Flora

Age at interview: 43

Age at diagnosis: 21

Brief Outline:

Flora was first diagnosed with depression when she was 21. Since that time she has tried a number of different SSRI antidepressants but had problems tolerating side effects and did not find them helpful. After a severe crisis she spent a short while in hospital. She currently takes tranylcypromine, an MAOI antidepressant and has found it to be effective, and also takes an antipsychotic medicine to help relieve anxiety.

Background:

Flora lives with her partner and son. She works in the field of social care but took a career break when she was unwell. She is hoping to start working in the near future with a charity and currently volunteers in the community. Ethnic background: British/Middle Eastern

More about me...

Flora experienced depression as a teenager but didn’t know that was what it was at the time. It was when she went to university, and was finding it difficult to cope that she first went to seek help and was diagnosed with depression. At that time the GP, who knew that there was a family history of depression and anxiety, prescribed Prozac (fluoxetine). For a while she felt that the combination of taking an antidepressant and having support from university tutors, and a counsellor, helped ease the load and she began to find life was more manageable. For the next few years she managed without antidepressants, although she experienced episodes of anxiety at times but looking back realises that she had a tendency to ‘muddle through’ when things were difficult.
 
When she was in her 30’s Flora had what she called a ‘major episode’ or a breakdown.
 
‘When I do crash, it’s in a really dramatic way, it’s like falling off a cliff and at that point when that happens it’s too late to try and come back, it really is…’
 
She tried a number of different antidepressant medications, including paroxetine and venlafaxine but side effects led to her feeling worse. Flora said that although taking antidepressants helped her to function she did not feel that they addressed the underlying depression.
 
‘I felt it was masking things…. Not really helping me but just somehow keeping me going… I got very overtaken by thoughts and feelings which were so overwhelming … I felt extremely hopeless about it’.
 
 
Flora was intermittently experiencing extreme periods of depression, followed by times when she felt able to cope, but her family were worried about her having so many ‘ups and downs’ and she was eventually referred to the community mental health team during a particularly difficult crisis. During one of these periods she attended ‘day hospital’ as an outpatient. After a time, and with the GP trying her on a number of different antidepressants, she began taking Seroxat (paroxetine) which she stayed on for about two years. During this time she gradually got things back on track, and began to feel well again. Flora decided she wanted to try to live her life without taking antidepressants.
 
‘I didn’t want to feel that I had to be on some form of medication… somehow it always felt like some kind of weakness and it meant that I had to acknowledge that there was something not right with me’.
 
Sometime later Flora had started a new and challenging job and was gradually finding it difficult to cope again. This time the GP prescribed citalopram as there had been some controversy over Seroxat (paroxetine) that she taken the previous time. Flora found citalopram heightened her feelings of anxiety and did little to alleviate her symptoms.
 
‘I couldn’t relate a lot of the time to any feelings, I’m not sure how much medication contributed to that, but I know that after a long period on these medications I felt often quite numb, unable to laugh or cry… just existing, it felt like I had lost my humanity…’
 
Finally, Flora experienced a severe episode of depression and was admitted to hospital. At this point she wanted to try something different, and asked if she could be prescribed an antidepressant that a relative had taken, called tranylcypromine. This is one of the older types of antidepressant drugs that are rarely prescribed nowadays as there is a high potential for adverse effects. However, given that none of the other antidepressants she had tried had been effective, and after reading the information she was provided about it, she decided to try it. After a few months Flora began to feel more able to address the issues in her life that she felt she needed to deal with.
 
‘Something shifted for me…. But partly I was able to wake up and suddenly see where I was’
 
She now takes this antidepressant on an ongoing basis, along with another medicine that helps alleviate anxiety, and she says she has felt the most impact from this combination, compared with other medicines she has tried over the years. 

Flora had tried other antidepressants that hadn’t worked for her...

What I remember we had some discussions about it, discussions of coming off the Citalopram and gradually, because other things weren’t working or hadn’t worked I told them about an MAOI that my mother kept mentioning called tripro...
 
