Language matters: indeed it does

This February 2020 edition of the BJGP contains topics that are more closely interrelated than first appears, and the relationship is crucial for GPs to recognise.

As you say, language matters and ‘The chances of a successful outcome are less good when … the consultation includes topics such as common mental health disorders and the highly contested territories of persistent but “medically” unexplained symptoms and maladaptive responses to commonplace adversities’:¹

• ‘Predicting and preventing relapse of depression in primary care’² — ‘There has been a shift in the understanding of depression as a discrete or episodic illness to being considered a long-term relapsing-remitting condition with possibly incomplete recovery between episodes …’

• ‘Anxiety and depression in adolescents and young adults’³ — ‘Of particular concern is the alarming apparent rise of these problems in girls and young women. A 2017 UK practice-based study of self-harm showed a 68% rise in incidence in girls aged 13–16 years between 2011–2014.’

• ‘Patients’ descriptions of the relation between physical symptoms and negative emotions’⁴ — ‘Primary care guidelines for the management of persistent, often “medically unexplained”, physical symptoms encourage GPs to discuss with patients how these symptoms relate to negative emotions.’

• ‘Medically unexplained symptoms’⁵ — ‘Most GPs labelled the presented symptoms as medically unexplained soon after the start of the consultation.’

Taking into account the recent report on the 2018/2019 Public Health England review of prescribed medicines associated with dependence and withdrawal,⁶ the links become clear. Many patients who may suffer ‘common mental health disorders’, and those who suffer economic hardship and commonplace adversities, are prescribed drugs for ‘depression’, ‘anxiety’, ‘trauma’, etc. — which carry underplayed risks of dependence and withdrawal. Many such patients go on to experience all manner of distressing ‘unexplained’ physical and psychological symptoms. Some of these ‘unexplained’ symptoms can be very severe indeed, including drug-induced akathisia, which can lead to self-harm and suicide. Antidepressants (and other prescribed medicines) can cause akathisia — especially at certain times of dose change or even after withdrawal — and this serious adverse drug reaction is frequently misdiagnosed as ‘anxiety’ and ‘restlessness’, with sometimes tragic consequences.⁷

Language matters very greatly.