People with treatment-resistant (difficult to treat) mental health conditions experience a cycle of care in primary care

Amelia Talbot is a DPhil student in the Medical Sociology and Health Experiences Research Group researching treatment-resistant depression. She is also a research assistant for a COVID-19 project. Amelia’s DPhil is funded by Green Templeton’s Rosamund Snow Scholarship.

Here, Amelia discusses her research:

Doctors often prescribe antidepressants (alongside what’s called talking therapy, like counselling) for people who have mental health conditions like anxiety, depression, panic disorder, post-traumatic stress, and obsessive-compulsive disorder. But antidepressants actually don’t help some people who have ‘treatment-resistant’ mental health conditions (also known as enduring, chronic, difficult to treat, life-long, recurrent). Treatment-resistant mental health conditions are where people’s mental health stays the same or actually gets worse after taking antidepressants for a few weeks.

People with treatment-resistant mental health conditions should have specialist care from a team of psychiatrists, counsellors, and other mental health professionals, but this is not happening due to long waiting times. This means that general practitioners (GPs) end up caring for people with treatment-resistant mental health conditions, but GPs often find this challenging. This is because research studies that provide GPs with guidance on how to care for people with these conditions are hard to find. I put together these research studies and created action points to help GPs support people with treatment-resistant mental health conditions.

Understanding the bigger picture

To understand more about this area, I looked at 11 different research studies carried out on this topic which provide guidance for GPs to care for people with treatment-resistant mental health conditions. I found that people with treatment-resistant mental health conditions experience a cycle of mental health care in primary care made up of three stages. I describe these three stages below:

Stage One: When to see a GP

People liked to treat their mental health themselves before seeing a GP. They felt like not having enough support from friends and family, and previous negative experiences with GPs were stopping them from seeing their GP for their mental health.

Stage Two: Experiences with GPs

People saw their GP when their mental health became too bad for them to treat by themselves. People were confident that their GP could help make their mental health better.

Stage Three: Treatment and self-management

GPs normally gave people antidepressants to help their mental health. But, people were unsure how much antidepressants helped their mental health. These people felt like antidepressants actually made their mental health worse, so they decided to stop taking them. They did not talk with their GPs about this decision.

People felt that their mental health had gotten really bad again after stopping their antidepressants. They felt like they had to see their GP again to get more antidepressants. Thse people still mentioned not wanting to take antidepressants.

Return to Stage One.

The Repeated Cycle Of Care

People in the research studies moved between seeing a GP, treatment and self-management in a repeated cycle. This is dangerous because people with treatment-resistant mental health conditions are not getting the help they need, and this has several implications:

For Policymakers

Secondary care needs more funding so that people can seek specialist care.

For People with Treatment-Resistant Mental Health Conditions

Seeing a GP before a mental health crisis is ok. If you feel that your antidepressants are not working, speak to your GP. It can take some time to find an antidepressant that works for you.

For GPs

People with treatment-resistant mental health conditions would benefit from a conversation about antidepressants failing to work. These people may benefit from a rapid change in the care they receive, including regular follow-up appointments with the same GP.

What’s Next?

I have written a chapter for this study for my DPhil thesis. I will publish this soon in a medical journal to get my findings to researchers and people who who work in primary care. I am also planning ways to get my research findings to people with lived experience of treatment-resistant mental health conditions.

Please contact me via email if you have any questions or want to talk about my findings (amelia.talbot@phc.ox.ac.uk) or follow me on (@AmeliaTalbot).

Acknowledgements

Thank you to Charlotte Albury, Sara Ryan, Charlotte Lee, Kamal Mahtani and Nia Roberts. Thank you to all public contributors. Thank you to Dan Richards-Doran who helped edit this blog.