Physical Activity and Men’s Health Week 2017 at Partridge Street General Practice 

June is Men’s Health Month and June 12-16 is Men’s Health Week at Partridge Street General Practice. Men are important and Health is important so let’s look at some issues in Men’s Health.

 

 

First up was Alcohol.

Then came Nutrition.

Then Smoking.

Now Physical Activity.

 

 

Remember those challenges of life? Men face challenges – we have to be providers, to be strong, to keep our emotions bottled up. Challenges are faced with solutions…or avoided with distractions. Let’s look at a solution. Physical Activity. This is a subject close to my heart and I’ve talked about it a few times before. In fact, you might even say I’ve talked about it a lot.

 

 

nick tellis running melbourne

 

 

What can Your GP do to help you get more physical activity into your life? We can explore specifics in person, but here are the basics.

 

 

Work up to 10,000 steps a day

Do something that makes you sweat for 25-45 minutes, 3-5 times a week

Find a physical activity you enjoy and make it regular

Get together with some like minded active friends

Repeat

 

 

 

Remember, getting physical activity back into your life can be hard, and many people won’t get it right first try. Your GP knows this and won’t give up on you. We can abandon a plan, but we won’t abandon you.

 

Image result for what now

 

So Men, Partridge Street General Practice is going to meet you halfway. We’re reaching out to You and we’re looking forward to you reaching back to us.
We challenge you to get healthier with us. 

  • Stop smoking
  • Cut down drinking
  • Eat better
  • Get more physical activity into your life

We’re going to do it, we’re going to live it, and the team at Partridge Street General Practice are going to run the City to Bay this year for the Childhood Cancer Association

Support them while we support you!

More details soon!

 


See you then or in person if you’d like to talk.




 

From the Men’s Health Week website:

 

A boy born in Australia in 2010 has a life expectancy of 78.0 years while a baby girl born at the same time could expect to live to 82.3 years old. Right from the start, boys suffer more illness, more accidents and die earlier than their female counterparts.

Men take their own lives at four times the rate of women (that’s five men a day, on average). Accidents, cancer and heart disease all account for the majority of male deaths.

Seven leading causes are common to both males and females, although only Ischaemic heart disease shares the same ranking in both sexes (1st). Malignant neoplasms of prostate (6th), Malignant neoplasms of lymphoid, haematopoietic and related tissue (7th) and Intentional self-harm (10th) are only represented within the male top 10 causes.

 

 

 

The above figures are taken from the Australian Bureau of Statistics. Furthermore, there are specific populations of marginalised men with far worse health statistics. These marginalised groups include Aboriginal and Torres Strait Islander men, refugees, men in prison or newly released from prison and men of low socioeconomic standing.

 

Men’s Health Week has a direct focus on the health impacts of men’s and boys’ environments. It serves to ask two questions:

 

What factors in men’s and boy’s environments contribute to the status of male health as indicated in the table above?

How can we turn that around and create positive environments in men’s and boy’s lives?

 

We’re going to ask and answer those questions this week. Stay with us online and in person – we’ve got your back!

 

img_8730

 

Your GPs at Partridge Street General Practice

 

Dr Gareth Boucher

 

Dr Ali Waddell

 

Dr Emmy Bauer

 

Dr Nick Mouktaroudis

 

Dr Nick Tellis

 

img_1440

 

 

Smoking and Men’s Health Week 2017 at Partridge Street General Practice 

June is Men’s Health Month and June 12-16 is Men’s Health Week at Partridge Street General Practice. Men are important and Health is important so let’s look at some issues in Men’s Health.

 

 

First up was Alcohol.

Then came Nutrition.

Now Smoking.

 

 

In life we all face challenges. Men face challenges – we have to be providers, to be strong, to keep our emotions bottled up. Challenges are faced with solutions…or avoided with distractions. Smoking is unequivocally a distraction from the challenges of life. Many patients say to me that they smoke because they’re bored or because it’s ‘their time’. Lets try another way. It’s healthier, you’ll live longer, and be fitter. You’ll also have more money, smell better, and be more attractive.

