Thread by @MarkOneinFour

I think it's a good idea to argue antidepressants and other medications might not be the best first step in a stepped care model. But people don't usually seek help when they feel a bit off they seek help when things are really bad. And therapy/counselling is uncertain quality

https://twitter.com/joannamoncrieff/status/1348646697044484097

We can have arguments about medicalising of human responses to adversity all we want, but we do currently have mainly medical services as our first point of contact when people are feeling awful. Alternatives would be good, and we should build them. But they aren't a quick fix

I don't think we're talking here about people who either are busting to prescribe antidepressants or people who are gasping to have them. But we're also not talking about having few off days. We're talking about people feeling 'holy shit, I have no idea of what to do about this'

So if we are worried about prescribing medication, we need a few things:

-Structured, regular support
-People to talk to and with about life
-Something that can be done when people feel they are really having difficulties both practical and existential
-A non polarised debate

We also need to make sure we acknowledge not everyone wants to go on a therapeutic journey; not everyone is safe to do so right now in these circumstance. But also that journey is absolutely what some people want right now. And that it can be hard to know in the middle of things

I think what we are seeing is that because of the current situation (and lots of other factors pre-existing it) there are a sizable number of people finding it hard to keep going right now. And that 'right now' is important. It can't be parked until 'a better way' is in place

If, as looks likely, pandemic conditions are going to continue far into this year, there will need to be a 'something else' as well as medication. But a something else that can be reached through the same conversation with a GP that currently can prescribe antidepressants.

People being prescribed antidepressants have already seen what else is on offer (if anything) but still had consultation with GP. At best GP can suggest an alternative or make a referral. You might argue that person shouldn't medicalise themselves, but they'd still have a problem

It's hard to sit with your head toppling over, even in perfect situation and with lots of options and support. I'd agree that taking antidepressants has lots of associated issues, but in this context, for the people in question, so would any alternatives, including sitting it out

Keep thinking 'I think your moods and emotions are understandable right now during this pandemic' has great personal power when expressed person to person. I'm not sure as a blanket abstract it really addressees people's needs when they feel at crisis. Won't get me in the shower