't know, i am not a doctor, but i would think she should consult my oncologist before prescribing me with the drug! she 'hmmmmed' at me and then said it was too much hassel so prescribed me with a similar SSRI which will probably have the same effetcs. and being a student nurse i have a bnf! it was a complete waste of time! so i definatly will not be seeing her again! this is why i always end up going to see my oncologist about stuff like this. she isn't stupid!
i'm also having a really bad day (and severe mood swings) which probably hasn't helped my feelings towards this morning!
and i keep forgetting to ask when i can have my hep b vaccines for work and uni. did you know that we are supposed to get all our old vaccines? (MMR, polio, tetanus etc) as daft as it sounds, i hate getting muscle injections! i think they hurt more than anything ever!
Must be careful not to infringe any regulations here, so will give some information, but not advise.
I sympathise with you. I have a similar problem with my GP surgery, as there are around 10 names on the list, and you see whoever is available. I have yet to see the same one twice, most are locums, and they always have to look everything up.
I believe that not all SSRIs have the same side effect profile, otherwise everyone would get fluoxetine (prozac), which was the first widely used one. I thought they had stopped prescribing it, but spoke to someone the other day who has just been put on it. There is quite a lot of literature on these drugs, and when you read it carefully, it seems that only around 40% of patients report benefit from them. The benefits come at around the 3-6 week period, but the side-effects come immediately, which is why so many people discontinue them at an early stage: all the costs without the benefits. Which drug is prescribed is often down to the preference of the individual doctor, and not often not based upon anything other than their own anecdotal evidence. The same is also true of anti-psychotics.
If she is talking about another class of drug, that will either be a monoamine oxidase inhibitor (MAO), or a tricyclic. A MAO can be nasty, and you have to really watch what you eat: anything containing protein that is less than 100% fresh can give you headaches and heart palpitations. Without making a recommendation, I have to say I was on one as part of the ClVPP regime (procarbazine), and I would not want to go on one again. The anti-depressant which is similar to a tricyclic, and used quite a lot, is venlafaxine. This inhibits re-uptake of both serotonin and noradrenaline. A good friend of mine, with a long-term history of depression, switched to this after not getting on with SSRIs, and got on well with it in all respects.
A decent psychiatrist should know the pros and cons of the different SSRIs inside out. You do not need a referral to a psychiatrist over this, but a quick phone call for advice from your oncologist could be really helpful. I find that consultants in one specialism are often happy to approach a consultant from another specialism for advice, whereas the GP will either attempt to handle it themselves, or refer you on.
With all due respect, this is a support board, and speaking so ill of GPs and psychiatrists the way you audaciously do is both rude and counterproductive. Especially considering doctor-patient relationships play a HUGE role for people who have an illness. Name-calling doesn't get anyone anywhere.
pinkmada, I sense you must be having a very difficult time. I take it you are on chemo?
Anyway, when your GP was talking about other "classes" of antidepressants, I will diverge slightly from lymphpre and say that she was very unlikely talking about MAOIs or tricyclic antidepressants. The former are a very old class with lots of side-effects and are rarely used anymore. The latter are only used now as tranquilizers as they can have serious cardioelectrophysiological side effects. (*edit: I see that the GP DID in fact prescribe a TCA which is VERY surprising to me given the many more safe options available! Simon, I apologize, you were correct!) She was likely speaking of the SNRIs (serotonin-norepinephrine reuptake inhibitors) such as venlafaxine (or Effexor), or...shoot...I forget the class...but an example in the class is called bupropion or Wellbutrin...and there is a final one and...shoot again, I forget the name of its class, but it is called mirtazipine or Remeron. Those three drugs are relatively new agents used for the treatment of depression which are NOT SSRIs.
As you know mentally fighting to stay positive is a huge part of getting through an illness. Depression is something which is definitely not just "in your head", and can seriously hinder the aforesaid process. Though I don't agree with lymphpre's comments about GPs and shrinks, I DO agree that it would likely be best for you to be seen by a psychiatrist who is not just experienced in the pharmacological treatment of depression, but also psychotherapy.
Hey Simon,
thanks for the reply. i was ranting. i do need to contact my onc again and let her know what my GP has pescribed me. the drug she tried to px me with that lowers my wbc is called lofepramine, a tricyclic) my psychologist is right, i do have severe trust issues when it comes to GPs and i question absolutely everything they do or say to me and this is why i almost always end up seeing my onc about anything that is wrong with me.
