Dr Safiy Karim MBA MPH MMedSci Ed FRCGP GP locum and GP exec NHS Nottingham City Clinical Commissioning Group Tues 18 th amp 25 th Sept 2018 Mental health PLT httpswwwyoutubecomwatchvXiCrniLQGYc ID: 932680
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Slide1
A GP’s Management of Depression
Dr Safiy Karim,
MBA, MPH, MMedSci (Ed), FRCGP
GP locum and GP exec
NHS Nottingham City Clinical Commissioning Group
Tues 18
th
& 25
th
Sept 2018 – Mental health PLT
Slide2https://www.youtube.com/watch?v=XiCrniLQGYc
WHO
Churchill
Slide3Aim
: To use a different approach to GP management of depression using ebm tips from abroad
Objective:Share the approach I am using with colleagues
New NICE guidelines (due later this year) – seem to indicate my approach is in line with emerging guidance.
Slide4The government has launched the
five-a-day campaign
to persuade people to eat at least
five
portions of fruit and vegetables every
day
. Fruit and vegetables are packed with vitamins, minerals and fibre, as well as being low in calories, so are vital to a healthy diet. 20 Jan 2003
Slide5What are the 5 a day for Mental health and wellbeing?
Can you recall?
Slide6Slide7What do I now do in a consultation (
probably no different to yourselves?)
Active listening
F12 button
PLAN A - Medication/IAPT/both?
Plan B – A piece of paper write out 5 a day plus.
Slide8Slide9Start with low dose Sertraline 50mg
Titration up and slow titration off (use of pill cutter)
B&H (Brain food)
Omega-3s,EPA, usually 3 a day
Evening primrose oil, GLA, 1/wk
Vitamin C 500mg/day
Sunlight & high dose Vitamin D
Let there be light (Boxes) -SAD
Slide10Stop Ruminating:
Exercise 30 minutes day. (min)
Learn something, use brain for new skills, dance, art prescription. SOCIAL.
Stay at WORK – care sick notesResearch sleep
Hunter-gatherer 10 hours/day
Habits, drinks, tech stuff
Careful use short time hypnotic
.
Slide11Slide12IAPT – is valuable and as effective as medication
I use the software rewiring model
10 days free use of HEADSPACE app
MindfulnessCBT
If I am stuck,
Refer to Psychiatry.
Slide13NICE, 2
nd
consultation on depression guidelines.
Not aligned to US/EU modelsNHS – Parity of Esteem(remind re health inequalities NHS outcomes)
Titration down dosage
Self help, physical activities
Slide14WHO
Slide15Aim
: To use a different approach to GP management of depression using ebm tips from abroad
Objective:Share the approach I am using with colleagues
New NICE guidelines (due later this year) – seem to indicate my approach is in line with emerging guidance.