Stephen

Age at interview: 48

Age at diagnosis: 44

Brief Outline:

Stephen thinks he had been depressed for quite a while but hadn’t admitted anything was wrong until a work colleague suggested that he might consider seeing the GP as he had been taking a lot of time off work over the past few months. Once he was diagnosed with depression Stephen found it easier to accept and was reassured that antidepressants could help him to feel more himself. He has taken them for four years now, and feels that they work well to keep his mood stable.

Background:

Stephen is single and recently moved to a new area of the country for his job testing computer software. Ethnic background: White British

More about me...

Stephen had felt unwell for quite some time before he sought help from the GP. A colleague at work noticed that he had been taking more time off work for minor ailments than was usual, and eventually Stephen realised that he ought to go and see the doctor. After a long chat with the doctor Stephen himself realised that he was depressed, and the doctor prescribed citalopram.
 
‘We just sat talking… and at some point I just said to her…’you know, I’m depressed’. And she went ‘I know… And I knew that when you first walked in but you had to admit it to yourself first, which is why I didn’t tell you.’
 
Stephen says it was a great relief to be given a diagnosis of depression ‘because I knew what was wrong and I could see there was a way of fixing it’. He initially started on a low dose of citalopram, and gradually over the course of a few months the dose was adjusted until it seemed to be the right amount for him. At first he had problems sleeping and felt the antidepressant seemed to alter his ‘body clock’ but after a few weeks his sleep patterns returned to normal. Although he can’t pinpoint a time when the medication began to have a positive effect, friends and colleagues began to make comments to him about how he seemed to be ‘looking better’.
 
‘That’s one of the things about depression, you don’t know you’ve got it and you deny things, you don’t realise things, but it’s other people… it was only actually when they told me I was looking better that I realised they knew I’d been ill to start with’.
 
Stephen recently tried to stop taking the medication under the guidance of his GP, to see how he would feel without it. He gradually reduced the dose over several weeks, but some while later he moved jobs and to a new area and began to feel stressed and depressed again. This time he recognised the signs and his GP recommended prescribed citalopram again. He continues to take it, and feels that if it helps to keep his mood level he is happy to do so.
 
Stephen has been open about his illness at his workplace and feels it is important to talk to others about how you are feeling. He has found that most people he speaks to have some experience of mental health problems, either themselves or through friends or relatives.

Stephen visited the GP after a...

I think looking back it’s clear that I actually was depressed for a couple of years before it was diagnosed first I fought against it maybe deep down I knew myself there was something wrong but did I admit it to myself and there was a friend at work who’s known me for 25 years and he took me aside one day and said ’There’s something wrong with you, you’ve had more days off in the last six months than you’ve had off in the previous 20 years. Is there something I can do to help you?’ and that made me think and I thought ‘He’s right, there is something wrong and I’ve been denying it to myself.’ So I went to the doctor sat with her for half an hour which is very long as I’d only booked in for an ordinary meeting which normally... ten minutes they allow and I was in for half an hour. And we just sat talking and at some point I just said to her ‘You know, I’m depressed,’ and she went ‘I know and I knew that when you first came in but you had to admit it to yourself first, which is why I didn’t tell you’.
 
And once that was done it was like such a relief because I knew what was wrong and I could see there was now a way of fixing it. I have to say my father had depression a few years ago so I knew that there was a ‘fix’ because he was recovered he got treatment and he got better which helped me a lot. So this would have been in 2008 and I was put onto initially a low dose of antidepressants and we built up till we got to a level which was making me feel stable.

Stephen’s doctor explained that...

I was actually more relieved from the talk rather than having the tablets because she was just such a good doctor that she made me feel that it might be a long powerful road to get better but it would happen and I knew that if I took a tablet that day I wasn’t going to feel better tomorrow it would take several weeks before it started to have any effect.
 
Is that what she told you?
 
Yes.
 
Or did you already have knowledge of that?
 
She basically well she basically said it was at least two weeks before they’re into your system before you start feeling any effect and it still might not be enough but I was on a very low dose, what the dose is I can’t remember after six weeks or eight weeks the dose was upped to a slightly higher level and we basically monitored it for, well she monitored it not me, but for like three or four months before we got to the level that felt just right. Because they can make you feel tired or I felt other side effects you’ve got to be very careful with that.
 
And did you get side effects when you first started taking them?
 
Every time the dose changed it would take me a couple of weeks to adjust and my sleep patterns were totally thrown out. I had none of the problems like upset stomach or anything like that but the one thing it did to me was really change my body clock.

Stephen said it was difficult to pinpoint...

I’m not sure I actually did realise, there was at no point where I thought ‘Oh I feel better,’ because it was so gradual. It was other people noticed, family and friends would say ‘you seem a bit more relaxed today Stephen,’ or whatever so. And I think I needed them to tell me because I didn’t know. That, I mean that’s one of the things with depression, you don’t know you’ve got it and you deny things, you don’t realise things but it’s other people. But it was only actually when they told me that I was looking better that I realised that they’d knew I’d been ill to start with. Because no one had ever said ...apart from this one friend, no one had ever actually said ‘you’re not right or ‘you seem a bit down today’. But when I actually was getting better they started to say that.

