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Jenny

Age at interview: 36
Brief Outline: Jenny started taking antidepressants when she was at university as she had been finding it difficult to cope. She took Seroxat (paroxetine) at first, but after a time it began to be less effective and she changed to venlafaxine which she took for around 6 years. During that time she developed severe chronic asthma which eventually led her to have to leave her job and return home to live with her parents who now care for her. Jenny has to take numerous medicines for her asthma, some of which are to counteract side effects that occur from the asthma medicines. She now takes sertraline and feels it keeps her on an even keel and able to cope more easily with the difficulties caused by having chronic asthma.
Background: Jenny lives with her parents who help care for her as she has chronic asthma and is often unwell. She had to retire from her job in healthcare due to ill health but keeps active by studying and doing voluntary work. Ethnic background: White British

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Jenny first experienced depression as a teenager following some difficult experiences including the death of her grandmother, and she began to self-harm, but the counselling she was offered was unhelpful and eventually she managed to get through the difficult times by herself. Jenny was first prescribed antidepressant medication when she was at university at a time when she had been finding it hard to cope with studying, and felt she didn’t fit in very well. The first medication she was prescribed was Seroxat (paroxetine) which worked well to improve her mood overall, but she thinks that it increased her appetite and that she gained weight during that time. Some while later she changed to venlafaxine which she took for around 6 years and found it really helped. During that time she developed severe chronic asthma which eventually led her to have to leave her job and return home to live with her parents who now care for her.
 
‘It was during these years that I developed the severe asthma and started having to go in and out of hospital. I was also started on long term high dose steroids which themselves are a depressant’. I think I coped quite well, people asked me how I stayed so cheerful. I just said it was the ‘happy’ pill I took each morning. Don’t get me wrong though, I still had some very down days but I think that already being on the antidepressants when the severe chronic asthma kicked in really helped as I was on an even enough keel to allow me to cope with the asthma’.
 
Coping day to day with the restrictions that having severe chronic asthma places on her life can be a struggle for Jenny at times. She took venlafaxine for some years on a ‘maintenance dose’, but there was one time she remembers when she had spent a long time in hospital and was feeling very low, and her doctor increased the dose. After a time she decided she wanted to cut it back down, but she tried to do this without consulting her doctor and found that she experienced very severe withdrawal symptoms for a few days.
 
‘The doctor said that with venlafaxine you have to drop down in much smaller doses than when you increase… I was given a stern talking to about fiddling with my medication dose without supervision!’
 
She now takes sertraline as her GP decided to change her medication when she complained that she was experiencing a very dry mouth. This may have been a reaction between a new drug she had begun taking for her asthma, and the venlafaxine.
 
‘The changeover involved weaning the venlafaxine down, whilst introducing the sertraline. This process took about 3 weeks and during this time my mood was rather erratic’.
 
Jenny feels that antidepressants can be really helpful for people if they work - in her case they keep her mood relatively stable under the circumstances. Last year Jenny had 9 emergency hospital admissions – she can go from being perfectly well to being severely unwell in a matter of hours. She takes a total of 19 different medications each day – some of which are to combat the side effects of her asthma medications - she also has another condition called secondary adrenal insufficiency which means her adrenal glands no longer function due to the large doses of steroids she has to take.
 
 ‘They [antidepressants] help me to deal with whatever else life throws at me…. Trying to cope with a serious chronic physical illness whilst your emotions are yo-yoing up and down would not be fun. I’m not sure I would have coped this long if I hadn’t been on the antidepressants’
 
Whist being an advocate for antidepressants if they work, Jenny also feels very strongly that better access to therapies such as CBT or psychotherapy is needed.
 
‘It’s all well and good to give out chemical help in the form of antidepressants, but they don’t address the causes of the depression or anxiety. Without some form of talking therapy or counselling…. surely you just end up with people in a cycle of depression and regression.
 

Jenny has a very acute form of asthma and is often in hospital...

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I developed the severe asthma and started going in and out of hospital. I was also started on long-term high dose steroids, which themselves are a depressant. I think I coped quite well and people were often asking me how I stayed so cheerful. I just said it was the ‘happy pill’ I took each morning. Don’t get me wrong though I still had some very down days, but I think that already being on the anti-depressants when the severe chronic asthma kicked in really helped. I was on an even enough keel to allow me to cope with the asthma.
 
