When anxiety first appears or existing symptoms spiral beyond control the GP surgery is most likely the first port of call. Often we don’t understand where the uncomfortable feelings are coming from or what is actually happening to us. It is frightening and debilitating but It’s reassuring to know that we have medical care available a short distance away. Where else would you go when you feel unwell? Based on past surgery visits you might expect a certain process. Prescription medication, health advice or referral to a specialist to fix whatever needs attention. This isn’t necessarily as simple for a mental health condition. The problem with anxiety is that the diagnostics often involve a complex and very personal set of causes. In addition, the ‘fix it’ prescription route might be all the GP feels they have to offer with time and resource pressures. Medication might be the initial answer in a few cases but it don’t address the root cause and can lead to unpleasant side effects and dependency.
When I began experiencing panic and anxiety symptoms 13 years ago I booked an appointment with my GP. It was difficult sitting in the stuffy waiting area when I felt so anxious. It was also difficult opening up to somebody about my mental health but I had reached a crisis point and wanted some form of intervention. After 5 difficult minutes of explaining how I felt the Doctor offered me a SSRI (Selective serotonin reuptake inhibitor) which I turned down. His following gambit was sleeping tablets for the insomnia all within the first 10 minutes. I got up to leave and he mentioned joining a yoga class as I opened the door.
In hindsight the best piece of advice he gave!
It is important to note that a GP visit will differ depending on many variable factors. This can include resource, education, waiting lists and how proactive and knowledgeable a Doctor is around mental health issues. I’m also not completely anti pharmaceuticals. I didn’t want prescription medication because I had too many personal concerns but for some people a prescription works well alongside other interventions such as CBT. The problem was that I didn’t know what to expect from the Doctor or what was available. Armed with zero information I couldn’t press for other options or hold the GP accountable to any recommendations. I had no idea what was happening to me when I walked in and was none the wiser when I left.
The National Institute for Health and Care Excellence provides guidance, advice, quality standards and information services for health, public health and social care. They have published guidelines relating to patient care when a patient visits medical staff suffering from a generalised anxiety disorder. Here are the recommended steps.
Step 1 – When you walk into the surgery for the first time.
On first contact the Doctor carries out a comprehensive assessment of the patient to establish a diagnosis as quickly as possible. A treatment plan can then be made. Any associated factors that may be causing anxiety are
Identified and advise given about over the counter medication. This means that on your first visit a Doctor spends time fully assessing your symptoms, basing any action on the severity of your condition and not just the duration. They provide you with information, signposting you to good resources. After diagnosis and education, the Doctor then actively monitors the patient.
Step 2 – When education and monitoring isn’t enough.
The point of first line intervention. There are a number of recommendations at this stage.
- Self-help material is offered based on the principles of CBT with minimal contact from a therapist. This should run for at least 6 weeks.
- A guided self-help programme, facilitated by a practitioner who monitors progress. 5-7 weeks of sessions either face to face or via telephone calls.
- Psychoeducational groups with trained practitioners with presentations, manuals and high level intervention. Around 12 participants in 6 weekly group meetings of 2 hours each.
Therefore, if you find yourself back at the surgery you should be offered some form of cognitive behavioural therapy programme (CBT). This can be as part of a group or facilitated by a therapist with differing degrees of contact.
Step 3 – Medication or high intensity intervention
If both steps 1 and 2 have been tried and there is ‘functional impairment’ or no improvement, then step 3 options are medication or high intensity psychological intervention. The treatment is dependent on the patient’s wishes and full written and verbal information should be provided on each so that an informed choice is made. The psychological intervention should consist of 12-15 one hour CBT sessions with a trained practitioner. The prescription advice suggests Sertraline, a selective serotonin reuptake inhibitor (SSRI) in the first instance based on cost with other medication suggestions should this not be possible. There follows prescriptive advice concerning side effects and patient monitoring, particularly in the risk of developing suicidal thoughts and self-harm.
Beyond step 3 are recommendations for a specialist assessment of needs and risks. Ensuing complex treatments can then be prescribed if needed.
Understanding health care guidelines and knowing what to expect before visiting the Doctor greatly empowers you in the first steps towards conquering an anxiety disorder. If your visit ends abruptly after 10 minutes with a prescription for an SSRI or advice that belittles the severity of your symptoms, then question the protocol. Ask your Doctor why they have not carried out a full assessment as in step 1 or offered the interventions at stage 2. Make sure that you are receiving information on the drugs offered to you and feel ready to make an informed decision at stage 3.
So many of my patients are offered no proper assessment, drug solutions on day one or the promise of CBT with impossibly long waiting lists. Even if resources are scare push the GP for self-guided or low intensity programs to bridge the gap.
I would love to hear of your experiences please do comment below and share.