Interview 06

Age at interview: 44

Age at diagnosis: 41

Brief Outline: Has responded very well to Prozac (currently 20 mg) and cognitive behavioural therapy, and feels she should be on an antidepressant permanently to correct a chemical imbalance.

Background: A married health care professional, with 4 children. Has probably suffered since her teens. She experiences mainly depressive episodes with some euphoria in-between.

Believes she has had depression for many years but was able to normalise it, and only considered...

I want to begin by asking you if you remember a time before the depression, what life was like?

I actually find it quite difficult to remember a time (before depression) because whenever I look back now I wonder if it wasn't sort of... that I've been chronically almost depressed for a number of years. Prior to being diagnosed, I had periods where I felt really, really low that, for what seems very little reason I would suddenly plummet to, great depths. And I had real difficulty keeping going on, on a day to day basis.

And eventually I would just sort of keep my head down, keep on working, feeling really miserable inside, but eventually emerge at the other side. And then to counterbalance that, there were times that I felt it was almost euphoric. So I had the huge sort of waves and dips, emotionally and mentally, for a number of years. So I look back now, and I think it was probably in my late teens, early twenties that I can remember a phase where perhaps I wasn't affected to that degree. But it became much more prevalent probably in the last 7 or 8 years. 

I was very aware that, at times, things were really difficult, but it still never struck me. I just thought that..... blamed it on hormones, blamed it on life events etc. But I went through a period where in one of my very low periods, that I began to contemplate suicide, contemplate, actually just that life wasn't worth going on. 

There was no point wading through this shit, I suppose any longer, it was just becoming more and more difficult. And it was at that point that... that I realised that if I was going to get through this'that I had to seek some help. And that's when I went to see my GP.

Wanted her GP (who was also a friend) to notice her problem, but was worried that if she told him...

I couldn't imagine being able to go along and tell him any of the things that were really going on inside me. Because how would that affect our friendship, and our friendship was a family friendship. You know, we went out socially, his wife and himself, and myself and my husband. Our children played together, and I felt that if he knew the real me, you know, he wouldn't necessary want to go out and spend social time. And it was like uncovering something in myself and at that time I saw as, as a weakness.

Well I obviously' it all became too much and I felt myself sort of falling onto his desk weeping and he was quite taken aback. You know, "What's wrong?" and I... it all just started and it came out one thing after the other, how miserable I was feeling, and about, you know, how low I felt. And I couldn't bear to continue living like that any longer. And that my friend had insisted that I come in and talk to him and, and he was really good. He wanted to know why I hadn't spoken to him before and I said, "That I wanted, I wanted you to recognise that there was something not quite right, and you didn't."

Said it took 7 weeks from starting fluoxetine (Prozac) to the time that her depression lifted in...

But I still... I was still waiting for this feeling of happiness I suppose to come in, and it didn't. And then one morning, and it was exactly 7 weeks to the day that I took, you know, the first tablet. I woke up that morning and I just knew that inside myself that I felt different. I'm not, I don't know that I could describe it, or have the language to describe it, I just know, I knew that morning when I woke up that I feel differently, things are different. And that was the turning point. So I think I'd started medication towards the end of May and this was into July.

It was this lifting again, this lifting of overall and just .... contentedness I think probably, this, it was, back there again, from I don't now how long ago since I had felt that way. Whether it was a combination of that and the sleep that I just generally began to feel better. And, and physically more well. And happy again. You know, I think I began to laugh out loud again and, and that it was from inside, it wasn't just a sort of superficial laugh, it was a sort of deep inside laughing.

When her GP suggested she come off Prozac (fluoxetine) after 2 years, she became depressed again....

So I try and make an appointment every three months or so to pop in and see him. And whenever he persuaded me' or would suggest or advise probably rather than persuade'. Advise that perhaps after being on the anti depressants for two years, that I should come off it. I was a bit unsure and he went on to say, 'Well you know it's worth giving it a try. Why don't you? You'll come and see me every two weeks and we'll see how you're getting on and we can monitor it closely.' And so I did. 

I came off it fairly gradually, although I believe that's actually not necessary. You can stop and start I've read elsewhere now without sort of tailing off, but I did sort of tail it off over the period of about a month. And then whenever I went back everything was reasonable, ok after the first few weeks, and then very slowly it began to sort of slide again. And so when I went back and suggested that perhaps I could go on to this medication again he said, 'Well ok.' He was happy enough with that. 

The guidelines suggested that you know if you had sort of one depressive illness you should be on it for six months. The second occasion, on it for a minimum of two years, and the third occasion that you would be on it for five years. And so, I feel well, and for the next four and a half years from now I am quite safe. I can still continue taking that. 