When I go into hospital I always take my anti-depressants, in fact all my medications, with me. Over the years I have learnt, through bitter experience, that hospital pharmacies and drug prescription charts are fickle sources of drugs!! I also take with me a spread sheet detailing all the drugs I take, formats, doses and timings. Even this doesn’t prevent errors and/or omissions. I therefore know that if I have a supply of my own medications I can at least self-medicate if all else fails, although I must say that I wouldn’t advocate this as a course of action. Possibly because I am such a frequent visitor, I always self-medicate, but I do go through the drug charts with the nurses during each drug round to check that the doctors haven’t changed anything or added anything. The only times I hand everything over is when I am in the Intensive Care Unit or A+E, but at these times I am too unwell to safely dose myself. Or if I am feeling “spaced” or think myself that I am unsafe to do it. There is no point in making myself feel worse my getting something wrong.
 
Doctors have been known to ask me if I think I still need the anti-depressants. I just smile at them and suggest they look at my medical history, drug regime and hospital admission record, and tell ne if they could live like me without some chemical mood assistance. None of them has yet challenged me twice!
 

Jenny takes numerous medicines for other health conditions...

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Jenny takes numerous medicines for other health conditions...

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The main thing I have noticed in terms of the anti-depressants is that when you have been on them a long time, had them on “repeat prescription”, GP’s tend to forget about them when prescribing other acute medications. There can be some interactions with other medications. But these are usually picked up by the pharmacist dispensing the drugs, if the doctor has missed it.
 
For me the only real issue I’ve had was when I started my current anti-depressant, it upset my Warfarin levels, blood thinning medication, but after a few weeks, and a few extra blood tests we got things levelled out again.
 
I have to admit to being different from most people. Due to the large number of drugs I take, I have my own copy of the BNF publication that doctors use, so that I can check up on any interactions etc that might occur when I have to start a new medication. I get a new BNF annually from my GP.
 

Jenny has an acute form of asthma and takes numerous...

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I wish I could take less medication. I sit at the breakfast table and look at the 14 tablets I call my second breakfast, and I wish that for just one day I could not take any pills. Many years ago, before I was as ill as I am now, I did decide that I wasn’t asthmatic anymore. I lasted 32 hours before I ended up in hospital. Now if I tried that I wouldn’t last 12 hours without help, and would probably be dead in under 24 hours. My medication literally keeps me alive. Thinking about this now, maybe this realisation is one very good reason to keep taking the anti-depressants. It’s a depressing thought that without pills I would be dead. If I had been born even 25 years earlier than I was, i.e. in the1950’s, I wouldn’t have survived to be 36, as I am now, and my body would have given up before this age.
 
After years of experience of anti-depressants I can now see changes in myself which might indicate a need for a dose or medication review. But I have also learnt how to identify when my low mood is related to my chronic health problems and when it is the underlying depression rearing its ugly head again. It has taken me quite a while to accept that when I have been unwell or in hospital I might be “down” for a few weeks. “Normal” people have this psychological response to ill health and/or hospitalisation. I used to think that because I was on my anti-depressants I shouldn’t be feeling like that. I now know that they don’t stop me feeling down when it is natural to feel down; rather they prevent me from getting stuck down there. They allow my not to pile one thing on top of another and get bogged down by life.
 
I think it is obvious from what I have already said, that I am a real advocate for anti-depressants if they work for you. For me personally they maintain me on a level plane from which I can then deal with whatever else life throws at me. Trying to cope with a serious chronic physical illness whilst your emotions are yo-yoing up and down would not be fun. I’m not sure that I would have coped this long if I hadn’t been on the anti-depressants. I have so many medications in the house that, taken in big enough quantities could kill me, that I think had I been as low as I was before the anti-depressants, temptation for the easy way out would have been too much. My asthma is not curable, the side-effects caused by some of the medications, have given me several other serious non-curable conditions, and some of the medications themselves are depressives. On top of all this I don’t know from one day to the next, how my lungs are going to be, and I’m in and out of hospital on a depressingly regular basis. Is it any wonder that I keep taking the tablets! I challenge anyone to live my life, with my history, without taking anti-depressants.
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