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Michael

Age at interview: 72
Age at diagnosis: 26
Brief Outline: Michael has always felt depressed even when he was young. His depression has been very reactive to his work life. Over the years he has tried a number of antidepressants and resided himself to the fact that he would always feel this way. After a severe depressive episode he started taking paroxetine and other medication to help with anxiety and paranoia, as well as having talking therapy. He has taken up a number of activities over the last few years and feels a sense of purpose for the first time in his life. He explains that he still has his ups and downs and alters his antidepressants accordingly. He is not sure about the extent to which taking antidepressants has helped him, but is afraid of the consequences if he stops taking them.
Background: Michael is now retired. He now does voluntary activities with a local healthcare trust. He lives with his wife and they have two adult children. Ethnic background: White British

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Michael recalled that he has always felt depressed, even from a young age. He described how his depression led him to feel shy and unhappy throughout his life. He often felt overwhelmed by his work and that he didn’t fit in with his colleagues. He was eventually diagnosed with depression in 1966 at the age of 26 and began taking Valium (diazepam), which was commonly prescribed at that time for depression and anxiety. He has been taking medication for depression ever since that time but is unsure to what extent they have helped.
 
‘I was given medication, I was on Valium as it was in those days, prescribed Valium and I was taking that throughout... I was on Valium for let’s say ten years… I just kept on the tablets…., I just took them… I just carried on taking it, I always carried on taking them and no doctor ever told me not to take any they never really told me to cut down any… just carrying on repeat prescriptions just going and going
 
In 1968, he was eventually hospitalized because of his depression. He began to feel a bit better in hospital and felt comforted by the fact he was in the company of others who had similar problems to him. For a time after this he felt reasonably well and got on with work and taking care of his family but pressures of work and difficulties at home caught up with him and he once again started to feel extremely depressed. His psychiatrist at the time prescribed him amitriptyline, a tricyclic antidepressant.
 
‘I got progressively worse with my depression and I was seeing psychiatrists again and at that stage they were saying they would stop putting, they increased my Valium and then they put me onto amitriptyline at that stage … I thought that was alright, I was okay on that but it’s such a long time to remember back really’.
 
Michael explained that he has generally accepted everything that his doctors suggested and went from day to day, taking his antidepressants without questioning anything. This continued for many years.
 
‘I just did things, I just went from day to day, take my pill, carry on, I didn’t question anything, I didn’t bother about anything, it was, and I was quite uncommunicative… when you’re, when I was depressed anyway I was sleeping a lot … I think I was taking a bigger dose of amitriptyline, I was sleeping a lot, I got no energy, I didn’t talk very much, didn’t want to do anything but I just kept taking the pills and doing what people told me. I just kept, I was living in a haze really and I’ve lived in a, I lived in a haze for, until I was 63 which is nine years ago, I lived in a haze really from should say 40 to 63.’
 
After some years his antidepressant was changed to Prozac (fluoxetine), and although he felt some benefits at first, his depression worsened and he became very withdrawn and unable to work.
 
Looking back Michael feels that for many years he had very little support from the psychiatrists and health professionals he’s seen and that their focus was primarily on prescribing medication. However when he saw a new psychiatrist a few years ago, his medication was changed to include an antipsychotic drug (risperidone) and a mood stabiliser (lithium) as well as a different antidepressant (paroxetine) and this marked the beginning of a change in his mood and state of mind. It has taken many years to begin to feel more in control, but more recently he has found new interests and a sense of purpose in his life for the first time, which has come about through a period of intense therapy and finding new ways to think about himself.
 
‘I started to take part in things and they set up an involvement centre at the healthcare trust and I was one of the first to join there and I took to that like a duck to water and I was taking part in things, like doing interviews, going to big meetings and I absolutely flowed and I could write well, communicate, and I was doing really, really well. And it just blossomed and I’m a totally different person, this ten years …totally.’
 
Overall, Michael doesn’t feel that taking antidepressants has had a great impact but he would not want to stop taking them as he is fearful that he would become unwell again. He says continuing to take the medication makes him feel safe and more confident to be able to keep going with life.
 
‘You can never tell can you, what would I have been like without them, I don’t know. I don’t know what I would have been like without them. I fear that I would have been a lot worse without them. But I don’t know whether that’s true or not’.
 
Michael has been very accepting of the advice to keep taking medication that he has been given, partly because he has often felt unable to make decisions or think clearly about things, but also because he generally feels doctors are the experts. The one drug he felt unhappy to continue taking was lithium because of side effects and some potential health implications.
 
‘I just kept on the tablets, I felt they didn’t, I just took them, I felt they didn't make any difference to me really but I’ve always been frightened of coming off them… I wouldn’t say I’ve got a lot of trust in them as a person [doctors] or how they’ve treated me but I feel they’re, their basic aim is to make me feel better so I believe that I’m a follower of what they say’.
 
Michael feels that health professionals should provide more information on how antidepressants work and how they are likely to affect you. He recommends that people take their time to discover the right treatment for them, and to try counselling before antidepressants.
 

Michael didn’t like taking lithium because of concerns that...

Michael didn’t like taking lithium because of concerns that...

