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Catherine

Age at interview: 41
Age at diagnosis: 14
Brief Outline: Catherine first experienced depression in her last year of secondary school and for a number of years had severe episodes of depression. She spent some time in hospital when she was younger as an inpatient. She has tried a number of different antidepressants, some of which were ineffective or had unwelcome side effects. She currently takes takes Prozac (fluoxetine) and finds that it helps to keep her mind balanced and more stable. Catherine also has a physical condition called fibromyalgia which causes chronic pain, and takes a number of other medications to help with this.
Background: Catherine is married and works as an E-health Officer in a Mental Health setting. Ethnic background: White British

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Catherine found family life difficult as a young teenager. She started to suffer from extreme fatigue, inability to focus and finding it hard to concentrate on her studies, but at the time did not know anything about depression. She left home and moved to a new area to stay with relatives to take her school exams, but the move and changes she encountered made her feel worse and she took an overdose of a variety of medicines that she found in the house, and was admitted to hospital for the first time. Although she saw a psychiatrist in the hospital, she wasn’t given any formal treatment as he thought that her family situation was to blame and that she needed more practical support.
 
Over the course of the next few years Catherine found life more and more difficult and felt unsupported through the troubles she was experiencing. At one point she was admitted to hospital but found that there was little understanding of young people’s problems. However, at that time she was assessed by a psychiatrist who prescribed antidepressants for the first time.
 
‘It was quite a relief for that to be validated… that was the first experience of medication… I was put on antidepressants for the first time… the good thing was I was actually in the unit being observed and being supported so it wasn’t as scary as it might be at home and being given a prescription and having to go away and take it’.
 
The first antidepressant Catherine was prescribed was a imipramine, a tricyclic. This lifted her mood for a while and whilst taking it as an inpatient in hospital Catherine was provided with psychotherapy and other support. After she was discharged she began to struggle once again and the medication was changed to lofepramine.
 
Catherine struggled with life over the coming years and began experiencing new symptoms such as hearing voices, paranoia and anxiety and she took several overdoses over this period. During this time she continued with antidepressants but was also prescribed antipsychotic medicines to take alongside them. When she was 19 Catherine tried fluoxetine, one of the newer SSRI antidepressants which had just been introduced, which she felt agreed with her more as it had a less sedating affect than the other medications she had been using.
 
Over the years Catherine has also tried other antidepressant medications including paroxetine and mirtazapine but although she experienced some benefits, Catherine found some of the side effects difficult to cope with. Fluoxetine has been the most effective antidepressant for Catherine, with the fewest side effects, and she has been taking it continuously now since 1998.
 
Despite many setbacks and difficulties Catherine says she made a slow recovery over the years whilst taking fluoxetine, learning to use other strategies for positive wellbeing such as healthy eating and taking exercise. She has benefited from Cognitive Behaviour Therapy (CBT), and other talking therapies; and also finds complementary therapy such as Reiki and massage helpful. She eventually went on to take an Open University degree and now works full time in the mental health sector supporting other people with depressive illness.
 
Catherine is reluctant to stop taking fluoxetine as she fears the depressive symptoms could return. In recent years Catherine was diagnosed with a physical condition called fibromyalgia which causes severe chronic pain, and she feels the antidepressants help her cope with the difficulties this poses for her in her life.
 
‘The chronic health service … said they had many patients who were on antidepressants as part of having chronic conditions… physical and mental health in depression quite often go hand in hand’.
 
Catherine feels that antidepressants can help people struggling with severe depression to be able to reach a place in their mind where they can begin to think about and confront their own issues, that it is not a solution to problems, but can help to make things more bearable.
 
‘When you have such significant depression that you’re not wanting to live anymore….. the medication takes that edge off the thoughts of suicide and wanting to harm yourself to the point where, actually okay you’re still low, still struggling, but you’re able to start to do things about it in other ways’.
 

Catherine feels that doctors should realise that a patient may...

Catherine feels that doctors should realise that a patient may...

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There is a fear I think from doctors where somebody is going to say no because a doctor is offering you something, you politely, because there is a well of people who have already made that decision, I’ve spoken to people myself who are adamant they don’t ever want to take antidepressants and I think they’ve got to be prepared for that, they’ve got to be prepared for all responses, not just the yes I will and just hand out a prescription or yes I will can I have more information but no I’d rather not and I think it’s about, you know you must spend that extra five or ten minutes giving, you know, saying to the person are there any questions you’d like to ask me about this medication I’m about to prescribe to you, this is what it’s about.
 

