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Stuart

Age at interview: 52
Brief Outline: Stuart has experienced depression since his teenage years but it wasn’t until he was in his 30’s that he sought help from the GP following a breakdown. He has tried a number of different antidepressants, and currently takes citalopram as a preventative measure. He feels that medication is helpful in combination with other treatments such as CBT therapy and mindfulness.
Background: Stuart is married and works part time as a teacher. He is also involved in voluntary activities to promote positive information about mental health. Ethnic Background: White British

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Stuart realised looking back that he has had depression since he was a teenager but he didn’t seek help when he was growing up because of the social stigma and macho culture that defined depression as a sign of weakness. As a teenager he was withdrawn and unhappy much of the time but he learned to live with it and get by.
 
‘I had known that something wasn’t right for a number of years but I guess I was a typical man, I didn’t seek help’.
 
 It wasn’t until he was in his 30’s and working in a high pressured business environment that he experienced a breakdown and sought help from the GP. Initially Stuart wasn’t comfortable with the idea of taking an antidepressant, because of the stigma, and the negative feelings that he experienced at the thought of needing to take regular medication.
 
‘It was part of the shame really it’s you know, it’s like, it’s like, you know I’d never taken medication for anything beyond a headache in my life.’
 
At first he was prescribed a tricyclic antidepressant, but after taking it for 6 months or so it was clear that it was having little effect on lifting his mood. The GP put him on an SSRI (fluoxetine) to begin with. Over the years he has tried several antidepressants to try to find one that suited him best.
 
The doctor switched me to fluoxetine and I had some strange side effects with that…I was back at work by then but still not, not a 100%’.
 
Later he was referred to a psychiatrist, for more specialist support. The psychiatrist prescribed venlafaxine, which was the one antidepressant that Stuart feels has had a noticeable impact to improve his mood. Although venlafaxine worked well for Stuart, he found it affected his libido. At first, he felt he could accept this, and he took venlafaxine for a number of years with noticeable benefits. At that time he was also referred for Cognitive Behavioral Therapy (CBT) by the psychiatrist, and feels that of all the therapeutic interventions he has tried, this one has been the most helpful. However when he eventually re-married it felt more difficult to accept this side effect and he began taking citalopram which he has taken ever since.
 
Stuart feels that antidepressants have helped to stabilise his moods to an extent, but he has still experienced periods of depression during the times he has been using medication. His view is that medication can be helpful, alongside other strategies, especially in his case therapy, and mindfulness techniques.
 
‘Part of that journey has been through therapy and part of it has been through antidepressants and it’s probably some combination of both that’s helped over the years but I think the, the drugs have been more useful in terms of controlling some of the symptoms and the mood swings, whereas the therapy is the thing that’s really helped get to the bottom of it.’
 
Over recent years Stuart has changed aspects of his lifestyle, including re-training to become a teacher, and re-marrying, and he says it can be difficult to really know to what extent ‘recovery’ from depression may be a reflection of the treatment, and how much has come about due to life changes or the normal passing of time.
 
‘The trouble with… all the way through with the drugs is naturally disentangling what is the effect of the drug and what’s the effect of the depression and what would have happened anyway’.
 
He also feels that it’s been important for him to find out as much information about depression and the treatments that are available, and to share experiences with others - as he says the more you understand something, the better able you are to cope with it.
 
Stuart now takes a low dose of citalopram as a preventative measure, and feels this helps to keep his mood more stable, but does not see it as a ‘cure’. He does still experience periods of depression, but usually he finds he can get through them more quickly than in the past as he is better able to manage his emotions through improved self- awareness.
 
‘For me it’s a preventative. So I’m not taking it because I am depressed I’m taking it because I’m prone to be depressed and it is, you know, there are numerous studies saying that… people who have lifelong depression are much more prone to it continuing and that by taking antidepressants on an ongoing basis it reduces the chance of that, it reduces the frequency of that happening.’
 

Stuart’s wife made him go to the doctor after he broke...

Stuart’s wife made him go to the doctor after he broke...

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Well I had, have had depression ever since I was a teenager and I didn’t realise it for quite a long time and it was only diagnosed when I was in my thirties and then looking back respectively I could see that I had known that something wasn’t right for a number of years but I guess I was a typical man, I didn’t I didn’t seek help although I did visit a GP when I was a student who was very unhelpful which didn’t help. But I managed to get through my teenage years and through University and the situation got worse as the stress built up in the job that I was doing, I was working as an electronic engineer designing mobile phones and products like that doing a lot of travelling. And it got worse and worse until at one point I just couldn’t stop crying I was actually working abroad at the time and I just really couldn’t carry on.
 