 

 

Image result for good looking non smoker

 

 

What can Your GP do to help you give smoking the boot? We ask you about your smoking, get an idea of how much and when you smoke, and then go into why you smoke. What does it do for you? We can then help by offering some solutions rather than distractions. Counselling, Psychotherapy, Hypnosis, and medications are all options we can explore in person. Remember, smoking is addictive, and many people will not quit for good the first time they try. Your GP knows this and won’t give up on you. We can abandon a plan, but we won’t abandon you.

 

 

 

Ask

Assess

Advise

Assist

Arrange Follow Up

 

 

 

 

Sit down. Have a think about how much you smoke (and what you smoke) and why and when you smoke.

 

 

 

File_001

 

 

 

How did you go? See you next post or in person if you’d like to talk.

 

From the Men’s Health Week website:

 

A boy born in Australia in 2010 has a life expectancy of 78.0 years while a baby girl born at the same time could expect to live to 82.3 years old. Right from the start, boys suffer more illness, more accidents and die earlier than their female counterparts.

Men take their own lives at four times the rate of women (that’s five men a day, on average). Accidents, cancer and heart disease all account for the majority of male deaths.

Seven leading causes are common to both males and females, although only Ischaemic heart disease shares the same ranking in both sexes (1st). Malignant neoplasms of prostate (6th), Malignant neoplasms of lymphoid, haematopoietic and related tissue (7th) and Intentional self-harm (10th) are only represented within the male top 10 causes.

 

 

 

The above figures are taken from the Australian Bureau of Statistics. Furthermore, there are specific populations of marginalised men with far worse health statistics. These marginalised groups include Aboriginal and Torres Strait Islander men, refugees, men in prison or newly released from prison and men of low socioeconomic standing.

 

Men’s Health Week has a direct focus on the health impacts of men’s and boys’ environments. It serves to ask two questions:

 

What factors in men’s and boy’s environments contribute to the status of male health as indicated in the table above?

How can we turn that around and create positive environments in men’s and boy’s lives?

 

We’re going to ask and answer those questions this week. Stay with us online and in person – we’ve got your back!

 

img_8730

 

Your GPs at Partridge Street General Practice

 

Dr Gareth Boucher

 

Dr Ali Waddell

 

Dr Emmy Bauer

 

Dr Nick Mouktaroudis

 

Dr Nick Tellis

 

img_1440

 

 

Nutrition and Men’s Health Week 2017 at Partridge Street General Practice 

June is Men’s Health Month and June 12-16 is Men’s Health Week at Partridge Street General Practice. Men are important and Health is important so let’s look at some issues in Men’s Health.

 

 

First up was Alcohol.

Next is Nutrition.

 

 

 

 

img_1724

 

 

 

You are what you eat and you just cannot out-exercise a bad diet. I wrote about this a few times before…

here

here

here

and even here!

 

What are my tips?

 

 

6f3385db-5d62-4b53-b1e4-0f6078d15ce0

 

 

Smaller Portions

Mindful Eating

No Sugar (including, as far as possible for you, ‘hidden’ sugars)

More Water

Less Alcohol

 

 

 

 

Sit down. Have a think about how much food you eat and why and when you eat it.

 

How did you go? See you next post or in person if you’d like to talk.

 

From the Men’s Health Week website:

 

A boy born in Australia in 2010 has a life expectancy of 78.0 years while a baby girl born at the same time could expect to live to 82.3 years old. Right from the start, boys suffer more illness, more accidents and die earlier than their female counterparts.

Men take their own lives at four times the rate of women (that’s five men a day, on average). Accidents, cancer and heart disease all account for the majority of male deaths.

Seven leading causes are common to both males and females, although only Ischaemic heart disease shares the same ranking in both sexes (1st). Malignant neoplasms of prostate (6th), Malignant neoplasms of lymphoid, haematopoietic and related tissue (7th) and Intentional self-harm (10th) are only represented within the male top 10 causes.