Stephen tries to get the last appointment...

You say that you go back to your GP for regular reviews, do you do you go every month or how often do you do that?
 
Every two months at the moment so I’m due in about three weeks.
 
So you get a repeat prescription for the six weeks?
 
Yes.
 
Or eight weeks and then go back to get the new one and talk about?
 
Yes.
 
Right. And so is that a good opportunity to talk about anything that you need to in terms of your, you know, how you’re feeling as well about the medication?
 
I tend to try and get the last possible appointment because that way you can actually have the longer chat if need be. and the doctor ‘s very good at that, I think they understand that sometimes the ten minutes allowed for the appointment isn’t long enough so I do tend to aim for the 6 ‘o’ clock one if possible.
 
So it doesn’t matter if you overrun a bit?
 
Well she might mind the fact that I’m keeping her late, I don’t know but I think it’s better for me that we’re not rushing things.

Stephen talked to his doctor about...

I asked if it would be okay and the doctor agreed it would be possible.
 
And what was it that you were thinking, did you decide that you didn’t want to be taking them anymore or did you just think maybe it would be worth a try?
 
I wanted to see if it was worth a try basically.
 
So tell me about how you managed to do that and what happened when you did it.
 
The strategy was basically; first of all she wanted to get it down to a lower dose to the lowest possible dose, a stage down.
 
And how did you stage it down did you take one every other day or something like that or half a tablet?
 
It was, she gave me a new prescription which was a half dose and it was a case of just go straight down to half a dose for a few weeks and then after a few weeks it was one every other day. And then after a few weeks after that, stop. So it probably took two months to actually come off them from the point that we’d discussed whether it would be possible. And it was only a trial.
 
So you mean you’d discussed the possibility that you might want to go back or might need to.
 
Might need to go back yes, it was just a trial to see if it would be possible how to do that and it was clear after two or three months that I had to go back on basically.
 
And was that because you, did your mood return to how it had been before you‘d been on them, was it as bad as that?
 
It was never as bad but I could feel it, you know, just the sensation one of the symptoms I sometimes got when I was actually... before I had an attack, you know, it took me a while to realise I’d get a, a feeling of wind floating in my stomach and if I feel that coming on and also acid reflux so it’s like a stress related illness in some ways and I could feel that coming on sometimes.
 
Was it related to any specific events of did it just come randomly?
 
Well to me it just seemed to come randomly I couldn’t sort of nail anything down. That was it, the symptoms for me, actually it was a different doctor for, because I’d moved here at this time so I had to go to a new doctor and discuss the symptoms and say this is what I’ve had in the past, I’ve been off these pills for three months now but I think I should go back on them. And so I spent another twenty minutes with a new doctor explaining the history and she put me onto the same tablets.

Stephen’s doctor didn’t just give...

My doctors have been my therapists because they are willing to spend the time. If I’d simply gone in and they said ‘oh you’ve got depression here’s some pills ‘then I might have said ‘oh is there anything else I can do’? But the fact they are willing to spend half an hour just chatting and talking through the problems, I won’t mention it here but I think some of the things that kicked off the depression years ago... I’ve discussed my doctor we, I think I know what caused the initial attack put it that way.
 
So you’ve had some discussions about not just medical things but about how you feel about things with your doctor and that’s helpful?
 
Yes.
 
And so is that to the extent to which you feel you need that kind of talking help or would you have liked to be able to have counselling or any kind of other therapy?
 
I don’t, as I say I get enough from my doctor but I’ve got my family at the other end of the phone line if I do feel low I just get on the phone and phone my mum or my dad or my brother or whatever and just have a 20 minute chat just talking things through, that helps. So I think I’ve got a very good family unit around me.

Stephen is fully involved in decisions...

And have you always felt that you’ve been involved in the decisions about your treatment?
 
Yes because it’s usually me that does most of the talking.
 
Okay.
 
They come up with the prescription or the solution whatever but it’s me that’s telling them what the problem is and what I think I need etc. and then as I said we might discuss about going on to a higher dose so it’s often down to me. She might say ‘Oh I think you should double it,’ and I’ll be saying ‘Maybe not ....but if that’s what you thinks’ best I’ll do what you thinks’ best.’ Or I might say to her as happened in the last one, ‘I’m feeling a lot worse than I had done because of the extra pressure, could we discuss increasing the dose?’ and then she’ll say ‘yes’, so. I do think I’m very involved in it.

‘It’s as much about talking...

It’s not just ‘I feel a bit sad’ there are usually deeper reasons. It might take you a while to get to the reason as I say it took myself and my doctor just chatting for a while to actually work out how far back the symptoms, the cause of the illness as I say ...I’d probably been depressed for many years before I realised or we realised. So the first thing is be empathetic with the person, understanding, and then start to talk about the way forward. Whatever you do don’t just sit and say ‘oh I think this person’s got depression here’s a prescription’ you actually have to get them to understand what’s wrong with them so they understand why you’ve given them the tablets. If I hadn’t admitted I was depressed I don’t think a tablet would help me because it's as much in the mind as it is in the body, the chemicals you have to, so you have to be able to talk to the people as much as prescribe things to them.