Tranylcypromine?
 
That’s it tranylcypromine and she’d read a lot about MAOI’s and a lot of psychiatrists say some of the benefits they have were, are far better than the new SSRI’s and for some people they, they work much better. And the only reason why they’re not used so much is as they’re seen as a bit old style, old school it’s because there are health implications to do with dietary there are certain things that you've got to be careful of eating. And I think there are just concerns there with, complicating things further if people aren’t able to manage the diet. But because my because I’ve known people in my extended family who had used this in the past and never had a problem with it and it seemed to have worked for them. I met the psycho pharmacologist do you call it and the psychiatrist and they pointed out all the, the dietary aspects of it.
 
Can you explain what those are?
 
Well with this particular medication it I can’t remember now what it is that it does but it upsets an imbalance of something in your body and that, that a chemical that’s creating in bodies is also created by certain foods certain soya products and yeast foods like marmite certain meats like, I think pork, sausages, it’s to do with the way the meat is left for a while or something the way that’s it’s processed that it would enhance this chemical in it. There are other non-meat products I can’t remember.
 
Did you have a list of things to avoid?
 
Yes. So they’re printed off and they gave me actually, I’d say they were extremely good in terms of the information, they gave me information, all the health information, they told me which website to go on with the medical information about the pros and cons being on the MAOI.
 
Very, very slowly they gradually tried, gave the dose and then increased the dosage and the immediate side effects really were quite, they were quite obvious and that was like my blood pressure dropped considerably a lot and I would faint quite a lot and it would be quite overwhelming and they said that was one of the side effects something to do with how fast the blood could get to the brain and. And so that was difficult and that was difficult because sometimes I was trying to access something, a service within the hospital to do an activity and someone would always have to be with me and I felt, you know, I found that difficult . And so apart from the, that physical time and that took about two or three weeks and they were monitoring it quite closely and they, there’s a certain period of time frame that if it didn’t improve they would stop me using it because I always did tend to have low blood pressure anyway and it was obviously causing me, you know, I was hanging onto the wall when I was walking, it was quite bad and sometimes I had no inclination it was coming so next minute I would find myself on the floor.
 
You couldn’t really take that outside the hospital environment then could you, quite unsafe.
 
No, no exactly so it needed somebody to be around or to be in a safe place sitting mostly. But after a while I continued to take it and that passed and… something eventually changed for me, shifted for me.
 
I kind of feel that, well in terms of the health side of things it hasn’t affected my health in any way I keep, all the health side effects that we were worried about I think there are only some people who react to it and others don’t and I find that you can quite easily eat a lot of foods they say I shouldn’t eat it doesn’t have any effect.
 
You’ve tried them have you?
 
Yes I have and the pharmapsychologist from can’t remember now, said I said how will I know I said because sometimes I do have a bit of this or that and she said you’d know pretty much immediately, you’d get heart palpitations, you’d get a huge headache and sometimes I eat quite a lot of cheese you shouldn’t eat and I generally don’t, but occasionally I really want some cheese and I eat quite a lot of cheese because I love having an array of cheeses somewhere never had any problems. But I know what the sides would be if I did so the food aspect doesn’t seem to be any problem I don’t seem to have any, as far as I can see, any other side effects. I feel very much the kind of wellness and wellbeing in myself that I would feel if I weren’t on the medication and when I’m feeling a little bit stressed it’s no more than again what I would have felt or do feel sometimes in daily life if I’m not on medication.
 
So for want of a better word it makes you feel slightly in inverted commas your ‘normal self?’
 
I feel.
 
Your authentic self or something?
 
Yes whereas before I always somehow felt that it wasn’t normal to be continually on the medication and I think now I’ve kind of made my peace with it and in fact it’s less of a difficultly than I thought it would be so I’m happy to stay on it as long as it’s not giving me any problems. 

Flora felt that ‘I couldn’t relate a lot of the time to any feelings...