 

 

 

The above figures are taken from the Australian Bureau of Statistics. Furthermore, there are specific populations of marginalised men with far worse health statistics. These marginalised groups include Aboriginal and Torres Strait Islander men, refugees, men in prison or newly released from prison and men of low socioeconomic standing.

 

Men’s Health Week has a direct focus on the health impacts of men’s and boys’ environments. It serves to ask two questions:

 

What factors in men’s and boy’s environments contribute to the status of male health as indicated in the table above?

How can we turn that around and create positive environments in men’s and boy’s lives?

 

We’re going to ask and answer those questions this week. Stay with us online and in person – we’ve got your back!

 

img_8730

 

Your GPs at Partridge Street General Practice

 

Dr Gareth Boucher

 

Dr Ali Waddell

 

Dr Emmy Bauer

 

Dr Nick Mouktaroudis

 

Dr Nick Tellis

 

img_1440

 

 

Alcohol and Men’s Health Week 2017 at Partridge Street General Practice 

June is Men’s Health Month and June 12-16 is Men’s Health Week at Partridge Street General Practice. Men are important and Health is important so let’s look at some issues in Men’s Health.

 

 

First up is Alcohol.

 

 

alcohol men

 

drink-driving-statistics-facts alcohol men

 

 

 

Alcohol affects every organ system in the body and contributes (negatively) to pretty much every physical and mental ailment. Have a think about it. Remember the CAGE questions:

 

 

 

Have you ever felt you needed to Cut down on your drinking?

Have people Annoyed you by criticizing your drinking?

Have you ever felt Guilty about drinking?

Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

 

 

 

Sit down. Have a think about how much alcohol you drink. Think about why you drink. I’ve even got some thinking music for you.

 

 

How did you go? See you next post or in person if you’d like to talk.

 

From the Men’s Health Week website:

 

A boy born in Australia in 2010 has a life expectancy of 78.0 years while a baby girl born at the same time could expect to live to 82.3 years old. Right from the start, boys suffer more illness, more accidents and die earlier than their female counterparts.

Men take their own lives at four times the rate of women (that’s five men a day, on average). Accidents, cancer and heart disease all account for the majority of male deaths.

Seven leading causes are common to both males and females, although only Ischaemic heart disease shares the same ranking in both sexes (1st). Malignant neoplasms of prostate (6th), Malignant neoplasms of lymphoid, haematopoietic and related tissue (7th) and Intentional self-harm (10th) are only represented within the male top 10 causes.

 

 

 

The above figures are taken from the Australian Bureau of Statistics. Furthermore, there are specific populations of marginalised men with far worse health statistics. These marginalised groups include Aboriginal and Torres Strait Islander men, refugees, men in prison or newly released from prison and men of low socioeconomic standing.

 

Men’s Health Week has a direct focus on the health impacts of men’s and boys’ environments. It serves to ask two questions:

 

What factors in men’s and boy’s environments contribute to the status of male health as indicated in the table above?

How can we turn that around and create positive environments in men’s and boy’s lives?

 

We’re going to ask and answer those questions this week. Stay with us online and in person – we’ve got your back!

 

img_8730

 

Your GPs at Partridge Street General Practice

 

Dr Gareth Boucher

 

Dr Ali Waddell

 

Dr Emmy Bauer

 

Dr Nick Mouktaroudis

 

Dr Nick Tellis

 

img_1440

 

 

Men’s Health Week 2017 at Partridge Street General Practice 

June is Men’s Health Month and June 12-16 is Men’s Health Week at Partridge Street General Practice. Men are important and Health is important so let’s look at some issues in Men’s Health.

 

 

Do you look after yourself like you do your car?

 

From the Men’s Health Week website:

 

A boy born in Australia in 2010 has a life expectancy of 78.0 years while a baby girl born at the same time could expect to live to 82.3 years old. Right from the start, boys suffer more illness, more accidents and die earlier than their female counterparts.
Men take their own lives at four times the rate of women (that’s five men a day, on average). Accidents, cancer and heart disease all account for the majority of male deaths.
Seven leading causes are common to both males and females, although only Ischaemic heart disease shares the same ranking in both sexes (1st). Malignant neoplasms of prostate (6th), Malignant neoplasms of lymphoid, haematopoietic and related tissue (7th) and Intentional self-harm (10th) are only represented within the male top 10 causes.