But in five years time do I have to go back and sort of plead my case again? Ask, as it were, if I can continue taking them, or do I have to go back through that misery of feeling that it's all going pear shaped again and maybe existing for a number of months not feeling well?

Discusses how a therapist helped her to see that she might not be at fault if an acquaintance...

I think one of the analogies he used first off was, if I was walking down the street and somebody came walking towards me that I knew, and I knew well, but that they looked away and walked past me, how would I feel. And I said, "Well, you know, oh my God, you know, what have I done?" Or trying to remember the last time I met them, I mean what had I said. You know, feeling guilty that it was obviously my fault. It would never have crossed my mind as he would suggest, as he suggested to think that the person might well have had things on their mind, may not actually have seen me, may have been distracted by something else.....And I, I saw for the first time, other people had other issues that were quite separate from me.....And it made me realise over a period of time that....if something happened that I felt unhappy about [pause], I only saw it from one angle.

Is much more confident to organise her family life so she can have time for herself to walk in...

If I want to go and walk in the hills on the weekend when I'm off. I will go and do it, whereas before there was always other people that I had to consider. And it's not that I waltz out now and leave them all. I make sure that everything is alright. 

But if I want to do something, or I want to go into town and meet a friend for coffee or go out in the evening and meet a friend for a drink, then rather than turning it down because, you know, I feel that I need to be there all of the time, or that I will be thought less of if I'm not there all of the time, you know, I am quite able to sort of say to my husband or to the children'. and fortunately they are getting older and more independent'. that I'm going to pop out for an hour. I'll not be long. I've got the mobile phone with me, I'll see you whenever I get back in again. 

So I suppose those are probably the most' and also because I am much more able to relax, I get less wound up by things so if I just want a weekend of chilling out and not doing anything I'm much happier about saying it, you know, I don't want to do anything this weekend. Just want to sit here and vegetate.

She told her friend about a suicide attempt, and her friend took her straight to her GP for help.

This man, in a sort of twilighty evening, this man emerged walking his, his dog, and climbing up from one lock gate to the next, and came upon me standing there solitary in the light. And said, 'Are you alright?' He scared me actually to the point that I almost fell in. I mean, but it jerked me back into reality again and, and I stepped back. And he, he didn't get into conversation with me or anything, but I stepped back and realised you know, that I have, you know, this was really as far as I'd ever gone before. So I got in the car and drove home. 

And the next day, as I say I had was meeting this friend, and we went for a swim and I admitted, you know, what I'd done the night before and how easy it would have been just to let go. And, she said, "Oh, you know, I think the time has come, you must go and talk to your GP, you must do something about this." And she actually made me get out of the swimming pool, she made me get dressed and she rang the surgery and made an appointment. And thankfully, you know, I was able to get an appointment that same afternoon, and she waited with me. And actually accompanied me to the surgery. She didn't go in with me.

She is unsure how to tell her children about her depression, but may discuss it when they are...

Have you talked to your children about the medication and your depression?

Isn't that strange, no. I don't tell them that I am taking antidepressants. I never have told them that I was diagnosed with depression. Actually never really thought about it. Occasionally they have asked me, you know, what are those tablets for when they see me taking my tablet every morning. But because I also take HRT because it, this period coincided or came shortly after I'd surgically induced menopause, I have always just said it is part of my treatment for replacing my hormones and that I've not sort of distinguished one tablet from the other. I just take the two each morning. 

So no, I don't know what other people do. Do they share it? Maybe when they are slightly older and I mean my oldest is now a medical student, so I daresay it will not be that much longer before he actually knows what fluoxetine is. And I am sure the other have possibly heard of Prozac because of sometimes the bad media cover that you get of it. But I don't think that they relate that to the medication that I take because it is not called Prozac on the box. It's just called fluoxetine. So I am not sure.

Her mother was ashamed of depression, but this health professional strives to be more accepting...

I think that my mother had very similar experience to myself. She had, you know, I remember these highs and lows that she had. And I remember a couple of cases where she had you know a depressive, depressed period where she actually was on antidepressants. She didn't like taking them. She was ashamed of her depression, and she stopped taking them probably far too early, but you know this was just a period where I was in my probably late teens, early twenties. But then unfortunately she died shortly after that, so it's difficult to follow that through.  

And I suppose she wasn't seeing the real me in the short periods that we had together by that stage, because I had left home and was only coming back for a few days at a time. But whether you... she didn't see her depression as being a chronic illness. I'm not sure, I... part of me thinks that I am better at recognising it in others now. I sometimes see it in patients that are exhibiting maybe those early signs of what could be clinical depression that I might have missed before or given another reason for. But there is a familial link and I don't know if there is, but if there is a familial link you know I would hope that I would be more aware of how they are dealing with things in general. And maybe how I could help them if indeed they became like that. I think, I have a much more open relationship I think with my children now than I ever had with my own mother.