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Comment by erikpukinskis | Hacker News Reader

Just a side note for anyone reading: you can get an SSRI prescription from your GP (general practitioner i.e. normal doctor) you don’t need to go through a psychiatrist.

This is especially true if you are at risk for withdrawal, they will want to prevent that.

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I tried this once, Family Doctor actually ended up giving me a dose that was twice the maximum anyone is ever supposed to take. Thankfully the Pharmacist told me that was an extremely bad idea and he just gave me my normal dose and I continued on for a bit.

After that was when I ended up cold turkey because I lost my doctor and psychiatrists during a big move and couldn't get a refill at any clinic in the new town.

It ended up working out, but it took about a year of absolute torture and probably about another year of just "weirdness". But these days I'm "normal" and off the drugs and never been happier.

Those drugs you used contains benzodiazepine [1]. It's addictive and if used long, do more harm than helping. I'm glad you get rid of it.

[1] https://en.m.wikipedia.org/wiki/Benzodiazepine

Why would you think they're taking benzos on a thread about SSRIs?

Benzos and SSRIs are different things. The former is a CNS depressant that acts instantly. The latter builds up in your system over a month to increase the seretonin levels in your brain. They’re not really related except that someone with, e.g., anxiety might be prescribed both

Thankfully I wasn’t on Benzos, but my mother has been and they definitey can do a lot more harm than good.

2 years of recovery just sounds scary

At the time, very. In hindsight, nearly 10 years of being numb to the world was worse.

This works unless you GP is a huge jerkface in which case find a new one.

Just be honest: tell your GP that your previous provider quit/retired/changed insurance. Bring your prior RX bottles or paperwork. Let them know you have an appointment with your new provider on X date and ask them to cover you until then.

I've done this when changing insurance (twice) and when moving states (New provider had a waitlist. First time she wrote one month then when I reported the waitlist situation she ended up covering it for 3-4 months).

People in Canada aren't allowed to "find a new one".

My parents live on a fairly highly populated island, and the only doctor decided to leave. No new one is allowed to move in to serve the population until the government gets around to setting that up. It will probably be a year or more of thousands of elderly people having no medical care at all.

I explained on the phone that in the US, this demand and lack of supply would quickly sort itself out by someone moving in and setting up. Being a certified MD in the state is all they'd need. This was mind-blowing to my socialized-medicine parents.

In Australia it’s standard for a GP to prescribe SSRIs.

My pharmacist can even prescribe a month’s supply if I’m running out. Stopping an SSRI cold turkey is a really bad idea.

Definitely a very bad idea. The first 2 or so weeks felt euphoric to me but after that it was pure hell for months and months.

Indeed, and this easy availability is potentially a double edged sword.

any medical doctor of any specialization can legally prescribe anything. that doesn't make it a good idea. a piece of supporting evidence is that the doctor's malpractice insurance may not cover any "cowboy" prescribing tendencies.

GPs routinely prescribe SSRIs. Even pediatricians. At least in the US.

A lot of non-psychiatrist doctors prescribe SSRIs around the world, and that's a very good thing. These drugs are safe.

Agreed.

Please don’t make such blanket statements. They can have many harmful side effects, including sexual dysfunction.

I think OP meant to say, these are not drugs is not something you can OD with easily and kill yourself, not that they are side effect free .

In many cases they have induced suicide. There are many ways something can be unsafe.

There are many ways to regulate too. SSRIs are not OTC for the same reason.

There are many drugs a GP can prescribe that are just as dangerous or more so.

There is a reason SSRI are schedule 4 and not schedule 2 . They cannot kill you the same way [1]

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[1] While there is a lot of politics in the classification and putting weed or LSD in schedule 1 is very questionable the list is generally medically accurate.

That’s fair. But I’ll note that the “General” in “General Practitioner” means they specialize in the wide range of health problems that occur frequently in the general population. That includes things like depression, anxiety, ADHD, etc.

I wouldn’t advocate you get a prescription for antipsychotics from your orthopedist, but SSRIs from a GP is probably pretty safe.

Obviously, it depends on the doctor and the symptoms. But a good GP will also refer you out to a specialist when needed. That’s a big part of their job: assessing when to call in a specialist.

As other comments said, GPs routinely prescribe SSRIs. Moreover, it's not remotely cowboy to ensure continuity of care arising from exigent circumstances.

I didn't say it was "cowboy" which I put in quotes and you didn't, I simply said what I said, that insurers can put restrictions on doctors based on their specialties (true fact), that you (as a doctor) fear your insurer considering you to be a cowboy (also a true fact). Malpractice is something to worry about, including whoever educated you :) to look for the worst possible interpretation of what somebody says.

If all you need is a refill on a prescription you’ve been taking for 10 years, how is that “cowboy” prescribing? Also, these are trained professionals with years of education we’re talking about, not some random dude off the street.

anti depressants (and other drugs) have side effects, both in the short term and the long. Patients who want drugs may lie. Trained professionals, yes exactly, but need to have practical experience in an area of medicine to be an effective advocate for the patient.

I can't even believe I'm having to defend this position in front of this crowd, but now many GP's dismissed the symptoms of women's post-partum depression before it become a topic of mainstream discussion on television talk shows? Doctors are not perfect and are not free from various biases, and having had experience with your particular condition is invaluable to you.

> but now many GP's dismissed the symptoms of women's post-partum depression

Weird example given you're arguing against GPs prescribing antidepressants because patients may lie.

And I'd like to see someone lying to get SSRIs out of all the possible choices.

I'm arguing that in the US doctors can prescribe all medications regardless of their specialty (because it's true) and that it's not always a good idea, for example if the doctor is not familiar with recognizing the side effects which are outside of his specialty. (because that's also true) Your shrink is not going to prescribe you statins, as an example, but they could. It's important for a GP to recognize depression, but that doesn't mean they should treat depression, just as they should not give you a heart transplant.

You're arguing like something as at stake for you or you have bone to pick, I'm saying very generic anodyne things, i'm arguing for sober reasonableness.

In the US it’s common for a GP to prescribe SSRI’s. https://bmcprimcare.biomedcentral.com/articles/10.1186/s1287...

More broadly, in rural settings specialists are often impractical to access. So, the best possible standard of care is effectively off the table.

We are talking about SSRIs here, not highly addictive substances. They're among the most prescribed drugs worldwide, I can guarantee you a GP knows very well how they work. Comparing that to a heart transplant is absurd.

> I'm saying very generic anodyne things, i'm arguing for sober reasonableness

You're saying vague things that are roughly as controversial as "water is wet" when read literally, but are out of place and tone-deaf in the context of above discussion.

This is one topic that used to surprise me but I learned better. Hackernews readers seem to be a higher percentage than typical on SSRIs. That and I think we have no idea just how many people are really on them.

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