An Outsider’s Observation

Marion Brown is the first of our guest mental health experts to share their story this week. Marion is not a GP (she is a psychotherapist and workplace mediator) – though was married to one for 35 years. Her GP husband sadly took his own life as a consequence of longstanding experiences with stress – and eventually his own intolerable medication complication symptoms being attributed to Medically Unexplained Symptoms (MUS).

Medically Unexplained Symptoms in General Practice

As an independent psychotherapist I have become increasingly alarmed to see, meet and learn about people whose lives are being seriously harmed by medicines prescribed for the common human distress conditions.

I had no idea of the issues that I would find myself seeing unfolding.  Now – after four years of extensive research and exploration, including liaising with the BMA Board of Science to support recognition of actual patient experiences (1) – I feel compelled to write about what I am seeing and learning:

People are encouraged to visit their GP for help with all manner of symptoms – many of which may originate in conditions of stress and distress encountered in our lives and may actually be self-limiting given time, appropriate support and perhaps some change in circumstances.  However people want a quick-fix solution – so expect to leave the GP surgery with a prescription.  This could be tablets for ‘sleep’, ‘anxiety’, ‘depression’, ‘palpitations’, ‘panic attacks’, ‘indigestion’, ‘IBS’ and so on.

Most people know a bit about the mind-body connection – and how we can become ill through prolonged (or traumatic) stress causing mental and physical conditions.  In fact this may encourage people to ‘seek help’ quickly.  However, what they do not usually realise is that the medications prescribed for these common human alarm symptoms act directly on the central nervous system (CNS) – ‘working’ by interfering crudely with the functioning of the most basic and essential autonomic (sympathetic and parasympathetic) nervous systems, which control all the vital functions of the body (digestive, cardiovascular, respiratory, endocrine, sleep, reproductive, immune and other systems) as well as affecting moods, feelings and complex human thought processes.

Once people start taking medications – especially antidepressants which patients are told that they need to keep on taking ‘for at least six months’ or longer – their basic functioning has to cope with new additional systemic stresses. Many people develop new symptoms as the medicines interfere with the complex processes of physiological homeostasis.  If patients do try to ‘come off’ the medication, they can run into further immense difficulties of systemic readjustment with terrible functional and psychological symptoms(2).  These are generally played down or not acknowledged by the GP guidelines.

The GPs, having to comply with their professional guidelines (3,4 & 5) , become frustrated when the patients keep coming back with various ‘functional’, ‘somatic’ or ‘Medically Unexplained Symptoms’ (MUS) for which tests are carried out until it is established that there is ‘no physical cause’ – so the GP then, again following professional guidelines, tries to ‘reassure’ the patient that there is ‘no disease’ and that CBT and exercise – and perhaps ‘acceptance’ and ‘re-attribution’ therapies are what is needed.  Meanwhile the patient is very unwell with various bodily dysfunctions (and frightened, upset, and sometimes angry) and the doctor-patient relationship suffers as both parties become desperate with each other…. NHS resources are stretched beyond limits, patients become iller and actively damaged and disabled and GPs become overstressed and ill too.  

And the GPs go to see their own GP …. and the pattern repeats with ever-more disastrous consequences.

The recent announcement by the BMA(1) has raised awareness that patients are experiencing terrible problems with these commonly prescribed and widely used medications.  It appears to me clear that the rising problem of patients experiencing MUS, resulting in huge costs to the NHS, may actually be partly explained by the inexorable increase in prescribing of antidepressants (especially) which can and do interfere with human functioning and lead to confusing and debilitating ‘Functional Disorders’(2).  Apart from very cursory references, the current GP guidelines skim over these medications as potential causes of MUS.  It appears that GPs and patients are actually being misled – to the serious detriment of all concerned.

I realise that mine may be an unconventional view but I feel a strong ethical duty to share my learning and observations – offering a reframing of the management of ‘Medically Unexplained Symptoms’ in General Practice.

