Caroline

Age at interview: 60

Brief Outline:

Caroline took antidepressants during two periods of her life when she became clinically depressed, but came off them when her mood had stabilised and her GP advised her to stop taking them. When she experienced a third episode of depression her doctor prescribed citalopram which she has taken on an ongoing basis ever since. She finds this keeps her mood stable, and is happy to continue taking them for the rest of her life rather than become depressed again.

Background:

Caroline is married and works as a medical statistician. Ethnic background: White British.

More about me...

Caroline first experienced anxiety some years ago when she was studying for a PhD and had been under a lot of pressure. She was living in London at the time, and remembers feeling ‘tube phobic’ (feeling anxious when she got on the underground to go home). At that time she had some cognitive behavioural therapy (CBT) to help her to deal with the anxiety and after a time this passed.
 
A few years later she was working as a scientist on a large project and was again under a lot of pressure, and found herself feeling very ‘down’, and had insomnia. She saw her GP who told her to see whether she felt better in a week’s time and to see if in the meantime she could do anything herself to improve her mood, but to come back in a week if things stayed the same. She returned to see the GP who prescribed amitriptyline, which she was advised to take at night because it has a sedative effect, which might help the insomnia. For a while the medication made her feel nauseous rather than sleepy, but after a few weeks she felt it ‘picked her up’ and she felt much better, almost euphoric, which she described as feeling like a ‘pharmacological high’. After a few months the GP advised her that she had been taking amitriptyline for long enough and the dose was gradually reduced until she stopped taking it altogether. Although Caroline worried about coming off the medication - she was concerned that she might begin to feel depressed again, in the event she coped well, and continued to feel well.
 
For the next ten years Caroline remained well. However, once again, after finishing a very intense work project she started experiencing insomnia and went to see her GP again; who this time put her on a course of paroxetine. Again, this took a while to begin to take effect, but after a time she felt her mood began to level out again. At this time she was also offered counselling which she took up, which she feels it may have helped her to get a better perspective on things. Again, after a time she stopped taking paroxetine and her mood remained stable.
 
When the same thing happened a third time, in 2004 her GP decided to put her on what he called a ‘maintenance’ dose as he thought it would be appropriate for her to take antidepressant medication on an ongoing basis to keep things stable and prevent her mood from dropping again. This time he prescribed citalopram, which she has taken ever since.
 
‘I’ve taken it ever since then and I’ve not had any attacks of depression since then… I’ve felt and I feel perfectly normal …. it’s kept me stabilised . I feel very grateful to it. It’s been a really good experience taking antidepressant treatments and the only side effect that I’ve had is just the first couple of weeks you feel a bit sick’
 
Caroline has found that taking anti-depressant medication has enabled her to continue to work at her high-pressured job and that without it she may have needed to take substantial periods of time off work. Although Caroline still sometimes has difficulties sleeping, she copes by occasionally taking a sleeping tablet for a short time.
 
‘In my case it [depression] is always triggered by not being able to sleep properly and therefore not being able to cope very well or as well as I should be able to… I mean I’ve certainly had dips but I think I’ve always managed to get over them I’ve never got in that downward spiral. The thing about depression is you sort of get into a downward spiral that’s particularly exacerbated if you don’t sleep well but I’ve always felt able to bounce back’
 
Caroline is happy to continue taking citalopram on an ongoing basis and has no qualms about this.
‘I would see myself taking it indefinitely and I hope that they suddenly don’t announce that they don’t give it to over 70’s or whatever!’ 

Caroline’s doctor recommended an antidepressant and she was happy to take his advice.

It sounds as though you didn’t have any qualms about being offered the medication and accepting that offer?
 
No why would, why would I have?
 
Did you get any information given to you by the GP at that time to help you sort of decide if you wanted to take medication, how was that decision taken?
 
No, but well no. the GP just said ‘Well I think I’m going to prescribe you antidepressant medication and I’ll prescribe this kind, and if you take it at night then that should immediately help you to sleep better and then after a few weeks you should start feeling better during the day,’ so I just said ‘great.’