So I came home, I came home and was off work and was marched to the doctor and a therapist by my, my late wife who I was married to at the time. And that really was the thing that almost forced my hand into getting help and getting treatment and at that point I remember the therapist afterwards said to me that there was nothing I could do with you for the first two or three weeks and apparently I wouldn’t, I wouldn’t speak I could hardly talk it had built up to that point. And so she just did hypnotherapy to try and relax me for the first two or three weeks.
 
I was put onto one of the tricyclics, one of the older antidepressants and gradually really through working with the therapist, spent a lot of time trying to, trying to get some kind of understanding of what had happened.
 

Stuart stresses the importance of having realistic expectations...

Stuart stresses the importance of having realistic expectations...

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Don’t rely, think of it as a bit like taking an aspirin, you know, it’s something that if you’re lucky will give you some relief from the symptoms, will help you feel better but particularly if it’s someone who has, you can tell has maybe got deeper issues that are contributing to that then I’d say look at, you look at therapy as well look at CBT. The people who are not in a position to afford long courses of therapy then there’s some, you know, there’s things on the internet sort of online CBT an online website … help to help. So often I find for a lot of people it's about, you know, as it was for me it’s about education, you know, when it first hits you, you don’t know what’s, you know, what’s involved and so yes I definitely I think drugs are always, always worth trying and from my experiences they work very differently for different people and you can’t tell until you’ve started taking the drugs what they’re going to do for you, you can’t tell what the therapeutic effect is going to be, you can’t say what side effects you’re going to get if any. 
 

Stuart takes citalopram regularly to keep his mood stable...

Stuart takes citalopram regularly to keep his mood stable...

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So I had to go back to back to citalopram which is what I’m on now, another SSRI. Whether that does anything or not I don’t know it’s, I know if I, I did try coming off it a year or two ago and I foolishly came straight off it without tapering the dose down as you should and I did get quite a, quite a reaction to that, you know, I did drop quite seriously down in mood and I had to come back on it again.
 
So basically I’m now on antidepressants really as a long term preventative measure so the GP’s that I’ve spoken to have said well if you’re happy to be on them given that you’ve had depression all your life you, and you’ve got a drug now that doesn’t have serious side effects you might as well stay on it and so taking antidepressants is just something I do now.
 
For me it’s a preventative. So I’m not taking it because I am depressed I’m taking it because I’m prone to be depressed and it is, you know, there are numerous studies saying that that if you, people who have chronic lifelong depression are much more prone to it continuing and that by taking antidepressants on an ongoing basis it reduces the chance of that, it reduces the frequency of that happening. Whether that’s true for me I don’t know because I’d have to come off.
 

Venlafaxine is the antidepressant that worked best for Stuart...

Venlafaxine is the antidepressant that worked best for Stuart...

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My new GP, my new GP, had looked at my records and said ‘well you’ve been on’ I was actually back on fluoxetine by then, ‘you’ve been on fluoxetine for years, you’re still suffering from depression so, you know, let’s try and do something about it’. and she like many GP’s, well actually she was very good because she’d, she didn’t try to pretend that she knew the answer I’ve found some GP’s have favourite drugs that they tend to prescribe but she was, ‘this is your case, you’ve been suffering, you know, all your, most of your life, you know, this isn’t just, you know, someone having a bad patch’, so she referred me to a psychiatrist at the local hospital. And he said well obviously, you know, you’ve tried all the normal drugs why don’t we put you on venlafaxine which is it does the same as Prozac but inhibits or enhances one of the other neurotransmitters as well.
 
And that worked, I did see again quite a significant lift in mood after that but that one completely suppressed my libido, my sex drive, I had no interest - which was fine because I was single at the time. but and that, whether it was the drug whether it wasn’t… but I had quite a period then of being, you know, pretty stable in terms of mood but then a few years later I met my current wife and having no sex drive isn’t a very good approach to a new marriage. So I had to go back to back to citalopram which is what I’m on now, another SSRI.
 
And did you notice any, any effects from that different from the citalopram?
 
Yes venlafaxine was, that’s the one drug over the years that I have, I have, I can say I can sort of feel something different. It seemed to, you know, within the six week period it did seem to produce a lifting in, I did feel better. And I did seem to sustain that feeling better while I was on it so that’s, you know, it was, it was sort of I’d like to still be on venlafaxine from the point of view of its therapeutic effects.
 

Stuart said he could accept sexual problems caused by the...

Stuart said he could accept sexual problems caused by the...

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So she referred me to a psychiatrist at the local hospital. And he said well obviously, you know, you’ve tried all the normal drugs why don’t we put you on venlafaxine which is it does the same as Prozac but inhibits or enhances one of the other neurotransmitters as well.
 
