Hannah

Age at interview: 28

Age at diagnosis: 23

Brief Outline:

Hannah experienced a severe episode of depression a few years ago. Her GP prescribed antidepressants but she experienced severe nausea during the time she took them, and they did not seem to help improve her mood. After some distressing events she was referred to the community mental health team and admitted to hospital. Eventually after trying different antidepressants and doses she decided to discontinue the treatment they offered her.

Background:

Hannah is single and works in IT. Ethnic background: White British

More about me...

Hannah first experienced depression when she was 12 and was being bullied at school. As a teenager things became intolerable and she attempted suicide, but never had professional help. Like many people, she learned to live with being depressed intermittently and although Hannah experienced depression whilst at University, she struggled through without seeking help.
 
After university Hannah began working, but when she found herself taking days off because she was feeling so low she finally decided to see the GP. The GP referred her for counselling, but there was a long waiting list, and in the meantime suggested she try an antidepressant. Having collected the prescription, Hannah felt anxious and worried about taking them and when she looked up the medicine she had been prescribed on the internet she read reports which suggested that this drug could potentially induce suicidal thoughts in some people. She returned to talk to the GP about her concerns but he reassured her and eventually she decided to give them a try. When she began taking them she felt very sick and considered stopping them but was encouraged to keep going with the treatment by the GP. Although she continued to take the medication she didn’t feel it was helping to improve her symptoms which were becoming so intense that she felt suicidal, and she returned to see the GP who referred her to the local mental health team.
 
She saw a psychiatrist who increased the dose of her antidepressant, and she felt hopeful that some improvement might follow. However her symptoms continued to worsen and she was having suicidal thoughts. Her psychiatrist felt concerned about her and decided to change her to venlafaxine. After taking this for a short while Hannah was still feeling no improvement in mood, in fact her feelings of despair were worsening, and during this time she was referred to see the Crisis Team. After being assessed Hannah was admitted to the psychiatric hospital as an inpatient, reluctantly as a voluntary patient, and then some while later after taking an overdose she was sectioned. During her stay in hospital Hannah felt distressed and resisted taking the medication, because she had begun to feel that it was doing her more harm than good.
 
After being discharged from hospital Hannah was able to access the counsellor she had been originally referred to see, but by this time she was beginning to feel that the mental health services were not serving her well. There followed a period of time where she was intermittently seeing the psychiatrist and other members of the mental health team and she changed to mirtazapine, but she never found any of the antidepressants she was prescribed worked for her and she began to feel desperate. On two occasions she took overdoses of the medication, not she says because she wanted to end her life, but more as a desperate attempt to try to feel some relief from the feelings she was experiencing. Eventually after a time she stopped taking the antidepressants altogether, and was finally able to access therapeutic support through the local general hospital where she had been admitted several times after suicide attempts.
 
‘I had gotten to the point where] you know when I overdosed on the mirtazapine a few times but it was, it had like become a pattern in a way … I just continually had thoughts about taking an overdose and it was very difficult to break that pattern of thinking but […] I just decided I didn’t want to continue taking them.’
 
Hannah’s experiences of mental health services have not always been positive; although she emphasised that the health professionals that she saw during that time were always sympathetic and kind.
 
‘One of the things I found really difficult is that that I don’t know if health professionals are always necessarily aware but I think when, when you try an antidepressant and it doesn’t work it just kind of adds to the hopelessness that you’re already feeling and even though in some ways it’s the hope that there’s other ones you can try I think the more that you try the more the worse things get.’
 
Hannah feels that antidepressants have benefits for some people and that sometimes the very fact that you have been and sought help and are making some attempt to address the problem can be helpful.
 
‘I think maybe… it’s probably quite good to not have any expectations I think... which is difficult’
 
Hannah feels that it’s important that health professionals should offer patients a range of different options rather than just antidepressants. In her own case and with hindsight Hannah feels that had she been able to access counselling services at the point at which she sought help things might have worked out differently. 

Hannah spent a week wondering whether to take the antidepressant she had been prescribed. She began to have second thoughts after reading an article on the internet and so returned to see the GP for another chat before deciding whether to take it.