 

 

Smoking, Skin Cancer, Suicide, and So Much Alcohol

 

The above figures are taken from the Australian Bureau of Statistics. Furthermore, there are specific populations of marginalised men with far worse health statistics. These marginalised groups include Aboriginal and Torres Strait Islander men, refugees, men in prison or newly released from prison and men of low socioeconomic standing.

 

Men’s Health Week has a direct focus on the health impacts of men’s and boys’ environments. It serves to ask two questions:

 

What factors in men’s and boy’s environments contribute to the status of male health as indicated in the table above?

How can we turn that around and create positive environments in men’s and boy’s lives?

 

We’re going to ask and answer those questions this week. Stay with us online and in person – we’ve got your back!

 

img_8730

 

Your GPs at Partridge Street General Practice

 

Dr Gareth Boucher

 

Dr Ali Waddell

 

Dr Emmy Bauer

 

Dr Nick Mouktaroudis

 

Dr Nick Tellis

 

img_1440

 

 

Mr Perfect and #socks4docs

Mental health and depression are serious issues. GPs see, treat, and support people with these issues everyday but who looks after the GPs? We can see that doctors are only human and suffer the same stresses as everyone else. Sadly, sometimes, it is too much.

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I wrote previously about how to detect depression in patients. ‘Listen to the patient’, ‘How do they feel?’, ‘How do they make you feel?’. Experienced GPs can spot depression a mile off…in other people. How many turn that acumen on themselves? How many have their own GP to care for them?

 

 

I also wrote ‘American studies show patients are scared of psychiatric referral. Australian GPs are also scared of psychiatric referral’ and ‘Untreated depression is associated with decreased quality of life and increased mortality. Depression can be successfully treated and treatment is effective. The earlier the better!’. This is as true for GPs and doctors as it is for every other person.

 

 
So GPs, doctors, and others – Exercise, diet, psychotherapy, GP counselling, reducing drug and alcohol use, getting more and better sleep are all options. These take time and effort so give yourself permission to spend these on You. Your friends, family, and colleagues are here for you. They will #bekind.

 

 

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Depression is not just a chemical imbalance. No pill can defeat the entirety of the patient’s life and circumstances pushing them in the wrong direction. Consider the your environment and be aware of the particular pressures of medical work and life. GPs have a fantastic and privileged therapeutic relationship with their patients, and they can use this to capitalise on the essential window of time before delivering medical advice. This “privileged moment for change” prepares people to be receptive to a message before they experience it. Robert Cialdini has coined the term ‘pre-suasion’ to describe this. The therapeutic relationship allows pre-suasion, and therapeutic change can then be addressed, with consideration of motivation, opportunity, and ability.
 

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Dr Eric Levi has literally stepped forward online with the #crazysocks4docs / #socks4docs hashtags. It’s a lighthearted way of getting us to acknowledge a serious topic. I’m in!

 

#socks4docs (holiday edition)

 

 

 

 

 

 

The equally dapper Terry Cornick has been kind enough to contribute his story to my blog – and I hope it gives some of you hope, a good read, and another option for you and your patients.

 

 

Terry is a Healthcare Consultant, Mental Health Advocate and Freelance Writer.

His professional background includes Consulting in Healthcare and he loves creating, research, technology, and communications. Daily he deals and develops relationships with Doctors so knows a little about them too and the unique stresses they are placed under.


Initially as a hobby, Terry created a grassroots men’s mental health support network named “Mr. Perfect” that is growing by the minute. Although it does not pay a cent, it pays handsomely in purpose. You can check it out at
www.mrperfect.org.au


Known sarcastically by his wife as “Dr Terry” he lives on the North Shore of Sydney with his young family and is currently contemplating his next move professionally, navigating the ever challenging and life-threatening dilemma for men of “providing” yet being “Mr. Perfect” personally too.