When you are depressed you’re just so absorbed in yourself, you don’t feel empathy or I certainly couldn’t feel empathy and I couldn’t relate a lot of the time to any feelings and again I’m not sure how much medication contributed to that but I know that after a long period on these medications I felt... often quite numb and unable to laugh but unable to cry just existing and feeling very abnormal because realising that I had lost, it felt like I’d lost my sense of humanity, you know. When I’d hear about something and think why can’t I feel sadness for this person or happiness for that person?

Flora’s doctor was reluctant to prescribe sleeping pills...

My father has been on a lot of medication in his life and changed a lot and has, he felt, a lot of experience and he was always saying, you know, try something else and don’t accept their dosage if you think you need more or less and at one point before I think I’d been to the doctor he actually I know this is not legal but he had actually supported me by giving me some medication he’d been on and one that actually was quite supportive which was trazodone which has a kind of as lightly sedative effect. So when I told my doctor that they actually did I think for a while include that because it was particularly helpful at night.
 
This was in addition to the antidepressants?
 
Yes in addition because it had a relaxant sedative effect and one of the big things about my depression at that time was I couldn’t sleep at all and I had this thing which they called, something about the leg it’s a leg that...
 
Restless leg?
 
Restless leg and I’d be awake for hours and very, very tired, constantly tired and feeling more hopeless and more depressed because I’m not getting enough sleep. So I wasn’t getting a lot better and after a couple of months, well during the first few months of that I had to keep going back and asking for sleeping pills because I felt that I wasn’t being given a chance because the sleep was depriving me of my ability to kind of get better and I wasn’t coping. But because now GP’s are so concerned I think and over concerned because of past abuses of sleeping tablets or people sort of stocking up on them or taking too many I was only given a few at a time and it really, really was unhelpful because I feel now again in hindsight if my sleep had been sorted out then I would have had a lot better chance to recover.
 
Even when I got better and I came home and I remember having a review a couple of months, a month or so to, and said things are better and I’m doing more and my life feels a lot better it’s probably three months down the line I said I’m still having problems sleeping and the answer to that that I was given was that’s usually the last thing to go with the depression and often symptoms they take a while to leave you even though you may be feeling better. So I still had some sleeping tablets that I could take if I needed to but because I wasn’t depressed in the same way it didn’t have as a debilitating effect on me not sleeping and the Stelazine he said you might want to take that at night because then that kind of relaxes you . And just actually as he said after a little while that just improved and it was just the last thing to go really.

Flora asked to be prescribed Stelazine (trifluoperazine) because...

I kept saying I really wanted to also have another medication which was called Stelazine that’s the brand name, that‘s the trifluoperazine.
 
Yes.
 
Which is old again an old style what they call antipsychotic but it’s helpful in cases of anxiety and again they.
 
How did you know about that one, again from your relatives?
 
Yes, family who had used it in the past in fact my grandmother is still on it and she’s been on it for 30 years and they’re saying that she wouldn’t be able to manage without it and it’s just one little pill and she’s an extremely anxious person but it takes, it just means that she can kind of get on with life. And there were side effects to that, there still are quite serious side effects to that and it’s not one that they generally like to prescribe, they say they prefer to prescribe newer drugs that have replaced those like Kitapen (quetiapine)?
 
I don’t know that one.
 
I don’t know how to say it. And the reason being is that it can produce Parkinsonian type...
 
Shakes?
 
Yes and motor reflexes that you can’t control in your mouth for example so your mouth will quiver or drop and it could possibly I think effect part of your body but it definitely tends to be the face. And only apparently 50% of the people who stop taking it recover from that so, you know, there’s a 50% chance that you’re left with this side effect, so that’s why they generally don’t recommend it. But my psychiatrist gave me all the information and just said wanted me to know everything and I said well you know my grandmother has been on it all this time and she’s perfectly okay and he said well you're grandmothers very lucky, you know, but that’s not something you should base your decision on. but he also said that it’s, it’s something we’re if it’s being given long term there’s a long term build up in the body but if it’s taken short term or for brief periods it’s unlikely to have that kind of effect.
 