Catherine feels it’s unrealistic to think an antidepressant...

Catherine feels it’s unrealistic to think an antidepressant...

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It’s not just about the medication; it has to be about other things that you’re doing in your life as well, not just medication. Medication is very much a kind of crutch, it’s an additional kind of thing to other things I don’t think you can solely rely that medication is going to cure all the problems in my life, it’s not, it’s great isn’t it, it’s great as a tool really, in a toolbox with lots of things that can be used.
 
So do you think it’s kind of helped you to get to the place along the way where you’ve had different bouts of therapy and you’ve been within, it’s helped you in the headspace to be able to deal with some of those things?
 
Yes, yes, I think it gets you to a, when you have such significant depression that, that you’re not wanting to live, you know you’re suicidal, you’re not wanting to live anymore. I think the difficulty with, with trying to say well we’ll just start to talk about things you’re not even in that place you can do that at that point. Whereas the medication takes that edge off the, the thoughts of suicide and the wanting to harm yourself to the point where actually, okay you’re still low, you’re in a low mood, you’re still struggling, you know to get through the day but you’re able to then start to do things about it in other ways and I think that’s where the benefits come in. Where it’s just that kind of lifting you 20/30% up and the rest, the 70%, the rest is down to you, you know, you’ve got to do the right, people around you and see what services you have around you. 
 

Catherine took Prozac (fluoxetine) and felt it suited her, but...

Catherine took Prozac (fluoxetine) and felt it suited her, but...

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I think it was 1990, yeah 1990, I first went onto Prozac and actually that was probably the best move they’d made because the increase in energy was much, much more noticeable. It created a much better sort of, the apathy lessened the, the lethargy lessened, that kind of reduced, and I didn’t really have too many side effects at all from Prozac.
 
Did you have any?
 
I think the only thing I can remember at the time was occasionally fidgety but I didn’t, apart from that I didn’t experience anything else at all with Prozac. And I continued on that with the continued with the antipsychotic and the Prozac together for the next maybe about five, five or six years I stayed on that. I think in the midst of that there was, sometimes you kind of think that the antidepressants maybe don’t last they don't have a longevity to them, you take them for a few years and the kind of effects start to, to wear off so. While being on Prozac I was also given paroxetine but that was a complete nightmare.
 
It wasn’t very pleasant at all, it is not a pleasant drug.
 
Tell me about that.
 
Yeah I started to, again the, I lost all, I lost all interest, it took away my level of creativity, it took away any interest I had in things that I felt like, not that I was constantly bored but the fact that I felt bored but I wasn’t interested in doing anything anyway and I think I also lost kind of any ability to communicate in any kind of meaningful way, I felt very flat, you know, flattened by a tyre.
 
Took away your motivation?
 
Yeah motivation, thought processes, cognitive functioning that kind of thing was pretty, quite horrible. I didn’t actually stay on that medication for very long at all before coming off that and actually I was really quite glad to see the back of that.
 

Catherine was put on mirtazapine and felt it helped alleviate...

Catherine was put on mirtazapine and felt it helped alleviate...

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Think they had a complete overhaul on the medication at that point and that’s where the mirtazapine came about. I think that was the first time I’d experienced severe anxiety, which is why I think mirtazapine was particularly thought to be quite useful because I’d had a period of insomnia again the first time I’d ever experienced insomnia and severe anxiety. And mirtazapine for the first year was actually really, really good although the very, the huge negative on mirtazapine was weight gain, which was horrendous because if you’re already, if your self-esteem’s low even though your moods increasing you're getting bigger, you know, it’s just, it’s just horrible and I went up, I must have gone up to a size 18 and I put on about four stone it was really quite, quite horrible.
 
Did you notice increased appetite, where you eating a lot more?
 
Yes a huge increase in appetite and it’s funny because they say well it’s not always just the medication, just try and eat a healthy diet and everything but it was completely different for me, I’d never been that way ever on anything and I know you can comfort eat with depression but, you know, that’s going a bit too far, you know, I have been, I have, have tended to be little bit up and down but usually it’s within a stone certainly not within sort of four, about three or four stone.
 
And yet the positives to that were that I was sleeping and anxiety was hugely reduced, so it was a huge dilemma and I’d really struggled with, with what I was going to do about that but actually the answer came from itself in that for whatever reason it stopped working anyway, and as the lethargy, as the sleep had pretty much sorted itself out and had, so had the anxiety, it was felt that well why not go back to Prozac.
 