 

Trying to summarise and reduce my story to a blog is a challenge to say the least. Although a relatively spritely 33 years old, the increasing grey hairs and wrinkles around my eyes and my “old soul” remind me daily this life is a battle. And the battle is ultimately with yourself (hands up I have paraphrased this from a song I once heard, I just cannot remember which).

 

 

I love to compartmentalise and segment so my mind can attempt to process things, ideas, events, thoughts, feelings. Broadly speaking I did this with my life; pre-25 years old, 25 to 30 years old and 30 years old and beyond.

 

 

The first stage can sometimes appear as a blur. But perhaps an easier way of me dealing with it. It was a painful period for the majority of it. A challenging upbringing, tragic events, abuse and trauma pushed me so far into a shell that I never thought I would emerge from it.

 

 

During the okay times, this was okay with me. My introverted character and lack of self-esteem meant hiding was easier and far less painful. Until the occasional explosions. But life then returned to the blur.

 

 

A couple of moments in my early Twenties truly made me question my sanity. So at 21 years old I googled “Depression”. I matched 6 out of 8 symptoms. So clearly I was fine. I closed the laptop and the cycle of darkness continued as did the periodical suicidal meltdowns (behind closed doors of course).

Then the “Great Escape” took me to the other side of the world travelling. Less than two years later I was back in Australia for good, despite this being the deepest, darkest scene of my life. After a night out on the Gold Coast I stood on a balcony peering and leaning over contemplating that this was a good time to jump and end the pain. I felt so weak and thankfully, eventually, stepped back.

 

 

Somehow, after a few more substantial blips and obstacles, my life starting to become what others saw as “success”. More money that I knew what to do with, travel, a waterside apartment and a beautiful partner. One of my best mates teased me at work and called me “Mr. Perfect” regularly, not knowing 1% of my history or what was going on in my complex mind.

Look familiar?

 
Behind the acting and those curtains and backstage was a chaotic scene. Anxiety, PTSD and Depression drove me to the edge. But approaching my 30th year on this earth I made some changes. As I was about to get married, my absent dad passed away in the UK. I was sick of my job and when we started to talk about having a family, I could imagine putting my child through a similar existence.

So I visited my in-law’s family GP. He looked me in the eye and asked “How long have you felt like this?” I paused. “For as long as I can remember.” His usually relaxed face turned serious. “I know a great Psychiatrist I would like you to see”. It took every ounce of energy to do so but once that train was in motion I was getting professional help (lucky enough to have the resources to do this privately) and within six months I felt positive.

I started writing a book and then a blog (I did not show my wife) and Mr. Perfect was born. A chat in the pub with mates, a cursory read of a report about men’s “connectedness” and healthcare professionals I know telling me there was little grassroots support for their male patients, and the Mr. Perfect movement gained momentum.

 

 

There have been many blips, I am not “Perfect” after all. From stopping my medication without advice, from stopping my Doctor appointments to then leading back to professional help when the cloudy spells turned into storms and into hurricanes. These weather systems are here for life, and that’s okay, but with the right strategies I can turn this into something impactful for others.

 

 

But there is hope. Friends, family and colleagues have all benefited and most importantly my son will arguably be the most loved and supported kid when it comes to talking about his mental health.

Thanks Terry! You can see the themes above of time and a relationship as potent therapy for the management of major depressive disorder in general practice. The initial clinical gestalt and the ongoing therapeutic relationship can be powerful tools for change. Depression is subjective and has been part of the human condition throughout history. This gives us all we need to move forward.

 

 It therefore seems fitting to end with the words of a doctor from another time:

“The three grand essentials of happiness are: Something to do, someone to love, and something to hope for.”

