Clare
Clare has struggled with depression at several points in her life and has taken antidepressants to help stabilise her mood. Nowadays she takes citalopram regularly as a preventative measure as she recognises that her coping mechanisms aren’t always very robust.
Clare is married and has three adult children. She works in local government. Ethnic background: White Irish
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Clare first went to see help for depression after the birth of her first child when she found she wasn’t coping with having a new baby and a demanding job. At that time she took an antidepressant and gradually got her life back on track. Her doctor explained that he felt they could help her to cope.
‘If you came to me with a broken leg you wouldn’t turn down a plaster cast,’ he said ‘So what I’m going to give you is I’m going to give you some tablets that are going to help you just to get over this kind of hump if you like.
Since then she has experienced several episodes of depression particularly at times when life events have left her feeling unable to cope. Although she has felt uneasy about relying on antidepressants she found that GP’s that she has had seen have helped by spending time explaining things and involving her in decisions about her treatment.
‘I think what, what kind of tipped me towards taking medication on each occasion as it’s happened, the GP concerned has taken time to explain what they do, why we take them, what the side effects might be and come back and see me if it’s not working. So it was an involved, I was involved in the process... I felt as though they had listened to what I was saying about my un-wellness and they were giving me something that would help and I think that was the important thing because I was very, very resistant. I didn’t want them’.
Over the years Clare has also had Cognitive Behavioural Therapy (CBT) and counselling, which she feels have helped her develop a greater sense of self-awareness and to find strategies for coping when things are difficult. She now takes citalopram on a regular basis as a preventative measure to help keep her mood stable and avoid the ‘up’s and down’s’ that she has experienced over the years.
‘Without a maintenance dose I’m going to continue to go through the rollercoaster ride of being well, being unwell, being well, and being unwell. I said it’s become clear to me when I look back over the last 30 years that there is something about my being that does not cope as well as other people with life’s ups and downs but when life’s ups… I deplete my serotonin, I lose my, you know, my coping strategies much quicker than other people and so that’s why I’m on what I now refer to as a ‘maintenance dose’ of antidepressants’
Despite mixed feelings about being on antidepressants, Clare ultimately feels that she is a more able to be the person she wants to be with them rather than without them.
Clare’s GP described how an antidepressant works, and told her that it’s no different taking a medicine for depression than for a physical condition.
Clare’s GP described how an antidepressant works, and told her that it’s no different taking a medicine for depression than for a physical condition.
He was very gentle and he was very he actively listened to me and I thought that was, I now know that that was really important because I felt, I felt as though somebody was giving some credence to the way I was feeling at the time. And so it was he that described the serotonin and the need for it to be replenished and he described to me the way in which the physiology of the brain if you like, the anatomy of the brain, the ‘how it all works’. What it was that I needed to have in order to feel better and he relayed me the story about the plaster cast that all those years before that the GP had mentioned so I was very open to when he said ‘Look we will prescribe for you some SSRI’s,’ I can’t remember what it was he prescribed, it wasn’t what I’m currently taking.
Clare thinks that patient information leaflets have improved over recent years.
Clare thinks that patient information leaflets have improved over recent years.
I’ve never had a course of tablets without reading the information leaflet in it which used to happen in the past.
Yes.
You know you would just get...
I was going to say do you take much notice of the information that’s in the box?
I you read it every time you which is… because I’ve read it now about 40 times because I’ve had, you know, I always get it out and oh yes no I haven’t had that and I haven’t had that. But what's a good thing about leaflets of course they don’t just give you the contraindications or the side effects, they go... less than one in a 100 will get this, you know, it’s actually quite, the definition’s quite good because it’s quite detailed and I’ve noticed it’s changed as well.
What changes have you noticed?
Well just I think kind of I can’t, see now I’ve said it I can’t think of one but I think it was more kind of one in a 100 will experience this and there was the graph thing that had kind of gone from one in a 1000 to one in a 100 or something. So obviously that’s the research that the drug company’s do into, you know, the more information they get from what people are reporting I would imagine.
Clare was prescribed Ativan (lorazepam) when she first experienced symptoms of depression. She said it helped at the time, but now more is known about these types of medicines she feels it’s sensible to restrict their use.
Clare was prescribed Ativan (lorazepam) when she first experienced symptoms of depression. She said it helped at the time, but now more is known about these types of medicines she feels it’s sensible to restrict their use.