She suggested that I start taking citalopram and I think I was in, I think I was in two minds about taking it, I think I would have rather have gone to see a counsellor first and tried that really but at the same time I really wanted to do something to feel better and to make sure… I didn’t miss any more days from work.
 
So I remember so she wrote me a prescription and I think I spent a week worrying about it and wondering whether to go ahead and take it and especially I think because the first thing I did was Google the antidepressant and find out more about it which was probably the worst thing you can do sometimes I think to be honest because there’s so much information out there and it’s not always the most reliable sort of information. But there was, I came, I remember I came across an article and that was, it was it raised concerns about that particular antidepressant where I think someone had taken it and they had suicidal ideas like they hadn’t previously had them and it was, it was kind of even though these... I think it was quite a biased article and it was implying that that was why this person felt more began to feel suicidal which but we don't know if that was necessarily the case. So but reading that was kind of put me off taking them completely and I remember I, because I still wasn’t feeling well I spoke to a friend who, and told her I’d been to see my GP and tried and got her thoughts and she very helpfully suggested ‘why don’t you tell your GP your worries and that you’ve come across this article and see what she says.’
 
So I went back and to see my GP and it was just helpful sort of talking to her about it again and I just I don’t remember exactly what she said but I remember feeling more sort of prepared to try, to give it a go at least.

Hannah read through the leaflet before she started taking the antidepressant. She worried it could make her feel worse, but was feeling so bad that she decided to try it.

I think initially, I know when I first started taking, when I first started taking antidepressants and I took the citalopram that I did read all the information, actually I probably did read all the information leaflets on all of them but I think the first time I thought ‘oh my God’ because there was so many different things it was almost like some of them it was almost like it negated taking them in the first place because I’m sure like some of them where it says like, you know, ‘can cause suicidal feelings’ that’s if you weren’t already feeling suicidal it’s just ‘well is it worth that risk?’ But I don’t think I was influenced on the whole, I’m not sure though.
 
Yes I was really worried to begin with but then as it went on, I mean as I took different ones to be honest I think I was feeling so bad that I just wanted anything to help.

Hannah had been feeling increasingly distressed while on venlafaxine, and was referred to the mental health crisis team because of the risk she might harm herself.

I talked to the psychiatrist when I saw him and I think from the letter that he then sent my GP that I got copied into, he seemed quite concerned about that and he thought because clearly the medication I had hadn’t been helping he switched me to venlafaxine so I started on I think it was 75 milligrams of that and but it just it felt like because it had been several months then since I’d originally gone to my GP and I hadn’t heard any more about the counselling as well so things were quite, I think in a bad place.
 
So then I think a few weeks later and, the other thing was I’d been taking more time off work during the period and I think I went back to my GP again and said to her as well that I was having these increasing thoughts of taking an overdose and that I was worried that I was going to act on them and she, and because I’d been off, I think I, and whereas in the past I’d been taking days off here and there, I’d taken a whole week off, I just wasn’t going into work. And so she contacted the local Mental Health Team again and they arranged for the Crisis Team to come and see me.

Hannah wondered if it was worth the risk of taking a drug that could increase the risk of suicidal thoughts.

I think initially, I know when I first started taking, when I first started taking antidepressants and I took the citalopram that I did read all the information, actually I probably did read all the information leaflets on all of them but I think the first time I thought ‘oh my God’ because there was so many different things it was almost like some of them it was almost like it negated taking them in the first place because I’m sure like some of them where it says like, you know, can cause suicidal feelings that’s if you weren’t already feeling suicidal it’s just well is it worth that risk?

Hannah didn’t want to take medication in hospital but eventually agreed to as a way ‘’to get out of there’.

I didn’t, I really didn't want to take any medication because I was actually feeling quite unwell, physically unwell when I was in hospital.
 
Was that as a result if having done, because you’d overdosed?
 
I’m not sure.
 
But it was on that medication was it that you overdosed?
 