After about I don’t know some months, six months maybe, maybe longer I gradually reduced the dosage of the trifluoperazine to the point where it’s been now nearly I think two years and the last sort of six months or so the psychiatrist said well you know look at it as that you have a tool box and here’s a set of your tools and, you know, when you find you need them then you’ve got them there but you don’t have to take them all the time so the trifluoperazine he said he was happy for me to take as and when if I was going through, you know, difficult circumstances or I wasn’t sleeping so well for a few weeks and feel I might like to take one a day, the highest dose I was taking of that was about three at that time so one a day was quite, was the minimum dose.
 
And you didn’t get those side effects that you mentioned using that drug, the shakes?
 
No, no and I did go back with reviews, asked is there any alternative to just find out whether there was actually an alternative and he kind of talked me through the other ones and said that they, you’ve tried one or two of them and said they’re all kind of similar really and although I said that I was worried he did say if you’re not taking it on a regular basis and large doses you’re unlikely to have that problem. So, you know, if you feel it suits you and you want to take it on an occasional basis then don’t worry too much that’s probably fine.

Flora spent time in hospital and tried an MAOI antidepressant...

In some ways it was very good that I was in hospital; because I was very contained and there were some very severe side effects which they did warn me about with the MAOI and also the fact that I was on nothing for a while and I also was able to be, I was given regular and a much higher dose, I wouldn’t say a higher dose but a more effective sleeping tablet so I kind of felt that I had more support to get the kind of rest that I needed.
 
How did you feel when you actually come off the citalopram, because you felt pretty lousy on it?
 
Yes.
 
How did you feel in that interim period when you weren’t on anything?
 
Very, very depressed and not anxious at all I lost the anxiety really I was just an extremely depressed extremely an extremely black dark place and the only thing that I felt hopeful about was the fact that I was being contained and also there were no pressures on me, suddenly I didn’t have to pretend to cope, I didn’t have my son to look after, I didn’t have to wash up, cook, try and maintain house sort of act normal to neighbours and that was a relief. but also not having to do that meant that I, it was much easier to fall into an even darker place because, you know, to some extent having to do these things kind of keeps you going in some respect.
 
So then you started on the new drug?
 
Yes.
 
And did that build up slowly or?
 
Yes very, very slowly they gradually tried, gave the dose and then increased the dosage and the immediate side effects really were quite, they were quite obvious and that was like my blood pressure dropped considerably a lot and I would faint quite a lot and it would be quite overwhelming and they said that was one of the side effects something to do with how fast the blood could get to the brain and. And so that was difficult and that was difficult because sometimes I was trying to access something, a service within the hospital to do an activity and someone would always have to be with me and I felt, you know, I found that difficult . And so apart from the, that physical time and that took about two or three weeks and they were monitoring it quite closely and they, there’s a certain period of time frame that if it didn’t improve they would stop me using it because I always did tend to have low blood pressure anyway and it was obviously causing me, you know, I was hanging onto the wall when I was walking, it was quite bad and sometimes I had no inclination it was coming so next minute I would find myself on the floor.
 
You couldn’t really take that outside the hospital environment then could you, quite unsafe.
 
No, no exactly so it needed somebody to be around or it is in a safe place sitting mostly. But after a while I continued to take it and that passed and… something eventually changed for me, shifted for me.

Flora put on weight when she took Seroxat (paroxetine)...

The other thing is that I had a friend who, I knew two people by then who had been on Seroxat for fifteen years well one was about eleven years the other one for fifteen years and both of them are extremely happy on it and said that they’d been told, you know, they should be on it the most of their lives there was no reason to come off it and they could manage their jobs, their life more or less with it and they both told me if they didn’t they’d be worried that it would be a slippery slope. I didn't want to be in the same position and also I’d put on a lot of weight on it and I’m not sure whether it was the medication because I was told that it didn’t particularly have that effect as far as they knew, people didn’t generally complain that that was a major side effect. and in terms of other side effects I, I didn’t really notice any so when I was on Seroxat I felt quite well and I didn’t have, especially when I sort of recovered I didn’t feel the, I would say the tension and sort of the feeling of extra pressure on my body that the Prozac had me feeling because I often had a lot of tension in my neck and in my shoulders often I would be doing lots of things I felt slightly more speeded up slightly with a manic edge, I didn't feel that was the case with Seroxat.
 