He listened to me and he said I was, I was clearly exhibiting the symptoms of quite a lot of anxiety and stress. He didn’t at that time diagnose depression but he was clearly saying that I wasn’t managing day to day living and I did what he then described and I’ve always used since he said ‘If you came to me with a broken leg you wouldn’t turn down a plaster cast,’ he said ‘So what I’m going to give you is I’m going to give you some tablets that are going to help you just to get over this kind of hump if you like.’
And I think he prescribed Ativan, but that may have been my GP in London that’s the bit I’m not terribly sure about however whatever he prescribed me I took reluctantly because I was full of anxiety around becoming addicted to them and there was the whole negative kind of connotation of taking anything that wasn’t, you know, an antibiotic or a Paracetamol or whatever. So however they did help and they helped me to find what I would call the equilibrium in that they helped me to get over the very difficult time that I was having and make some informed decisions about my future or our future. So that was really the first time that I had, I had been to a doctor about my mental health. I had I think gone to my GP in London, I actually think now that I think about it he had prescribed Ativan and it was remarkable as I lost a lot of weight and I thought ‘this is great’. So it was kind of like an upper, the Ativan I wrote it down and I can’t remember what that was for and I was only on it for a short while but it was remarkable because I lost a lot of weight which is obviously a bonus to be honest although horrible side effects because I didn’t eat.
The very first ones that I got that were fantastic I lost weight but I would never want to take them again because I think they’re now banned and I believe that’s what put me off subsequently when the doctor said have these tablets I was like no, no, no, because those were they were head, they messed with my mind.
Did they make you feel different?
They made me, they were uppers you know and I’m a child of the sixties so there’s that whole ‘uppers and downers’ thing in the 1970’s when I got these uppers as they were I was euphoric, I was on a high, I didn’t eat I didn’t need to eat, I was awake like 18/20 hours a day I was “whoa”, you know, I don’t mean it was like party time but I was, you know, very happy but it was false because as soon as I came off them, you know, it was like oh right okay so I put on loads of weight and, you know, went back to normal so they were definitely I’m really glad they’re banned because they were obviously really horrible things. And people did become addicted to them that were on them long term so that; I think that’s kind of my story about antidepressants.
Clare takes medicines to counteract the effects of other medicines she’s taking.
Clare takes medicines to counteract the effects of other medicines she’s taking.
It’s interesting because apparently there’s something called I can’t remember what the phrase is but it’s that thing that were you’re on a medication you have to take another mediation to counteract the effects of medication you have to take and there’s, there’s a phrase for it it’s not over medication, something like that and one of things that I discovered was that these two medications both had constipation as, as a side effect.
Is that, so you take one for the arthritis?
Arthritis.
Then something else to counteract that?
I take the Naproxen twice a day (for arthritis) and I take my citalopram once a day so I have three tablets a day and they both have as a small side effect a sluggish bowel.
Is that the same for the citalopram?
Yes.
So it’s another side effect?
So I’m now I’m really good at drinking a lot of water, you know roughage but there are times when I have to take another medication to get the old body working properly.
So is that something you discussed with the doctor?
Actually it just.
As a side effect is it just from on the side of the leaflet?
No I just noticed it physically thinking oh God I’m really, you know, this is, this is not good. You know?
But you can usually manage it through diet though, roughage and so on?
I can yes I think at the time I was I wasn’t, my diet, I was on a diet trying to lose weight for the wedding so my diet wasn’t as good as it could be I think that was a factor as well so yes so again it was a kind of angst about oh God now I’m constipated three lots of prescriptions.
Clare would prefer not to take antidepressants but each time she’s come off them her depression has returned. She was afraid her doctor would not let her carry on taking it, but they agreed to reduce her dose to a ‘maintenance’ level.
Clare would prefer not to take antidepressants but each time she’s come off them her depression has returned. She was afraid her doctor would not let her carry on taking it, but they agreed to reduce her dose to a ‘maintenance’ level.