Yes, but I’m not sure if it was as result of that, I think it might have been more because I was so distressed about being in there because I wanted to leave and the nurse came to see and try to give me the medication first of all and I didn’t want to take it and she said ‘okay that’s fine’ and then she left and I was kind of left there for hours and I didn’t know, I felt like I didn’t really know what I was doing in the hospital because obviously I wasn’t well but it, it just it was like because no one had shown me around even come to talk to me.....or I just I don’t think, I think I can’t remember if I was feeling sick then initially I think I was feeling really anxious and wanted to leave and I remember ended up going to find a nurse and saying I really want to leave and she said ‘oh you have to see the doctor on call’. So I saw the doctor on call (It was a Saturday) and he said like basically I was trying to persuade him to let me leave and I was really upset and he said it’s like I could leave because I wasn’t sectioned but he would advise against it and oh because the other thing was that I found it really difficult was that because the other thing was that I found really difficult was that I was on observations during the night so they were shining a torch light every fifteen minutes so I couldn’t sleep at all. so I was like, you know, ‘I want to go home’ because I didn’t have any belongings that was the other thing so I wanted to go home, you know, and just go to bed and have a shower and things. and yes so anyway because I knew then actually I could still leave so but he got called away so he left so I just went to get the few belongings that I had, my phone, from my room and went to leave but the nurses prevented me from leaving they actually stood against the door and wouldn’t let me leave and made out that the doctor had sectioned me. which actually I found out later that he hadn’t but as far as I was aware I couldn’t leave because... so I did eventually phone a friend and they really kind and... brought belongings for me.
 
And so did you stay?
 
Yes well as far as I knew I couldn’t leave.
 
So initially the nurse didn’t force me to take it and then when I saw the psychiatrist on the Monday he I was really unwell that day in the morning but he came back to see me in the afternoon and tried to persuade me to take it and I think he was just saying, you know, why don’t you give it a try, you know, it might make you feel better. So and then the nurse came around not long after and tried, with the mediation to get me to take it, so I did take it then. I think it was more of I realised that I probably needed to do what they said in order to get out of there more than like I believed that it was necessarily going to help me because, because everything I’d taken so far just hadn’t worked really so . Yes so even when and then actually yes then I had to have the a review with the well a social care worker and a GP, because they’d put me on Section 5 which only lasts like a few days for someone who’s already in hospital and wants to leave.

Hannah was taken to A&E after an overdose of mirtazapine. She worried staff would not be sympathetic as ‘it’s self-inflicted’.

I did end up overdosing on mirtazapine and I think it was with some venlafaxine tablets I had as well.
 
Did you get help after that or did you sleep it off or?
 
So I rang up... I spoke to the my psychiatrist and yes so I told him what I’d done and it was, it was towards the end of the day on a week day but he basically he told me to see like he asked if I could order a taxi and go to A&E, so that’s, so I did. And actually yes that was well it was really awful winding up in A&E again, it’s just it’s like a really anxiety provoking place being in there.
 
How did they sort of deal with you with the fact that, what you’d go in there with, were they sympathetic to you?
 
They were actually, I was really worried and, because especially like you hear of like reports of people who have, you know, self-harmed and gone to A&E and the response has, you know, it can be like the staff the response can be quite I guess critical and negative... Obviously because, because you know it’s something you’ve done yourself but they were fantastic, they were very understanding.

Hannah ran out of venlafaxine and so stopped taking it abruptly. She describes the withdrawal symptoms she experienced.

I stopped taking venlafaxine I actually started getting withdrawal symptoms because I’d stopped it abruptly and felt yes so I felt like, maybe it was the day after I went to see him but I yes I was feeling really, really sick and like I think maybe some fever sometimes. and I was trying to go back to work at that point as well so I had planned to go into work just like for the afternoon and I think like I went in and it was really awful because like I really needed to be there to give myself a sense of purpose but I couldn’t I just couldn’t work because I felt so ill and staying home really was, it was really hard because it was very isolating and. so I think, I think when I was unwell at work a friend was really kind and she suggested she rang my psychiatrist for me and just say that like, because I think she was concerned about me and I’d run out of medication, so she rang him and explained that I was feeling sick you know, and he’d known that I’d stopped the medication because I told him, so he said he’d write another prescription for me.
 
What were those withdrawal symptoms?
 
Like feeling really nauseous and I think I did have some flu like symptoms and that I felt a bit like hot and cold at times.
 
Just didn’t feel quite right?
 