So in many ways I thought well it’s not doing me any harm, you know, maybe it is doing me some good but because I’d put on a lot of weight as well and I didn’t like being on medication I wanted to try coming off it and I had also been in a therapeutic group for a couple of years too so I kind of felt like I had got myself into a place where I felt I was okay and I could manage my life. And I did very, they were very cautious about it going off it very, very gradually sort of one every other day for quite a long time and then one every three days very gradually and I didn't notice any side effects coming off it and I eventually lost weight through just working at losing some weight but I sort of felt that somehow that Seroxat may be playing with my metabolism that I couldn’t lose weight very easily and it felt like and looked like that once I was off it the weight would start shifting when I was making the effort to eat less and to exercise. and so I felt much more that I was, my, back to who I recognise because when I put on a lot of weight, put on about two, two and a half stone I physically didn't recognise myself, and I had to like the clothes... I had to keep buying bigger sized clothes and I felt very unattractive and unhappy in my body, so I kind of wanted to feel better in that sense.
 
So I eventually went off it and that was around probably about 2007 and then I wasn’t on anything for until a large major episode which came about in 2009.

Flora saw being on medication as a sign of weakness...

I asked if I could reduce it to eventually stopping. And one of the big reasons for doing that was I still had a big prejudice against being on medication, that medication can, you know, that to be permanently on something I had a block about that and I didn’t want to feel that I had to be on some form of medication and so whether that comes from the stigmas attached to medication my dad always said if you’re a diabetic you need, you know, to be on insulin, you know, if you’ve got a health problem, you know, you need to take whatever for that health problem. somehow it always felt like some kind of weakness and it meant that I had to acknowledge that there was something not right with me. And I think I just found that difficult to do and I didn't want to acknowledge that it was something endemic I kept thinking it was the set of circumstance, that set of circumstances and that I was okay now and things in my life was balanced enough not to need to be on medication. 

Flora found therapeutic support helpful in addition to taking...

The other two really key things, several key things that have been useful for me have been things like therapeutic support along the side of the medication so getting some kind of understanding of what’s going on and I certainly found CBT very helpful and it’s I think particularly helpful when you’re not too ill because if you're not too ill you can engage with it and understand it and when you're getting unwell hopefully you can use some of those resources to stop it getting worse in some respect or to kind of keep yourself a little bit from succumbing to it. But the other thing really has been mindfulness; I don’t know whether you want me to say anything about that.
 
Yes quite a few people have mentioned that they have tried this, I think it’s a kind of new up and coming tool to use.
 
Well I kind of accessed already mindfulness type meditation through, it’s evolved through Buddhist meditation techniques and I already did... do Buddhist meditation techniques in various forms and some of them incorporate kind of the mindfulness. But obviously they weren’t in a mental health kind of setting or for that purpose. And I was lucky enough to be referred to a mindfulness course and what, and what I really, really found and discovered was that it really, really strengthened my own personal meditation practice and it really, it was a mindfulness based and cognitive based course so it was kind of in relation to people who may have suffered anxiety and depression so it was kind of helps you see connections I think with what goes on in your mind and how you process things but what you can do which is through breathing techniques and, and kind of more formal kind of meditation to kind of disengage from that. For me that’s more effective in many ways than CBT. Because CBT involves thinking again but your thinking is skewed when you’re depressed very, very hard to use your thinking mind. Whereas mindfulness what that teaches you is that when you're focusing with, first of all you disengage what is going on in your head because you are taught to focus on your breath you can focus on other things but it’s generally your breath and it might be a certain part of your body. but there’s always an anchor point so whatever is going on in your mind you’re taught to acknowledge it notice it but as soon as you start going off in the story of it and reviewing it or replaying videos in your head, as soon as you realise it’s happened just gently bring yourself back to the breath and don’t judge yourself.
 