So when she suggested you know, you’re on quite a high dose I think the time’s come now to reduce it down I said yes that’s absolutely fine by me I’m happy to do that. But then it got to eventually about six or nine months later to get to the stage where it was like ‘what do you think, what do you want to do about this medication that you’re on?’ and I could feel my adrenalin kicking in, I could feel myself becoming anxious, I was and I virtually said to her I don’t know if I used the words but ‘please don’t take it away from me’. and I explained why I was saying that to her I said I have this vision that without a maintenance dose I’m going to continue to go through the rollercoaster ride of being well, being unwell, being well, being unwell. I said it’s become clear to me when I look back over the last 30 years that there is something about my being that does not cope as well as other people with life’s ups and downs but when life’s ups and downs become quite, you know, controlled I deplete my serotonin, I lose my, you know, my coping strategies much quicker than other people. and so that’s why I’m on what I now refer to as a ‘maintenance dose’ of antidepressants and as someone who doesn’t take medication I have chronic arthritis and I have to take tablets for that as well and it really sticks in my throat that every morning I have to throw two tablets down my throat. but I know why I take them… but I don’t take paracetamol, you know I don’t take pain killers I have other ways of coping with those kinds of . But this, this thing that helps me to cope with everyday life I think.
I was on 40 milligram and I’m now on 20 milligram.
And that was instead of coming off them really was it then, you lowered the dose?
Well we lowered the dose we, I agreed to lower the dose once I was feeling much better I realised that, you know, I didn’t need to be on such a high dose and we had the conversation about stopping and how did that feel because she knows how I feel about taking medication so she kind of broached the subject and I think, I don’t know if she was taken aback when I said’ no I want to keep taking it’. And I checked out with her about you know, becoming dependent on them.
And what did she tell you about that?
Well we had a conversation about it and it was around my, my kind of view that and so she took on board my, my kind of history and my, my reasoning for and I think that, that’s the good thing about the approach has been quite holistic, you know, it has been quite it’s not just focused on one thing but it’s looked at in the context of ‘me’ and I think that’s why she kind of agreed because don’t, doctors don’t just agree to a maintenance dose of a quite serious drug just on a whim. and so, but the good thing for me was I went thinking I was going to have to really bang my drum and I did bang my drum but she banged it with me if you like. Got these are terrible analogies but you know what I mean we were able to come to an agreement if you like that yes this is the way we should go with this.
And when you reduced its form 40 to 20 did you do that gradually over a period of time?
Yes.
How did you do it?
Oh how did I do that I think what we did was initially the first week I would take the 40 for six days and 20 for one and then, you know, we did it that way and then it got 40 20, 40 20, 40, 40, 40 and then, you know, in that way so it weaned me off the 40 milligram onto the 20 milligrams so we did it quite oh I can’t remember how long it was but it wasn’t like, you know, you’re on 40 now you’re on 20 it was gradual.
Clare feels she’s not as robust as some people and doesn’t always cope well with life’s up’s and down’s. ‘I have this vision that without a maintenance dose I’m going to continue to go through the rollercoaster ride of being well, being unwell.’
Clare feels she’s not as robust as some people and doesn’t always cope well with life’s up’s and down’s. ‘I have this vision that without a maintenance dose I’m going to continue to go through the rollercoaster ride of being well, being unwell.’
You know there’s a part of me that still doesn’t want to be on medication just a small wee part of me that thinks ‘do you know what [name] get over it, get on with it and stop it, be more in control of your life, be more adult, be more all those things, you know, that they tell you in all those agony columns and, you know, you should do this it’ll be fine and be assertive’.
I have this vision that without a maintenance dose I’m going to continue to go through the rollercoaster ride of being well, being unwell, being well, being unwell. I said it’s become clear to me when I look back over the last 30 years that there is something about my being that does not cope as well as other people with life’s ups and downs but when life’s ups and downs become quite, you know, controlled I deplete my serotonin, I lose my, you know, my coping strategies much quicker than other people. and so that’s why I’m on what I now refer to as a ‘maintenance dose’ of antidepressants and as someone who doesn’t take medication I have chronic arthritis and I have to take tablets for that as well and it really sticks in my throat that every morning I have to throw two tablets down my throat. but I know why I take them… but I don’t take paracetamol, you know I don’t take pain killers I have other ways of coping with those kinds of. But this, this thing that helps me to cope with everyday life I think.
I think it’s allowed me to, actually I think it’s allowed me to be the kind of person I would, more of the kind of person I would want to be.
Yes.
You know so it’s yes it has it’s actually it’s different to other people’s experiences it’s actually my kids have told me they, they like the ‘me’ that is when I’m well, you know.
Clare and her husband have different views about taking medicines. They don’t discuss the fact she takes an antidepressant, but overall he’s very supportive.
Clare and her husband have different views about taking medicines. They don’t discuss the fact she takes an antidepressant, but overall he’s very supportive.
No well if I tell you that this is a man who last winter fractured his ankle so badly that his foot was facing the wrong way and didn’t want to have a plaster cast.
Oh gosh.