(i had the yucky stuff with my period again this month and my onc is referring me to see gynae asap. and i know that if i had went to see my GP about this then he'she would have given me antibiotics, and told me to 'wait and see'. at least with my onc, i get things seen to quickly.
i have not started to take the drug she prescribed (citalopram) and have continued to take the fluoxetine (and a lot of paracetamol) but i am almost out so i have to go back to my gps.
the first couple of weeks of me taking the fluoxetine i lost a few pounds but the headaches have only been the last few weeks (i have now been on them for 6 weeks) but i really havent noticed any difference with them. although my partner has told me that i have had a lot of mood swings recently.
i will ask my onc if she could even just arrange a phone call session with a psyciatrist. what is it they say? GPs no less and less about more and more and consultants know more and more about less and less? that makes sense.
Cgranulomatis, thanks for the reply, Simon wasn't being disrespectful, i have had a continuous struggle with my GPs as they never seem to listen to me. i am a year in remission and struggling with everything now. i am also a student nurse and my GP knows this but she was extrememly patronising when she was talking to me. (again, i can appreciate that she might not have been as patronising as i thought and it could just be my perception). the inverted commas around 'family' was just to emphasise that she was speaking to me like a child. but my gp googling the drugs i am on instead of using her bnf is a bit worrying when even nurses have bnfs (its like the pharmacy bible over here) and then telling me that i could take aspirin or ibuprofen with the paracetamol when it clearly states that you cant take these with fluoxetine and i cant take these anyway because of my haital hernia and then her prescribing me with a drug that will lower my blood count without consulting my oncologist i think is just careless and unprofessional and definatly not client centered care. she told me it was 'too much trouble' for her to contact my onc and prescribed me with a similar ssri even though she said it would probably cause the same side effects. anyways, i really just needed to rant about how incompetant my GP was being and how it seems to be a pattern with my GPs and really just say my feelings out loud. But thank you for the reply.
Yeah, it does sound like your doctor doesn't listen to you, and for sure that is not exactly going to help with your perception of her abilities. I can't believe she said "it would be too much trouble to contact your onc". Man! But I hope that doesn't soil your perception of all family docs, 'cause many of them are good. One thing is, doctors who are doing locums don't know you as well, and since they are transient, don't ever GET to know you well and develop a therapeutic relationship.
There is a huge discrepancy between what a doctor thinks (knows) is a good doctor and what a patient does. From a doctor's point of view, a good doctor is obviously someone who has very good clinical accumen in the realm of diagnosis and therapeutics. The icing on the cake would be a good bedside manner, but unfortunately with older docs, this is often not the case. Then you go to a patient's point of view (and there has been studies on this): showing that a patient is much more likely to view a doctor as a "good doctor" if they feel like the person's bedside manner is good, regardless of their clinical accumen.
To clarify, many doctors know of an eccentric older physician (lets' call him Dr. X) they work with who is one of the most brilliant people they've ever met, and if they ever got sick, would want Dr. X looking after them; HOWEVER, because Dr. X's bedside manner is atrocious, patients (who are not aware of what makes a good clinician from the knowledge and clinical accumen point of view) will uniformly say they hate Dr. X and don't trust him. The converse is true as well: there are plenty of doctors out there who are really nice and easy to get along with, but don't have the best clinical skills. Patients often trust anything this doctor says, and when another doctor gives a dissenting opinion, they are less likely to listen, even if doctor II is correct.
What am I trying to get at? Well, the optimal doctor would be someone who not only has a razor sharp clinical accumen, but also has amazing bedside manner. Wouldn't that be great eh?!
Soooooooooooooooooooooooo, in Canada, I don't think we have the bnf or whatever...we have something called CPS. While it is the "bible" so to speak of drugs, physicians often nowadays use things internet search engines first of all because it is way faster, and second of all because search engines help to find the medical databases (like Micromedex) that clinicians around the world use. The CPS (or bnf) is a great resource, yes, but the 'net can hook you up with electronic versions of that resource which saves a lot of time.
Finally, I mentioned a few medications like bupropion, mirtazipine and venlafaxine--did your doctor mention any of those?
Incompetent GP 
Which drug is prescribed is often down to the preference of the individual doctor, and not often not based upon anything other than their own anecdotal evidence. The same is also true of anti-psychotics. 
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