References and further reading:

  1. BMA (2015) – Prescribed  Drugs Associated with Dependence and Withdrawal – Building a Consensus for Action 

http://bmaopac.hosted.exlibrisgroup.com/exlibris/aleph/a21_1/apache_media/H6IB5G1BL8CXVG6EV7.pdf  and subsequent news announcement update  October 2016 https://www.bma.org.uk/collective-voice/policy-and-research/public-and-population-health/prescribed-drugs-dependence-and-withdrawal

  1. Carvahlo A.F. et al.  (2016)  The Safety, Tolerability and risks associated with the Use of Newer Generation Antidepressant Drugs.   Psychotherapy and Psychosomatics – Vol.85, No.5, 2016   

http://www.karger.com/Article/FullText/447034

  1. Royal College of Psychiatrists (2011)

Guidance for Health Professionals on Medically Unexplained Symptoms (MUS)  http://www.rcpsych.ac.uk/pdf/CHECKED%20MUS%20Guidance_A4_4pp_6.pdf

  1. Burton, Chris (Ed) 2013.  ABC of Medically Unexplained Symptoms Wiley-Blackwell/BMJ Books
  1. Patient.info  NHS approved information for doctors and patients

http://patient.info/doctor/medically-unexplained-symptoms-assessment-and-management  

http://patient.info/doctor/somatic-symptom-disorder  

22 Comments
  • Marion Brown
    Posted at 18:44h, 29 December Reply

    Thank you to GP View for publication.
    It may be that readers feel reluctant to comment openly.
    If they wish to contact their own professional body, and/or the BMA (Board of Science contact Laurence Russell lrussell@bma.org.uk), that would be useful – and/or the All Party Parliamentary Group for Prescription Drug Dependence prescribeddrug.org . All are collaborating to address the issues.

    • Heidi Bo Beidi
      Posted at 02:39h, 10 January Reply

      Thank you so much for taking the time and being brave enough to speak out on this topic. I was put on a total of 8 different medications (some in combination) and, over the course of 2 years deteriorated to the point that I was fired from my job. It’s been 3 years, 9 months and 10 days since I was last able to work. The symptoms I’ve experienced have been absolutely disabling and finding ANY provider, whether a GP, Psychiatrist, Psychologist or Naturopath,, has proven to be a frustrating exercise that has left me bitterly angry, disillusioned, hopeless and untrusting of the medical profession in any capacity and don’t get me started on Social Workers!

      I’ve spent many months as an admin in a Facebook support group for people in the same situation seeking answers that they can’t find anywhere else. In these groups at least we can provide the validation we need to realize it’s not all in our heads, we’re not crazy and some people do recover in time. But it’s never enough. Watching so many lose their very lives over the damages caused is brutal for anyone to witness even from afar online.

      The more providers like you do this critical research and speak out about their findings, the more hope we have that others will receive the critical help they need. But the help we really need to achieve recovery is both financial and physical. We lose our livelihoods, friends, families and even our homes. We need help finding medical care who understands what’s happened. We need help with lengthy taper protocols. We need help with basics like cooking and cleaning and shopping. The destruction is both mental and physical and comes in waves. We really need in patient, long term care including a careful clean diet, medical testing for original and new underlying conditions and deficiencies and possibly nutritional supplementation.

      So, thank you again and blessings from the United States of Overmedication

      • Marion Brown
        Posted at 22:18h, 10 January Reply

        Thank you for your input Heidi. Your comment sums up the experience of so many people.

  • Jane Taylor
    Posted at 09:40h, 30 December Reply

    This is a good article and needs to be spread and read far and wide. From my own experience (and that of many many others) I feel it is crucially important to emphasise the the very serious harm caused by Adverse Drug Reactions to SSRIs etc ie. AKATHISIA which is not recognised by the vast majority of the medical profession. Instead, mis-diagnosis (as worsening of original symptoms) is rife and very harmful leading to increased dosage and additional (e.g.. anti psychotic) medications which are so very detrimental to long term physical and mental health. It is truly a very BONKERS situation we are in in the 21st century. So very many advances in technology over the last half century but so very much more harm caused to human beings in the name of ‘medicine’.

  • Marion Brown
    Posted at 13:21h, 31 December Reply

    An article has also appeared today about a doctor’s own experience http://www.wbur.org/commonhealth/2016/12/30/doctors-side-effects-medication

  • Bob Fiddaman
    Posted at 10:42h, 03 January Reply

    Marion, I applaud your efforts here to bring this long-standing problem to the table.

    I have, for many years, been in correspondence with the MHRA, the agency put in place to protect the public from unsafe medications, of which SSRIs, I believe, are.