And in fact insisted that they took the plaster cast off and he just stood up kind of thing and thought he could go back to work. He doesn’t do medication, he doesn’t do doctors, he doesn’t do, all of that with [husband] is a sign of weakness, and it’s a sign of frailty that doesn’t feature in his being. so again I think, interesting I wonder if I dare ask him, not dare ask him but would I bother.
Would you have the conversation?
What did he think about me still being on tablets? I don’t think I’ve ever asked him no I don’t know, I don’t know.
Is it something that you very much keep for yourself?
Well it’s just, it’s just ‘me’.
You know that…
He would pick them up from the doctors for me if he was going past, he would say to me, you know, next week when we are packing to go to [European city] he’d say, you know, have you remembered your tablets, you know. It’s not a bone of contention between us it’s not something that causes problems or it’s just.
That’s his way.
That’s his view of life, that’s his, that’s what makes him, him and I accept that and I don’t, I don’t have that as something that gets in the way because I accept that that’s his view and I, who am I to say that he’s wrong to think like that you know because he supports me.
Clare reflected ‘I genuinely hope there will be a day when I can say ‘no’, you know, ‘I’m okay I can deal with things’. But I don’t know if that will happen’.
Clare reflected ‘I genuinely hope there will be a day when I can say ‘no’, you know, ‘I’m okay I can deal with things’. But I don’t know if that will happen’.
If I need to be on that until the day I die I’ll be on it because the ‘me’ on it is much, a much nicer more stable person than the me not on it. but then the other side of me goes ‘how lovely would it be to be the you that you are on the medication without it and it’s that how do I get to that, how do I get to that place? And again that’s about I know that I don’t, I’m not just the person I am today I need to keep developing and working on who I am and working on my coping strategies and, you know, lifelong learning about my mental health and I, I genuinely hope there will be a day when I can say’ no, you know, I’m okay I can deal with things’. But I don’t know if that will happen and so I’m not downing myself because of that because I kind of have this duel carriage way that I’m going down and I could be in either lane.
Clare feels that the first step is to be able to explain how you feel to the doctor. A good doctor will allow you the time to explore together what might help.
Clare feels that the first step is to be able to explain how you feel to the doctor. A good doctor will allow you the time to explore together what might help.
My advice would be find a doctor that you can talk to that you trust and go with what they say. If you can find that I think that’s the key to it, I would never say to somebody ‘do It or ‘don’t do It because everybody’s different and everybody, everybody’s story’s different and everybody is different about why they are in the place they are. and that’s, that’s why my experience has been I’ve found a GP, I’ve found three GP’s who have listened to me, who have taken it on board, who have allowed me the time to explore what’s going to help. in many ways I suppose what I’ve experienced and I’ve been so fortunate is that I’ve experienced best practice in terms of discussing treatments with the patient and working out what is going to be best for that person. So I’ve had things done with me as opposed to done to me and that’s what I would say.
When you're not feeling well there’s still that thing about there is a power balance when you are going to see your GP even when you’re articulate and you have your facts and you know what you want somehow that disappears when you’re sitting there and you go ‘no it’s just about my toe’ whereas what you want to talk to them about is, you know, you’re worried about , you know you forget and they say you should take a list, you should write it down. So I suppose that’s what I would say to people is write it down because that’s what helped me was my friend and colleague saying ‘write down how you’re feeling in your words and hand it to the doctor’ then you don’t have to be articulate because they’ve got something that hopefully they will then look at and go right ‘so you're feeling, you know, miserable, you’re feeling really down, you feel as though everybody hates you right what’s that about?’. So that’s what I suppose because most people can write how they’re feeling even if it’s only words, you know, it doesn’t need to be an essay. You know so I suppose that’s what I would say to them, if they haven’t got a, they need both the GP who’s got to not dismiss it and go well you know what this is what…. for me what is it what do you want.
Claire describes her doctor as ‘amazing’. ‘She was positive about me participating in my getting well’.
Claire describes her doctor as ‘amazing’. ‘She was positive about me participating in my getting well’.
I would have to say here and now that the GP that I’ve had is one of, in the practice it’s a woman, she has seen me through this whole episode and she has been amazing, absolutely amazing and this is in a GP practice that as kind of got a policy of not prescribing anything, you know, they don’t give you anything for anything unless you’re kind of dying. but she’s been supportive she has been listening, she has been positive about my participating if you like in, in my getting well, you know so it’s been very much a collaborative, a collaborative thing.