Caroline has had several episodes of depression and found SSRI antidepressant medicines very effective. She has experienced few side effects, and now takes citalopram regularly.

I was going back to the same GP all the time, he said right I’m going to put you on maintenance and it’s worked really well… again I felt really, really sick for a few weeks, I felt but that just wore off and I’ve taken it ever since then and I’ve not had any attacks of depression since then I’ve felt and I feel perfectly normal.
 
On citalopram I just feel normal. And I, I mean considering what’s happened between, since 2004 yes I’ve been under quite from time to time various stresses and strains but I felt and there have certainly been a couple of times when I’ve had… oh various things… and I thought well….. despite the citalopram I think I’ll be going under now but I haven’t and I’ve been able, it’s kept me a much more stabilised I think so I feel very grateful to it. It’s been a really good experience taking depressant treatments and the only side effect that I’ve had is just the first couple of weeks you feel a bit sick but that wears off. 

Caroline took amitriptyline for depression and said ‘it worked fine’ but she felt ‘high’ on it. Her doctor only prescribed it for her for six months.

So I went to see my GP and he was very, very good and he said okay look you’re not feeling well this week you should try and do various things to make you feel better but if you don’t feel better in a week come back, so I didn’t feel better in a week so I came back and he prescribed amitriptyline and I had to take it at night because it would make me feel dozy after I’d taken it and indeed it did. I didn’t feel less depressed I felt rather sick for a while, I didn’t feel less depressed for a few weeks but what happened was exactly what it said on the packet, after a few weeks I started feeling slowly better and better it was like having a big pair of hands. And after a few months, I don’t remember how long it was I took it for, but after a few months I was buzzing round the ceiling it was very, I thought it was a pharmacological high and then my GP said ‘Oh I think it’s time for you to come off that,’ and I felt really heartbroken having to come off and he said ‘Sorry but you’ve had your course and now you come off.’ And I remember okay I’m going to write you, I forget, three months more prescription but come off gradually and I remember working out the, the, so instead of taking it every day if I’d miss every three days and then I’d miss every two and then it would be every other day – it just tailed off.
 
But that worked fine and I was fine for about 10 years.

Caroline takes citalopram on a regular basis, and occasionally takes zaleplon when she can’t sleep. She is aware that they should be used with caution.

You see you can take something at, if you wake up at 1’o’clock my rule is I do take a drug if I’m, to take them to help me sleep if I’m still awake after an hour… So if I, so if I get into bed I’m still awake after an hour… I’m still awake, that rarely happens but if it did then I could take… either zopiclone or zaleplon? Or something like that because there would be time for it to wear off by the morning. If I woke at 2 ‘o’ clock and then at 3.00 I’m still awake then that’s... that’s actually quite a short night if you don’t go back to sleep. On the other hand if you have to get up in the morning it’s too late to take a regular sleeping pill so it’s kind of in between.
 
I do think, I think because they’re very short acting then they’re much less likely to or they’re less likely to be addictive than ones that last are say for say eight hours or have a life of eight hours or ten but I’m sure they addictive if you take enough of them. 

Caroline has a routine to ensure she remembers all her tablets including the antidepressant.

I just take it every morning after I’ve brushed my teeth.
 
Every morning?
 
Yes.
 
And are there times when you’ve forgotten to take them or forget or are you usually quite vigilant about it?
 
Well every Saturday morning I have to take several pills, I take pills for, I have hyper thyroidism and I have to take some pills for dermatitis so every Saturday, every Saturday I… cut out seven pills of citalopram, and seven pills of thyroid medicine and seven pills of the dermatitis medicine and then so it’s sort of like.
 
That’s very organised.
 
Well I, and then sometimes I come to the end of the week and I find I’ve got one left…
 
So do you know, would it be bad, detrimental if you didn’t, if you missed a few or… do you know?
 
I… the most I’ve not, I don’t think I’ve ever missed more than two in a row and very rarely not known if they’re detrimental but I mean all of the stuff on the blurb always says come off gradually. So I don’t have any personal experience of coming off too quickly and I’ve not noticed any ill effect from missing two days in a week- that’s the maximum. I’ve ever done.