It helped to meet other people and to go to some of the groups and realise that, you know I wasn’t completely crazy and other people had similar thoughts and feelings and suddenly it was the first time even though I know that other individuals, for example, in my family had suffered, it was the first time that I really heard from other people things that I had thought myself, felt myself and that was actually one of a key, key supportive development to my recovery was just feeling connected again. 

‘I’d say that anybody who’s experiencing depression or...

Get as much information from as many different sources as possible not just to accept the first thing that they were given by their GP and if they were given something by their GP to then look that up and on the websites they’ve got mental health and medical websites so to go to one of those make sure it’s connected with a mental health service or hospital so that you know it’s, you’ll get all the details of side effects and other details if you want to find out more about the drug itself. But also I would suggest that they go on line and maybe go on go to health forums and there’s also sort of some depression kind of forums to talk to people if they don’t know anybody but where they can contact the people to find out what their experiences are, just in terms of some support and also might make contact with people who might make helpful suggestions or be able to share some of their views. Also locally if they have a MIND service or a similar mental health charity that they can access MIND is particularly good because they are generally very well resourced but it depends what part of the region you’re in but they have a fantastic website they have also in major cities and towns Wellbeing Centres where you can actually ring up locally or just drop in to speak to somebody confidentially or to find out about other kind of support that might be in the community just counselling or groups or any kind of thing. I’d say that anybody who’s experiencing depression or anxiety or some kind of mental health problem then try and get as much advice and support as you can and for everybody that’s different.

Flora’s employers supported her at work when she was taking Seroxat

So I was on Seroxat and through various supports, therapeutic, CPN workplace were very, very supportive and although I’d lost all my confidence they were very happy to ease me back into work anyway was helpful and all the way along if it hadn’t been for them I would have been, I think, in a very difficult situation and the depression and the illness probably would have continued for a long time because it would have been compounded by then being jobless by then my self esteem could have gone.
 
So I was very lucky and very, very gradually over the following year I stayed on Seroxat, I stayed on it for two years I gradually got back into work and then increased my hours got my confidence back and after two years I sort of really felt that I was well I had decided not to complete my course that was an unnecessary pressure and I thought that would just take me back to the same place and I needed to be realistic with what I could do. So as I felt my life was fairly balanced and I wasn’t, I was in a job which was comfortable and not too challenging but I could challenge myself if I chose I, I asked if I could reduce it to eventually stopping. And one of the big reasons for doing that was I still had a big prejudice against being on medication.

Flora reflected that by the time she was seen by the...

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.

Flora found it helpful seeing a psychiatrist. ‘The best support...

In terms of psychiatrists and medical professionals 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.

‘I’d say that anybody who’s experiencing depression...

Get as much information from as many different sources as possible not just to accept the first thing that they were given by their GP and if they were given something by their GP to then look that up and on the websites they’ve got mental health and medical websites so to go to one of those make sure it’s connected with a mental health service or hospital so that you know it’s, you’ll get all the details of side effects and other details if you want to find out more about the drug itself. But also I would suggest that they go on line and maybe go on go to health forums and there’s also sort of some depression kind of forums to talk to people if they don’t know anybody but where they can contact the people to find out what their experiences are, just in terms of some support and also might make contact with people who might make helpful suggestions or be able to share some of their views.
 
Also locally if they have a MIND service or a similar mental health charity that they can access MIND is particularly good because they are generally very well resourced but it depends what part of the region you’re in but they have a fantastic website they have also in major cities and towns Wellbeing Centres where you can actually ring up locally or just drop in to speak to somebody confidentially or to find out about other kind of support that might be in the community just counselling or groups or any kind of thing. I’d say that anybody who’s experiencing depression or anxiety or some kind of mental health problem then try and get as much advice and support as you can and for everybody that’s different.