    One question the MHRA have failed to nswer is with regard to the licencing of SSRIs. They claim, in Prozac, for example, that the ‘benefits outweigh the risks’, however, when asked for a list of detailed benefits, the MHRA cannot provide me with one single benefit. There are, by the industry’s own admission, a large number or reported side effects, including akathisia, which is now known to be a pre-cursor to suicideal thinking nd suicidal completion.

    I have gone public with all of the correspondence with the MHRA and I am baffled as to why GP’s up and down the country are not asking the same questions as I.

    My latest correspondence with them (Nov 2016) can be seen here – there is also backlinks to my previous correspondence with them regarding this issue.

    http://fiddaman.blogspot.co.uk/2016/11/prozac-benefits-vs-risks-mhra.html

  • Bindi Gauntlett
    Posted at 16:24h, 03 January Reply

    Wow what a powerful article! Far too often I hear people say that “they might as well go to the GP for antidepressants because it cannot do any harm can it?”

  • Marion Brown
    Posted at 17:49h, 03 January Reply

    Thank you Bob and Bindi – if only these medicines were ‘no better than placebo’ ….
    There feels to be great urgency to get this message out – when every single day more unsuspecting people are starting on these pills, which can indeed have very bad consequences.

  • Alec Stansfield
    Posted at 15:26h, 04 January Reply

    Great article Marion – thanks! This information needs to be shared as widely as possible. As well as the good news that there is now a solid understanding of “Depression” including what causes it, why people get stuck in it, and how to guide people out of the cycle, safely, effectively and permanently. Even though this represents only one of the many reasons that people seek help from their GP, at long last it provides a viable alternative to the more widely known medication route. I look forward to the day when this understanding becomes common knowledge.

  • Marion Brown
    Posted at 09:54h, 05 January Reply

    Thank you Alec. Many GPs are not aware of the understanding of ‘depression’ that you allude to. For GPs reading this, can I clarify that Alec and myself work from the Human Givens approach, which is am extremely effective approach especially if used at the outset in any distress situation – instead of starting people on medication. For GPs who have yet to find this approach, the website is http://www.hgi.org.uk and the approach to understanding depression is
    http://www.hgi.org.uk/resources/delve-our-extensive-library/depression/how-lift-depression-quickly-and-safely

  • Marion Brown
    Posted at 15:49h, 07 January Reply

    Thank you Jane Taylor for your comment above – and especially for mentioning Akathisia.
    It may be useful to share this brief video describing Akathisia.
    I have seen cases where GPs have missed the signs altogether in their patients (perhaps not surprising given time pressures?)

  • Heather Roberts
    Posted at 14:05h, 13 January Reply

    Totally agree with all those above who have thanked you for this wonderful article. Our son died by prescriptide, started with RoAccutane-isotretinoin for cystic acne, then got the well reported low mood this drug triggers, so was given Seroxat SSRI to cheer him up. It was all downhill after that, he was akathisic but no one seemed able to realise it. He suffered 11 years of hell, and always believe his anxiety and sometimes paranoia were his own fault, and was even castigated by a psychiatrist for being attention seeking when he voiced feelings of suicide. He was a fantastically brave guy.

    Like Bob Fiddaman we too have challenged the MHRA in Parliament and got nowhere. We think they and Big Pharma must share the same nest.

    Thanks again for what you wrote. One of your first contributors wrote I about a wish for some form of holistic inpatient treatment, with good diet and empathic listening. I think that sounds great. Home Treatment, which my son only had for 2 weeks till he was cast off alone to cope, when he was suicidal just before he died, is not the answer. Anxious people need kind understanding and company.

    • Marion Brown
      Posted at 20:26h, 16 January Reply

      Thank you Heather for sharing your son’s story. A tribute to him. I share your determination to ensure that the needlessly lost lives of our loved ones can be afforded the dignity of bringing about long-overdue change.

  • Rebecca Hall
    Posted at 10:03h, 16 January Reply

    I was on SSRIs and a slew of other psychiatric medications for 13 years. I was initially given Zoloft while I was pregnant the age of 19. I never had any anxiety or depression but the doctor insisted I take the medication to ‘calm my nerves’ which made no sense to me. I stayed on the meds all those years being told I may need to take them for the rest of my life. I was told they were safe during pregnancy when I had my second child. She cried for two years before she had an ‘unexplained’ seizure and has been fine ever since. I could get absolutely no help from any of the hundreds of doctors I saw to get off the meds. Countless diagnoses and surgeries and mysterious illnesses all disappeared when I became medication free. It’s been almost a year and I’m very happy to have ditched the doctors that never listened to me. This took 13 of the best years of my life. I slept most of those years away and look back and can’t think of one enjoyable moment. I enjoy telling my current On and anyone that will listen how much better my life is now that I quit taking pills.