Alexander Chalmers (29 March 1759 – 29 December 1834)

If you are worried about depression, anxiety, or have any other mental health concerns, reach out:

ACIS 131465 (South Australia – Acute Crisis Intervention Service)

Partridge Street Doctors

Your GP at Partridge Street General Practice

Dr Gareth Boucher

Dr Ali Waddell

Dr Emmy Bauer

Dr Nick Mouktaroudis

Dr Nick Tellis

Beyond Blue & Beyond Blue New Access (free mental health coaching)

Mr Perfect

Doctor’s Health SA

GPs Down Under

GPDU

Care to Plan, Plan to Care

Whichever way you look at it, there is a great little health precinct on Partridge Street! Let us work together to Help You. Care Plans, Team Care Arrangements, Health Assessments, and Mental Health Care Plans may allow You to receive Medicare Rebates for Great Care from Our Team.

Read more here:

PSGP GP Management Plan Information Sheet

PSGP Health Assessment Information Sheet

 


Your GPs, providing great General Practice Care:

 

Dr Nick Tellis

Dr Nick Mouktaroudis

Dr Ali Waddell

Dr Gareth Boucher

Dr Emmy Bauer

Great Physiotherapists at Aspire Physiotherapy and Pilates – Sally, Alex, Megan, and Monique

A Great Dietician and Diabetic Nurse Educator – Helen at Family Nutrition and Diabetes Services

A Great Podiatrist – Ryan at Sense Podiatry

A Great Psychologist – Dr Amber Keast

Add Great Nurses at Partridge Street General Practice and all the other Allied Health Services and We have a Great Team to Help You!

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Feeling down about Depression?

(Cross posted from the ThinkGP blog)

 

Many years ago, coming to general practice from an emergency medicine background, I sat down with a group of trainee GPs. We started to talk about what we would see in general practice. I’d been working as a locum in general practice for a year and I thought I knew everything. ‘Coughs and colds are the bulk of the work’, I confidently declared. Those older and wiser than me set me straight, and told me that general practice is all about depression and anxiety and that it’ll be a rare consult where these won’t play a role. They were wise words then and now, so let’s talk about major depression in general practice.
 

The books would describe major depression as a subjective diagnosis which depends on reported symptoms rather than objective signs. There are cardinal symptoms of depression, rather than signs. Five or more of the symptoms below, present most of the time nearly every day for at least two consecutive weeks. Depressed mood or loss of interest or pleasure must be present. The symptoms cause substantial distress or impair function, and they are not better explained by substance abuse or a general medical problem. They are over and above what the GP thinks would be normal given the patient’s situation.
 

depression

 
The GP who relies on books alone will be well read… and alone. Listen to the patient! It’s a mood disorder. How do they feel? How do they make you feel? Clinical gestalt is the theory that healthcare practitioners actively organise clinical perceptions into coherent construct wholes, or simply put, how experienced GPs can spot depression a mile off. Listen to your gut. Countertransference can be a powerful tool to show you where you need to go. We’ll come back to the Art of General Practice later. Experienced GPs can’t be everywhere, and so we need some other ways to screen for depression.
 

Enter the rating scales for depression. They read like the alphabet – PHQ-9, BDI, HDRS. They can be used for screening and measurement of progress. Perhaps only 50 percent of patients with major depression are identified without screening [1]. Patients may not volunteer depressive symptoms without direct questioning for many reasons including fear of stigma, a belief that depression is not a matter for primary care, or a belief that depression isn’t a “real” illness but rather a personal flaw, as well as concerns about confidentiality and antidepressant medication [2].
 

In Australian general practice, we use the K10 and the DASS21 or 42. These are validated, easy to administer, reproducible, and recognised as part of the Mental Health Care Planning process. This enables patients with diagnosed depression to obtain a Medicare rebate for psychological therapy with a psychologist. American studies show patients are scared of psychiatric referral. Australian GPs are also scared of psychiatric referral, as it can be hard work to access private psychiatry. MBS item number 291 comes to the rescue and many psychiatrists will use this. They also know that depression masquerades as a variety of somatic symptoms. Untreated depression is associated with decreased quality of life and increased mortality. Depression can be successfully treated and treatment is effective. The earlier the better!
 

