Antidepressants

Yes I said to him look this isn’t making any difference really I’m still feeling really low and I’m still having very bad thoughts, you know, and I’ve been on this for the best part of a year now, so why don’t we try something else. So he came up with a couple of suggestions and we actually worked through the pros and cons of each drug that he came up with.
 
And the pros and cons meaning what?
 
The side effects of the drug over the benefits of the drug because we obviously we’d looked at sertraline but we also looked at using in conjunction with the duloxetine quetiapine and he explained the drug and the side effects, well potential side effects and we decided in the end that Sertraline was a better option.
 
Is it quite helpful then to have another person that you can go to for support or advice rather than always just having the one person with their own take on things?
 
Yes different viewpoints give you a much wider, I don’t know experience, what might affect me might not affect you and to get different people’s experiences of it gives you a broader vision and you get to see more of how is this happening but this person coped this way and this person coped this way well maybe I can try a bit of both.
 
And I suppose of course a CPN has quite a wide experience of people who are experiencing mental health problems whereas GP’s aren’t quite so specialised necessarily are they?
 
No well that’s part of the problem the GP and I have had with the medication because she doesn’t have the experience of the mental health drugs whereas the CPN since, particularly since doing his nurse prescribers course does have the experience of the drugs and, you know, he sees the patients and he sees what side effects they have.

Doctors are very good but they're a jack of all trades whereas the mental health nurse specialises in mental health and I think it's very easy for the doctors to just, "Oh well we'll try you on another one," and not to look at what effect it is having, what emotional effects it's having or not dealing with and trying to interlock it with other therapies, that's certainly what the mental health nurse did was put it alongside psychotherapy and the mindfulness and bring them all together and use them altogether and I think that's been the key to not just have therapy or just have anti-depressants but to use it all because I think for me definitely you need the anti-depressants to get you up to a level that you can engage and make use of the tools that they can you provide you.

When an episode has, when an episode has started the familiar, the sort of routine seems to be that I take heed or not very much of the fact that I think I’m slipping in that way, I have tried to intervene sometimes and gone to the GP sooner. I’ve then had a referral to the, I mean initially I must have just been referred but now, I mean they tend to think I think oh it’s Rachel - we’ll put her back in touch with the mental health team and part of that is because they have a whole team approach so you see the CPN of the psychiatrist and I asked for the psychologist because I’d been sort of looking into it and reading stuff and it apparently it’s slowly getting accepted that medication isn’t the be all and end all that people can be greatly helped with psychological therapies. And so I basically asked for it and kept on, kept on saying to anybody who’d listen, you know, to the CPN I was put with and the psychiatrist and stuff like that. I was saying I feel that seeing a psychologist would be really good because, because I’d rather have strategies to cope than, than medication and no strategies.
 
So what’s the difference then would you say between going to see a psychiatrist and seeing a psychologist?
 
Psychiatrists are very clinical and their answer is virtually always medication.

In terms of psychiatrists and medical profession they’ve all been wonderfully kind, supportive, helpful I really, you know, can’t thank them enough because they have, they've been very good. The things that I feel that, where there have been shortfalls is that I feel that GP’s I don’t think know enough about how to support someone with mental health even those with the best of their intentions and so I think that appropriate referrals maybe in the past for me were not made quickly enough and in terms of medication again I think, I don’t know what the answers are for this but the GP’s just get their generic training on what they’re told the latest things are. But I actually feel that the best support that I’ve had and I’ve got has been when I have been referred to a psychiatrist and that’s when we can have in-depth conversations, that’s when I really can find out more about things because GP’s are very, you know, GP’s could never have put me on MAOI because they’re told that they can’t, it has to be only a psychiatrist.
 
And in terms of accessing a community mental health unit support either to get a CPN visiting you and to get psychiatric help I just feel it’s not as easy and as fast as it should be and I think it’s just that they’re very overwhelmed. And that people in my situation who generally are managing in life, have a few blips but are mostly in employment where there’s a history known the GP will try and support and suggest the counselling and the rest of it but I think that the specialists are fire fighting a lot of the time. but what happens is, certainly I found in my situation is that a lot of the time when things got extremely bad and extremely serious a lot of resources and costs had gone in to me which maybe could have been avoided, if I’d had access to their services earlier it costs a lot of money to be in there, you know, three months that are in a patient unit or, you know, to have regular CPN support and lots of meetings and lots of different health professionals, it’s very, very costly and I think the money isn't there for the real preventative work to kind of avoid people like myself actually.