Yes and it was, it was the kind of like the times I’ve felt sick before but like you know, usually after, you know after a while like if you’re sick and you feel, you do feel better.
 
Yes.
 
But this just felt like it was a constant and nothing seemed to change that. so yes so then actually I can’t, I must have like not had any, yes so then I must have arranged to go and pick up some more, to pick up the prescription just to take some of the venlafaxine to try and stop the symptoms that I was getting and so I could kind of say, yes so I did that and then I did start feeling better again. But then I still wanted to come off the venlafaxine even though I think my psychiatrist wanted me to go with the venlafaxine and the mirtazapine I just didn’t want to take it anymore.

When Hannah was feeling suicidal a member of the crisis team organised an urgent referral to see a psychiatrist, and they wanted to admit her to hospital.

I was continuing taking that but then I think they, like things were really bad at this stage and I think the Crisis Team were worried that that I was at risk of taking my life and, because they did talk to me about going into hospital as an inpatient but didn’t really say anything more about that.
 
But then I think so towards the end of the week there were a few times when they’d called to try and get in touch with me and I didn’t want to see them so they were concerned then. And they came, one of the staff from the Crisis Team came round and organised an urgent appointment for me to see the psychiatrist that morning and told me I had to go with him, he wanted me to go with him to see him. so then I saw the psychiatrist and he like had asked, how things were and he did ask about my medication and I think for some reason he was quite surprised that my GP hadn’t upped the dose of venlafaxine but I’m not sure if they’d instructed my GP to do that or not, I just remember that was when he asked me what I was on and I said I was on 75, I think he was surprised by that. Or yes I think like he was expecting me to be on 150 I think and yes so at the end of that meeting he had to go and speak to his consultant about what would be the best thing to do next and, so I had to wait in the waiting room for a while and then he came back and said they wanted me to come into hospital which came as a real shock to me because even though they’d mentioned it previously they’d only really mentioned it and they hadn’t, specifically said they wanted me to go in....and I was really worried about going in and what that would involve and he told, because the Crisis member of staff was still with me at that time and he told the Crisis member, team member of staff to try and find a bed for me and it just, it all seemed to be happening so quickly.

Hannah felt unsupported when she was first diagnosed with depression and her symptoms worsened. Later, when she was referred to the crisis team she felt overwhelmed being seen by several different health professionals.

I’d gone from having not much help at all because I’d had to wait for all the time to see someone up to that point, from after being in hospital, I had the Crisis Team ringing me up all the time and you know, having to see …. appointments to see the psychiatrist which in one way, you know, it was really helpful that I had that support but at the same time I found it very I felt a bit harassed almost like it was quite hard to deal with because suddenly it all happened at once and also I think I was kind of, I just wanted to go back to work and for things to be the way they were before and I didn’t, suddenly I felt like I didn’t want all of this which was, it was .
 
You felt it was being imposed on you?
 
Yes and I felt a bit like the, because I knew as well that I was in quite a vulnerable place I felt that I would come to rely on that support and one of the things I really value is, is you know being independent and I think that ties in a lot with my self-esteem when I just, so I actually pushed a lot of people away like the Crisis Team I didn’t want to see anymore.
 
And who, who from the Crisis Team did you see, what types of, was it CPN or?
 
No I’d see, well they wanted me to see a CPN, who I met with once but and he tried to arrange an appointment for me to see him but I didn’t want to see him. So he informed the consultant but.
 
Why, what was the reason just because of that whole that you didn’t want so many people involved?
 
Yes and it was just someone else new and it was, and it was almost ironic in that when I really needed the support which was when I was in hospital staring at those four walls and they weren’t coming to see me and, you know, that was when I really needed it.

Hannah wishes doctors could ‘prescribe’ exercise classes or other strategies that might help whilst people wait for counselling, rather than giving out medication as the only option.

I think there should be more options without like because when I when I first went to my GP it felt like that was the only, that was like the only option really because there was such a long wait for counselling it didn’t feel like there was anything else. But even like I don’t know if there is any kind of sort of exercise schemes or some sort of therapy courses, I think definitely the more options the better but also you do need that because, you know, sometimes when you feel like you just don’t know what to do or what’s the best approach.