I recommend non-pharmacological treatment regularly. Exercise, diet, psychotherapy, GP counselling, reducing drug and alcohol use, getting more and better sleep are all options. These take time and effort, both from the patient and the GP. Remember, your time and presence are important to your patients. Ten minutes of education on diet and exercise can be worth months of medication and the effect can be long-lasting. Red flags include significant physical signs (weight loss is the big one in my opinion) or symptoms such as suicidality or psychosis on mental state examination.
 

Depression is not just a chemical imbalance. No pill can defeat the entirety of the patient’s life and circumstances pushing them in the wrong direction. The good GP will consider the patient in their environment and have an awareness of the social determinants of depression. Personality disorders, illicit drug use, and past abuse can lead to poor life choices and situations. Think about these before printing out a script.
 

When selecting an antidepressant, ask the patient what they’ve been on before. Ask about expectations and experiences and how they define success or failure. I tend to use medications that I’m familiar with and can then counsel patients accordingly. I find SSRIs to be an appropriate first line treatment. The side effects that concern my patients are anticholinergic (dry mouth), sexual (decreased libido and prolonged time to orgasm/ejaculation – so common that medications are now marketed for this purpose alone), and changes in sleep (too wakeful and agitated or too sleepy and hungover). I combat these with the advice to drink plenty of water and to time your medication according to how it makes you feel.
 

Traditionally, antidepressants are taken in the morning, but for those with a significant anxiety component, evening dosing is best. Trial and error will determine the optimal time for a good night’s sleep with no morning hangover. Sexual issues often require a change in medication. The newer medications promise fewer sexual issues, but often an older alternative can achieve the same goals at much lower cost.
 

depression2

 
The literature tells us the most resistant symptoms to treatment are insomnia, followed by sad mood, and decreased concentration. Depression is more likely to reoccur if these symptoms are persistent. I find that fatigue, anhedonia, guilt, worthlessness, and poor concentration are the hardest symptoms to treat successfully. It can be a long road for the patient (and the GP) back to wellness, and it can be hard to stick with treatment over time.
 

GPs have used many strategies to improve treatment adherence and all of us will remember pre-contemplators from our studies. We all get frustrated when patients don’t take our advice but providing information and warning of future consequences doesn’t always work. However, a solution is in clear sight. GPs have a fantastic and privileged therapeutic relationship with their patients, and can use this to capitalise on the essential window of time before you deliver your medical advice. This “privileged moment for change” prepares people to be receptive to a message before they experience it. Robert Cialdini has coined the term ‘pre-suasion’ to describe this. The therapeutic relationship allows pre-suasion, and therapeutic change can then be addressed, with consideration of the patient’s motivation, opportunity, and ability.
 

You can see the themes above of time and a relationship as potent therapy for the management of major depressive disorder in general practice. The initial clinical gestalt and the ongoing therapeutic relationship can be powerful tools for change. Depression is subjective and has been part of the human condition throughout history. This gives us all we need to move forward. Focus on the whole person sitting in front of you. Give them your time and expertise, be thorough, be kind, and be present. It therefore seems fitting to end with the words of a doctor from another time:

 

“The three grand essentials of happiness are: Something to do, someone to love, and something to hope for.”


Alexander Chalmers (29 March 1759 – 29 December 1834)




If you are worried about depression, anxiety, or have any other mental health concerns, reach out:

ACIS 131465 (South Australia – Acute Crisis Intervention Service)

Your GP at Partridge Street General Practice

Dr Gareth Boucher
Dr Ali Waddell
Dr Emmy Bauer
Dr Nick Mouktaroudis
Dr Nick Tellis

Beyond Blue & Beyond Blue New Access (free mental health coaching)

File_000 (2).png
Reach Out

References

  1. Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet. 2009 Aug;374(9690):609-19
  2. Bell RA, Franks P, Duberstein PR, Epstein RM, Feldman MD, Fernandez y Garcia E, Kravitz RL. Suffering in silence: reasons for not disclosing depression in primary care. Ann Fam Med. 2011 Sep;9(5):439-46.

Thanks to Klarem for the beautiful picture above, Marcia Vernon for the Beyond Blue link, and the guys at ThinkGP for their editing and help.