    • Marion Brown
      Posted at 20:30h, 16 January Reply

      Thank you for sharing your story Rebecca. There are so many stories that seem to follow a similar pattern. Well done for managing to eventually get off the medications and get your life back again..

  • Noel Thomas
    Posted at 19:27h, 21 January Reply

    Marion Brown is careful and cautious in putting forward what she describes as an unconventional point of view. Unconventional perhaps, but only because we are unthinking slaves to the power of the the Pharma/advertising industry, which ensures that most journals and journalists steer clear of the truth. Her message should be shouted from the rooftops. Sadly most GPs have not heard of David Healy, nor the RxISK website, and if they have heard of Peter Gøtzsche, they would not dream of reading his “ Deadly Psychiatry and Organised Denial “. It should be mandatory reading for anyone who prescribes psychotropics.
    Let us hope that this website continues to encourage the “ unconventional’. It is only by opening our minds, examining especially those options that seem the opposite of received wisdom, that we will avoid the dangers of burnout ourselves, and be able to open hidden or locked doors for our patients.

  • Marion Brown
    Posted at 14:50h, 23 January Reply

    Thank you very much or your encouragement Noel. It is worth mentioning other authors too – James Davies’ ‘Cracked’ is an excellent and very readable summary providing an eye-opener for GPs – and indeed everyone.

    Together with Joanna Moncrieff (The Myth of the Chemical Cure), Sami Timmimi (child psychiatrist) and others, James Davies co-founded the Council for Evidence Based Psychiatry which provides the Seretariat for the APPG-Prescription Drug Dependence prescribeddrug.org .

  • Donald Scott
    Posted at 18:16h, 29 January Reply

    Really informative article, Thanks, Marion.

    In addition to your recommended reading can I recommend Irving Kirsch’s seminal critique of the effects of psychotropic meds:

    http://alphachoices.com/repository/assets/pdf/EmperorsNewDrugs.pdf

    The comments section of his book as sold by Amazon, is an extraordinary example of the Empire of Big Pharma Striking Back. https://www.amazon.com/Emperors-New-Drugs-Exploding-Antidepressant/dp/0465022006

  • Marion Brown
    Posted at 09:19h, 11 February Reply

    For anyone wondering about the functioning (and dysfunction) of the autonomic nervous system (ANS) this blog offers a readable summary:
    http://www.holistichelp.net/dysautonomia-autonomic-nervous-system-dysfunction.html

  • Dr Lizzie Croton
    Posted at 11:01h, 20 March Reply

    Thank you Marion, I am a GP and I do occasionally prescribe these drugs. I’ve also taken them in the past but now thankfully off them. I’ve always been fascinated by MUS and the mind-body link and have done extensive training in this area and incorporate this approach into my practice. I not thankfully prescribe far fewer of these medications now, preferring to concentration on the “process” and “context” of the patient’s complaint. I look at diet, exercise and social support as well as teaching patients ways to regulate their ANS. Frustratingly, the 12 minutes passes by very quickly when looking at all this stuff and this is one of the many reasons why writing a script for a medication can seem an attractive option. For some people SSRIs can help, but most people if given the tools and support to help themselves, will take this option

  • Polly Dee
    Posted at 21:40h, 21 March Reply

    I’m a little confused by the comment above! Whilst it’s pleasing to hear that Dr Croton is fascinated by the mind/body link I fail to see how MUS comes into that!

    MUS is a diagnosis cooked up to look as if it explores the mind/body link but, in truth, it examines no more than the link between somatisation and the assumption of unnecessary expenditure.

    At a time when the government are encouraging us to take mental health more seriously and to put aside stigma, just what exactly does this diagnosis contribute towards this aim?

    Not a lot! ….. but it does signify that mental health care has been targeted as an area where money could be saved particularly in litigation costs should patients who took antidepressants and were withdrawn from them with inappropriate advice, decided to sue!

    What state is health care in, where diagnoses are designed to deal with these issues rather than to contribute to advances in true medical science.
    The integrity of this diagnosis has to be questioned.

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