Catherine was prescribed antipsychotics and antidepressants...

Catherine was prescribed antipsychotics and antidepressants...

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So the lofepramine I was on for about a year and a half but in the midst of that I also had another admission to the young people’s unit because I had additional symptoms of hearing voices and, and very much, kind of a lot of guilt, a lot of sort of paranoia and guilt so I did have another stay whilst still on antidepressants but also in addition to antipsychotics for a period of time as well which they felt would work well with the antidepressant.
 
Do you know what ones those were?
 
Sulpiride, was the antipsychotic.
 
Okay.
 
I didn’t see the back.
 
Oh well we can do that later that’s okay.
 
And they felt that that was still part of the depression, it just, it was just an addition to it and that I clearly still had a lot of struggles with, the really compounding factor was guilt and the guilt came about in the fact that I was scared that people were talking, that I was a bad person, you know, so all really, the, the depression cycle was about sort of blaming myself and I think that’s were there the kind of the psychosis came into it. And then I, after that admission and while still on antidepressants and then on the antipsychotic I went to supported accommodation.
 
I was on Prozac at the time, yes. I think my antipsychotic had been reduced and changed to Stelazine and I actually since experienced quite significant physical symptoms. I was experiencing very high, a lot of sweating a lot of anxiety in the stomach, a lot of stomach upset and mentally I was really feeling very unwell.
 
Did you attribute that to the antipsychotic drug?
 
Yeah, yeah, yes definitely the, unfortunately they, they didn’t agree with me.
 

The first time Catherine was prescribed an antidepressant...

The first time Catherine was prescribed an antidepressant...

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After six weeks I got placed in the young people’s unit, during that six weeks I suppose nothing really happened at that point, there was no real services for me to access, there was no, they didn’t, I wasn’t put on any medication because they didn’t know really what they should be doing, and there was a bit of sort of drama therapy and art therapy but nothing, anything very significant. So I went to the young people’s unit and there I spent seven months as an inpatient and it was then that we had all these questionnaires that, that you have in sort of blocks of paper, a lot of questions about how you’ve been feeling a lot about writing about your experiences and by that very kind of thorough assessment of more specialised services they were able to pretty much say after about four weeks that they felt I’d been experiencing significant depression for probably the last few years anyway if not before.
 
So in many ways that was quite a relief to be actually sort of, to have that validated, that there, there was something and in other ways I still obviously had a lot of struggles to contend with. But that was the first experience of medication and I was put on antidepressants for the first time and I’d never experienced, you know, taking or knew anything about antidepressants or medication so, but I suppose the good thing was I was actually in the unit being observed and being supported, so actually it wasn’t as scary as it might be at home and being given a prescription and having to go away and take something. So I started on medication then and it did lift my mood which was, which was really encouraging, I suppose the only kind of residual part that was left was the medication was there to take the edge off things but I still had a lot of work to do.
 
What was the medication that you were given.
 
It was imipramine I can’t remember what dose I went up to but it actually worked out really, really well and after I’d going through sort of therapy and all the services that, that the young people’s unit provides; psychotherapy, weekly meetings all that kind of thing and the medication. Eventually I was discharged and went to share a flat with another young girl from the unit. But I attended as an outpatient but I think I, I was still in many ways, week by week there was, there was, I was still struggling and I didn’t maintain a level, continue to maintain a level on the medication so it was changed to a lesser sedating antidepressant called lofepramine, in the same group.
 
Is these tricyclics?
 
Yeah tricyclics and I think that’s one of the ones that doesn't have the, has the least sedation because I did, I did struggle a great deal with, with lethargy and apathy and very, you know, so although I had maybe sort of mild anxiety it certainly wasn’t something, I didn’t need the actually sleepy addition to it. That worked actually better and I was on that for probably about a year and a half whilst still attending services.
 

Catherine takes medicines to cope with her chronic pain...

Catherine takes medicines to cope with her chronic pain...

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Fibromyalgia chronic pain, it’s actually a really, it’s what they class as a set of symptoms, it’s, it’s not a specific illness as such, it’s a set of symptoms where there’s chronic pain, widespread pain in the muscles and with it sleep disturbance, chronic fatigue is quite common, I experience chronic fatigue with that. I also experience Sjogren’s syndrome which is the dry mouth, dry eyes, dry skin and that’s quite common again to be with, to go with fibromyalgia. One thing maybe not quite so common is lymphedema in my left arm, swelling, they don’t really know if that’s really, if that’s related but they basically fibromyalgia chronic pain condition.
 