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I was taking risperidone, paroxetine and lithium and I took that for six months and that’s quite dangerous taking lithium, damage your kidneys and all kinds of things and it makes you fat as well, I always blame this on, on lithium and I thought when I stopped taking it, it would go away but it doesn’t, you have to exercise to get rid of it. and I fought to come off that, I was determined to come off it and I kept going to psychiatrists every time I saw them can I come off lithium.
 
And that was because you felt it wasn’t doing you any good?
 
It wasn’t doing me any good.
 
Did you know about all the sort of dangers?
 
Oh yeah they tell you, you have to have a card and all kinds of things yeah.
 
Right, so that was the one drug that you were not happy to.
 
I’m not happy to take it, no.
 
Whereas all the others you’ve been kind of quite.
 
Just accepting yes.
 
Yes.
 
Yeah, yeah, yeah.
 
So you were worried about the kind of concerns that you would have if you were going to resist taking one would be to do with safety and health?
 
Health yeah.
 
And other health reasons?
 
Yeah, yeah, yeah. But they do always check my liver and kidneys because Risperidone has some effects as well.
 

Michael reflected ‘I don’t know what I would have been like...

Michael reflected ‘I don’t know what I would have been like...

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Looking back I don’t think I had any, I don’t know, I would have been scared to stop taking it because I feel I would be really ill but I’ve always had the fear of not taking it because I’ve seen what happened when some people do stop taking it and I’ve always had a fear of not taking it and through all the ups and downs really bad, okay, I still carried on taking it without question really.
 
But you can never tell can you, what would I have been like without them, I don’t know. I don’t know what I would have been like without them. I fear that I would have been a lot worse without them. But I don’t know whether that’s true or not, do I, but I believe, I believe that I would rather kill myself rather than be totally depressed without them, I believe that really.
 
Do they give you a feeling of safety?
 
A feeling of safety that’s propping me up its, it’s a prop I’ve felt it’s been a prop. While I’m taking these I can survive, I can go on.
 

Michael has had good and bad experiences with psychiatrists

Michael has had good and bad experiences with psychiatrists

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Well, you see, it’s just the luck of the draw which psychiatrist you get for a start and some people have got bad ones and some have got good ones and there’s also, until you get a consultant you get the oh what do you all them the, the junior psychiatrists before they become consultants and they change every six months and I think they were thinking of changing them to every three months, so every time you go you have to tell your whole story all over again and I’d like to see them kept on longer for perhaps a year seeing people.
 
More continuity then?
 
Because every time you see a new one you have to establish a relationship with them, you have to tell your whole story again which is painful because they don't seem to read their notes, you have to tell your whole story every time. And by the time you’ve told your story your sessions almost finished and by the time you’ve got friends with them, where you feel you can trust them or you’ve sussed them out whether you don’t trust them, they’ve gone and you’ve got somebody else. So either people ought to have a longer time to get to consultants earlier and perhaps the other one sitting in but I think there ought to be longer term seeing people, you need time to open up to them, it’s not easy talking about things to people.
 
So one of the things that you would recommend would be its good for people to see the same person?
 
Yes.
 
Continuously.
 
Yeah, yeah once you get a consultant you do that until they’re better or something which I think it’s a lot better but again they, some, as I was saying some psychiatrists just say how are you, I’m feeling alright, you sure you’re alright, still taking those tablets, tablets alright, sleeping, okay, yes, appetite’s alright, okay. I mean you could say okay whether you are or not and they say right see you next week that’s five minutes and you’re gone. And others will say, and some of them won’t even look at you or they’re looking at their watch or just looking at the thing on the screen without even looking at you. Some have got terrible personal skills, interpersonal skills but some are great, some will sit and talk to you and when they say how are you they talk about it and tell me how you feel and how is this. And the ones that remember, you know, how’s your cat getting on or something like that, or has your wife done this or how is your, they’re, they’re the winners ain’t they. But it’s just the luck of the draw.
 
And would you say that over the years then you’ve felt better or worse depending on which kind you’ve seen?
 
Yeah. I mean I had a bad one that lasted for 12 years. Yeah I couldn’t tell him anything, if I said I was ill, he’d up my pills, if I said I was suicidal he’d have put me in hospital, so I just said alright, fine, okay and he said right see you. Or if I said, also he used to say, although sometimes I’d say yes alright, I’m fine and then he’d sometimes say well I think you ought to stay off work, go and see your GP and get a certificate to stay off work, and I’d say alright, no you ought to stay off and so I would but it was hopeless really, he never listened to me never, no conversation all short sharp.
 

Michael’s message is for doctors to provide information...

Michael’s message is for doctors to provide information...

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I think, first of all I think you ought to tell them about the side effects and I can realise why they don’t because some people wouldn’t take it if they knew the side effects. I think they should tell them side effects, I think that’s important and also, I know why they don’t because it might psychologically bring on the side effects, people might talk themselves into having side effects and some people wouldn’t take it, they’ll say oh yes I’ll take it and stop it, there’s quite a lot it’s quite a lot of reasons people don’t take the medication, they get home and read the side effects and they don’t take it but they don’t always tell the psychiatrist or the doctor. So I can understand why they don't do it but I think they should do it and I should also think, like I said, they should tell you what this is going to do for you, I’m going to give you this and this will make, and this will have the same psychological, this will make you feel better this will enable you to get up early in the morning, go out more, do things feel a bit lively, if they said, if they said they would do this it would be a good message. This will help you get better this will help you do so and so and they don’t do it, they just say, “Take this”.
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