ABU DHABI // Patients suffering from depression in the region are often not getting the medication they need because of a fear of being stigmatised if they visit a psychiatrist.
While doctors admit it would often be ideal for patients suffering depression to see a specialist – who can prescribe a course of anti-depressants, among other treatments – the reality is that they often do not, either because GPs do not spot the symptoms or because patients fear being stigmatised and regarded as “crazy”.
“We tell them to go to Amal hospital or to see a psychiatrist,” said Dr Leena Bhatia, a general physician at Al Baraha hospital in Dubai. “But they say that is for maniacs and crazy people, so not many go.
“We would give them the medications, but we are too scared and hesitant – we would prefer them to see a psychiatrist.”
Even if GPs are trained to recognise the symptoms of depressions, they are largely powerless to help. GPs in state-run clinics are not allowed to prescribe the most common anti-depressant drugs, which are known as selective serotonin re-uptake inhibitors (SSRIs) and include Prozac and Seroxat.
Even emergency doctors are allowed to prescribe the drugs for just a day at a time. That, according to Dr Hamy Moselhy, a psychiatrist at UAE University in Al Ain, is a “waste of time”. The medications need “four to six weeks to have an effect”. Private family doctors have more leeway, being allowed to give courses of up to 30 days.
But they often do not feel adequately experienced to do so, preferring to give a referral to a specialist. However, Arab patients are often reluctant to follow up on such referrals.
“We sometimes prescribe SSRIs, but only in small dosages,” Dr Bhatia said. “We worry that we don’t follow up with them much and of the medications’ side-effects.”
Instead, some doctors prescribe ineffective medications to placate their patients. “Vitamins are given to depressed patients,” said Dr Muna al Kuwari, the head of primary health care at the Ministry of Health.
Dr Adel al Zayed, a psychiatrist at Kuwait University in Kuwait, tells GPs “not to hesitate to give anti-depressants, even if unsure”.
“Arab people say ‘how can we be depressed, we pray all the time, to hell with psychiatrists and Freud’,” he said. “Anyone with a depressed mood, loss of interest or pleasure, is depressed, by definition.”
Dr Adel Zaraa, a psychiatrist at Hamad Medical Corporation in Qatar, has been urging GPs to listen to patients more at clinics.
“Over 70 per cent of patients who commit suicide are said to have seen a GP beforehand,” he said. “The message is clear, you must do something, and tell your colleagues.
“GPs are at the forefront, they see all the patients. Doctors need to listen. Patients have already told them their back pain could be a sign of burden or stress – ask them about their life. You cannot treat patients physically without keeping their mental health in control.”
Only “serious and complicated mental health care problems” should be referred to psychiatrists, said Dr Adel al Offi, a psychiatrist at the Ministry of Health in Bahrain.
Dr Moselhy agreed that visiting a GP often suited patients better. “Going to the GP is less labelling for patients than going to a psych clinic, especially in our society.
“It is easier for them to be treated there, and less time-consuming. A psychiatrist’s waiting list is longer than the GPs by far.
“They need more rights, and more training,” he said. “In the UK it is mandatory for GPs to work for six months in psychiatry – it isn’t the same here.”
However, several doctors said they saw the reason behind the ministry’s controls. “Some of these drugs are addictive,” said Dr Josef Guirgis, a UK-based psychiatrist. They could be abused even with a three-day course limit, he said.
“We have a problem: there could be damage if we prescribe them, and damage if we don’t.
“In this case GPs should spend an extra 10 minutes with patients and ask more questions.”
Since 2008, the Ministry of Health has been trying to integrate some mental health services into clinics, including counselling.
Ministry officials said they were waiting approval for certain non-addictive medications to be prescribed by GPs.