Tim

Age at interview: 29

Age at diagnosis: 27

Brief Outline:

Tim was diagnosed with depression two years ago. He had been feeling overwhelmed about work, and one day things reached a point where he felt he couldn’t function any more. He was offered CBT and decided to try that before thinking about taking antidepressants. Although it was of some help, he went back to see the GP and was prescribed sertraline. Tim later had psychotherapy, which helped him gain a sense of self awareness and understanding. He recently stopped taking antidepressants.

Background:

Tim works as a Policy Advisor. He is single. Ethnic background: White British

More about me...

Tim’s depression was triggered by difficulties and stress at work. His mother and girlfriend at the time felt that he should see the GP. His GP diagnosed depression and gave him the option of ‘therapy or drugs’. At first he was reluctant to take antidepressants and opted for therapy. He was offered Cognitive Behaviour Therapy (CBT). He also changed his job, but still felt depressed. He said CBT felt impersonal and that he felt ‘like a cog in a machine’.
 
He returned to see the GP a year later, and was prescribed sertraline, which initially lifted his mood, but after a time his symptoms worsened. He lost all motivation. He felt that as he had tried both antidepressants and CBT that there were no other options left to try. Concerned, his girlfriend took him to A&E and he was signed off work for 3 weeks. He was relieved not to have the pressure of day to day work.
 
Tim was worried about returning to work but found that his manager was very sympathetic and understanding about his situation. She had a background in psychology and suggested that he should try psychotherapy. He described psychotherapy as a positive and transformative experience.
 
Despite undergoing psychotherapy Tim felt apprehensive to stop taking the antidepressant as he was not sure whether his mood would drop without them . Tim feels that psychotherapy has helped more than anything else he has tried and that it has enabled him to accept himself, and explore relationships and life processes . He was not offered this option on the NHS, and had to pay for private treatment. Tim feels that talking to his therapist every week has given him more confidence in himself, and he decided after a time that he felt ready to stop taking the antidepressant.
 
‘I found that [psychotherapy gave me] insight which I hadn’t ever really kind of had before about the way I think about the world and the way I interact with it…I’d felt better for a fairly sustained period of time, certainly compared to how I was feeling so I decided I would come off them [antidepressants] and I had quite a lot of trepidation... as it turned out I came off them and I was absolutely fine’.
 
Tim feels that more options should be available through the NHS and that prescribing antidepressants or CBT is not always the right solution for people.
 
‘My mental health treatment if you like kind of passed out of the NHS because I’d exhausted all the avenues that I could and I was still taking antidepressants at the time, I was told that I should and I was reluctant to stop… they definitely had an impact but I think their biggest impact was psychological’.

Tim’s doctor explained the options were therapy or drugs..

I was diagnosed with depression by my GP, in Spring 2010 I think it had been triggered by the fact that I was having a very difficult time at work and I had actually walked out of the workplace just one day I couldn’t function and I couldn’t think I didn’t know what was going on I felt I just had an overwhelming urge to leave which I did and my girlfriend at the time and my mum were both like you need to see the doctor which, you know, I had that natural reluctance that lots of people do to go to see the doctor. and so I went the next day and pretty much straight away she said, you know, you exhibit all the signs of depression and I’m going to sign you off work for two weeks and so I was immediately signed off work with depression or stress I think it was put down as depression. and in a way that was quite a relief that she was just so definite about it and she was also quite frank and said now what we do with people that have depression is we either offer them therapy or drugs and you know this is a fairly new world to me so I mean in a personal sense I’d never seen a doctor before for a mental health issue although I’d had family experience of it and I remember thinking quite clearly I wasn’t, I’d rather not try the drugs so if you’re offering me these two things I’d try the therapy first please. So that was that and I, over the period of twelve months embarked on a something like a guided self-help course and then a slightly more intensive form of CBT.
 
So anyway I did that and I sort of, I didn’t really, I was kind of, you know, functioning but not functioning particularly well and feeling quite concerned that I didn’t have I had a kind of sense of well this isn’t really working that much but I remember the offer therapy or drugs so I went to the GP’s again and I this was about 12 or 14 months on from the original diagnosis so probably Autumn 2011 and I said, you know, I’ve tried the therapy that I’ve been offered and it's been okay but I don’t fundamentally feel any different so, you know, I’d like to try the drugs now please because those are my options. And I was quite, remember feeling quite kind of hopeful and the GP was sort of like okay fine and she prescribed me sertraline at 50 milligrams and I’m sure explained all the things that are normally explained to people taking antidepressants.

Tim’s doctor was very clear about how often he should see her...

It was a kind of sense of we’ll start you on this.
 
Right.
 
And see how you go, this was a kind of light dose and she was quite cautious about it and said, you know, I want to see you in two weeks and see how you’re getting on and I want to do this and I felt, because in that segment of time I saw the same person and I felt that she was quite she was quite good she sort of, what I appreciated was that she didn't pretend to know things she didn’t know and it was unreasonable to expect GP’s to be experts in everything, she said look, you know, this isn’t, I don't know, I’m not sure how she phrased it but she didn't try and, she made a conversation about my kind of situation which was appreciated and so she was quite good at kind of saying I want to see you here and I want to see you then.

Tim wanted to stop taking the antidepressant because he...