So would you say that part of the reason for carrying on with the Prozac now is to kind of alleviate the feelings that you have about that condition?
 
Yes, yes I would yes because the other thing is about that is I have attended the chronic pain services and ironically part of the process of, the services you use is psychological therapies which is CBT as well as physiotherapy and also I think many people who I’ve spoken to about fibromyalgia are also on antidepressants because they still think that the serotonin can be useful in fibromyalgia. Whether it, whether, I mean again it’s, it’s a, a difficulty whether you could say that having a long history of depression would ever have triggered off fibromyalgia because again there’s a thing about whether fibromyalgia, is it a psychological condition, is it a physical condition, is it both? There’s an ongoing.
 
And some of the symptoms are pretty similar too it sounds like from what you’ve just told me.
 
Yeah, yeah, so that, that can be, yeah that can be a bit of a difficulty but certainly my fear would be I would have a, I mean actually before I developed fibromyalgia I was already looking to coming off Prozac, so it wasn’t really as if there was a fear there at the time, I think the fear has come around from the fact that I have a physical condition to deal with while I’m working fulltime still, which is very, you know, it’s hard in itself a fulltime job and, you know. A lot of people with fibromyalgia aren’t fortunate enough to work at all, I am, so and I’m also now on a cocktail of pain medications so, you know I think the fear is valid I would say and kind of the Prozac thing and whether there’s a placebo thing or whatever I don’t know but, you know, for me it’s, it’s, I really don’t want to take that risk at the moment because I’m, I am working, I don’t want to disrupt that, what I have is still good and it would be a bit daft really to, to think about that just now.
 

Catherine has been on several types of antidepressant over...

Catherine has been on several types of antidepressant over...

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When you did those you know you’ve changed from various different antidepressants onto different ones.
 
Yes.
 
Has that been, what does the changeover involve? Has it been like one minute you’re taking one and then the next you’re taking some different one?
 
Well it’s been different and I think that’s a good question because the one I do remember and it was when I changed from mirtazapine back to Prozac I was given something and I can’t remember what it was but I was given something to help the changeover because I was told I might struggle with the sort of discontinuation symptoms, certainly with sleep and things like that and she gave me a seven day supply of something to help the transition. And I think there have also been cases where switching from I think Lofepramine to Prozac, you had to have lofepramine out of your system for a period of time, you couldn’t have the two together so you had to reduce off the lofepramine before starting the Prozac.
 
Is that what you did?
 
I did, that was a long time ago but I did that under guidance yeah. I don’t remember, I don’t remember experiencing too many difficulties with that, the lofepramine, at all, the biggest problem I had was with the paroxetine but because I’d not been on it for a long time it wasn’t too bad and actually the side effects for me were worse on it than actually the gradual reduction coming off it.
 
What were the side effects of the gradual reduction, because you said the side effects of being on it were that it decreased your levels of motivation?
 
Yeah, yeah, motivation, yeah, those thought processes the lot. The side effects of coming off it were disturbed sleep, vivid dreams was quite a common one and the continual low, because I was already in a low mood anyway, the low mood stayed to be low. But I think it was the dreams and the sweating, sweating, dreams and sleep they were the main three things from Paroxetine.
 

Catherine has tried a number of different things to improve...

Catherine has tried a number of different things to improve...

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It’s like being asked the question “what’s going to make you better?” I don’t know. You’re asked well, doesn’t necessarily make your cold better but what’s going to help your cold, well I’ll get a Lemsip or whatever, it doesn’t work the same for depression, anxiety, sleep, it doesn’t.
 
You know everybody’s responses are so different so that’s really a question that can’t be answered until you actually build up these tools and actually what we have to remember is there are some tools I’ve thrown out because I have tried things. I tried reflexology, it wasn’t for me and yet other people it is for them so that’s out my toolbox but I’ve tried it and I think that’s what you have to do, you have to try things in order to throw it at your toolbox because you just don’t know, you don’t know these things, you can only, it is a bit of trial and error, which is, is, is actually the frustration with depression and anxiety, is the fact that you have to trial things because there’s nothing worse than feeling utterly miserable and what you’ve got to do is spend weeks trialling things, you want to feel better like yesterday and it doesn’t, it doesn’t work, it doesn’t happen that way and that’s probably the most miserable thing that is about depression, is it can take, it can take a while and that’s horrible thinking about that.
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