I actually came off them in September so I took them for just under a year. and I can’t honestly say that I found them to be, to have a discernible impact beyond, they definitely had an impact but I think their biggest impact was psychological I felt a kind of, a nervousness around taking them initially in the sense that this is a really powerful drug I felt a very initial kind of high followed by a kind of low but I can't honestly separate out whether that was the way I was thinking and therefore feeling it or whether that was actually what was going on in a kind of chemical level.
 
I remember feeling quite kind of stressed out at the time that if I missed, because I was, I was sort of sustaining a working environment and I was feeling like I was making progress through the kind of therapeutic work that I was doing and I was very concerned always that if I missed the day of the pill that I would nosedive and that, you know I didn’t, I had no way of gauging what was making me feel better, you know, was it the pills, was it the psychotherapy that I was doing was it my circumstances, what was it I didn’t know and pills were at that moment part of that mix and I’d always felt quite uncomfortable by the fact that antidepressants where often prescribed and then you just continue on them for long periods of time, my sister’s been on antidepressants for almost ten years and there’s something deeply unsatisfactory about that to my mind.
 
So I was as I say I didn’t know if it was part of, what part of the mix was helping me, I had a sense that it was the discussions I was having through the therapy but I didn't really know so over the summer when I wasn’t working because I had the summer off I felt, I’d felt better for a fairly sustained period of time, certainly compared to how I was feeling so I decided I would come off them and I had quite a lot of trepidation and as it turned out I came off them and I was absolutely fine I really was, there was, I did a kind of over a period of a month I went from 50 milligrams to 25 so I was alternating days but the main feeling that I had was a fear that if I come off them it was a kind of psychological almost like a sort of dependency, like the only reason I’m feeling okay is because of this pill, it’s a kind of external sort of feeling. And I felt that and I was actually kind of possibility quite negative because I wasn’t taking responsibility for my own health in a way, or my own.
 
What just that reliance on a pill?
 
Yes just like I’ve now, I’ve come to a point where I’ve sort of stopped engaging with how I might feel and I’m just kind of now saying this pill will just kind of get me through the day and then I developed a fear whereby I would be like if I stop taking this pill I’m not going to, I’m going to be back where I was which is quite a disempowering thing in that, in the way that I sort of experienced it and felt it.

Tim felt CBT was too formulaic and patronising...

I remember thinking quite clearly I wasn’t, I’d rather not try the drugs so if you’re offering me these two things I’d try the therapy first please. So that was that and I, over the period of twelve months embarked on a something like a guided self-help course and then a slightly more intensive form of CBT.
 
On the internet?
 
No through the local services that were available I think it was the IAP service. So I did a six week course over the summer which was called Guided Self Help and I, you know, I found some use in that, I felt but afterwards I didn’t really, I still was quite, because at this point I’d changed jobs because that workplace was really not very good for me and but nevertheless I was still feeling equally not that great about things. and then I did a second more intensive course of CBT, intensive probably in the sense that it lasted longer, it was more like twelve or fourteen weeks spread over about three or four months and that was, you know, I found it, there was a security in the knowledge that I was going to see somebody and that was good but it wasn’t particularly, I felt like always the person I was seeing had to go and check their notes at the beginning of the session to think who is this guy again and that we would go through things in quite a kind of, quite a deliberate kind of slightly patronising fashion and it felt a little bit like this wasn’t really about me this was about that person going through the stages that they’d been taught to go through for people with depression so I felt like a bit of a cog in a machine basically.
 
I guess my, from my perspective the thing that’s helped me a huge amount is doing a kind of personal long term in-depth kind of psychotherapy and that’s, that’s helped a hundred times more than anything else that I had.

Tim feels there is a danger that doctors over-prescribe...

A very large portion of people if they went to their GP could get a diagnosis for depression or anxiety, a very large proportion I would say. so these things are quite common I think.
 
And there’s such a wide spectrum of experience within that diagnosis.
 
I’m sure, I’m sure yes but you know I just seems important that we kind of, I don’t know just have a slightly more honest engagement about the fact that life and the prospects of death are upsetting and difficult and the kind of relationships are fraught and, you know, that effects the way we live our lives and we can call them mental health problems and then get a pill to manage our condition but that just doesn’t seem to square with my understanding of what it is and I think that over medicating is a real risk.

Tim was at work one day when he felt ‘an overwhelming...

I was diagnosed with depression in, by my GP, in Spring 2010 I think it had been triggered by the fact that I was having a very difficult time at work and I had actually walked out of the workplace just one day I couldn’t function and I couldn’t think I didn’t know what was going on I felt I just had an overwhelming urge to leave which I did and my girlfriend at the time and my mum were both like you need to see the doctor which, you know, I had that natural reluctance that lots of people do to go to see the doctor. and so I went the next day and pretty much straight away she said, you know, you exhibit all the signs of depression and I’m going to sign you off work for two weeks and so I was immediately signed off work with depression or stress I think it was put down as depression. And in a way that was quite a relief that she was just so definite about it and she was also quite frank and said now what we do with people that have depression is we either offer them therapy or drugs and you know this is a fairly new world to me so I mean in a personal sense I’d never seen a doctor before for a mental health issue although I’d had family experience of it.
 
I was off work for three weeks I think and I was, in all of that time I was relieved to not have the pressure of day to day work because I felt this really kind of, there was a constant trial it sort of felt like but I was also building up a real fear that, you know, when I go back to work I could basically be told that, you know, this is unacceptable and that I need to be in if I want to keep my job.