And that worked, I did see again quite a significant lift in mood after that but that one completely suppressed my libido, my sex drive, I had no interest - which was fine because I was single at the time. That, whether it was the drug whether it wasn’t… but I had quite a period then of being, you know, pretty stable in terms of mood but then a few years later I met my current wife and having no sex drive isn’t a very good approach to a new marriage. So I had to go back to back to citalopram which is what I’m on now, another SSRI.
 
It is a known, a possible side effect with a lot of the drugs and I still have a little bit of that from the drug I’m on, I think, I don’t know.
 
But it’s difficult because I know some people have said you read these, the you know the thing that comes in the pack.
 
Yes.
 
And it says ‘sexual dysfunction’, that’s the term that they use and there’s no more explanation than that.
 
No that’s true actually that could well do with more explanation of what people really experience. It’s not really; it’s not, well for me it’s not sexual dysfunction its sexual disinterest which is a different thing yes, yes.
 
Is that something you’ve ever been able to talk to other men or people about or is that something, because you said you were quite open about some of the things to do with your depression?
 
Yes well I’ve certainly talked and yes one or two but yes it’s not the sort of thing that you, it’s not the easiest of things, side effects to talk about, you can talk quite easily about the fact it's giving you a headache or making you feel sick or whatever.
 

Stuart changed antidepressants several times to find one that suited him

Stuart changed antidepressants several times to find one that suited him

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So we kept going with that for a while, I forget how long a few months maybe six months. And then the conclusion was that it wasn’t, I was still very down six months in and so at that point the doctor suggested changing to an SSRI.
 
Did you make that switch straight away, did you just go from one, one day to?
 
No they taper it down and then take it.
 
You had to go off and then go back on?
 
Yes, yes.
 
And did that involve any difficulties for you at all? Did you notice any different effects?
 
Not the tapering down but going onto the SSRI I did notice as soon as I started taking it I started to feel light headed and a bit punch drunk. In retrospect I think that was just the, that was a very quick reaction to it.
 
I think had I carried on talking it that would probably have worn off and because I have now again taken that same drug again without any problems.
 
So you were only on that for a short time?
 
Yes.
 
And you didn’t like the effect that it?
 
No.
 
So you went back to which one?
 
I went back to another SSRI then which I didn’t get that effect.
 
Which was citalopram?
 
Yes, yes.
 
So then you changed again, did you have to taper off and change?
 
Yes, it’s but I’ve not, I didn’t have any problems with the tapering at that stage.
 
So it was just taking a bit less each time?
 
Yes that’s right yes. I always in more recent years I’ve always been on lower doses so when I went onto venlafaxine again I didn’t have any problems with the tapering with the coming off or coming on.
 

Stuart has read a lot about depression and antidepressants...

Stuart has read a lot about depression and antidepressants...

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So would you say generally speaking I mean the interactions you’ve had with your GP’s has it been a kind of a joint decision making process would you say, how’s that been?
 
It’s changed over the years it’s in the early years it was entirely driven by the GP I just didn’t know what was, what was going on and then it became more joint but it’s only ever a ten minute conversation, you know, so it’s not an in depth thing. And now I’ve found that I probably know more than the average GP in terms of not the drugs generally but in terms of the effect they’re likely to have on me. So now I find with my current GP, you know, it’s much more of he’ll say ‘Well what do you think?’ ‘What do you want to do?’ So you know it’s now much more me being in control.
 
Do you normally go in with an idea of what you think you want to do already?
 
Yes, yes that’s right yes.
 
And over the years where have you built up all this knowledge from, I mean you’ve mentioned a few things?
 
Lot of reading so, on the shelf upstairs I’ve got a whole shelf full of books on depression ranging from self-help books through to books that are more sort of medically orientated. a lot of just talking to people professionals, and the internet. I don’t read... it’s just funny how you, you sort of acquire the knowledge over the years in the early days because understanding it was important for me in terms of dealing with it I read a lot of books but then you soon get to the point where one book is saying the same as the next and you sort of, you’re not learning anything new from reading a new book. So it's now, you know, I tend to keep up to date with sort of developments through I listen to some pod casts when I’m cycling and that kind of thing on mental health which I find very helpful.
 
So you’ve got quite a wide knowledge of mental health issues?
 
Yes.
 
And in terms of the type, in different drugs and the types of antidepressants, how have you found out that information?
 
Again through the, through books mainly so and the internet but the trouble with the internet is that it’s so fraught, the people who tend to post if you look on forums are the people who have had bad side effects. It’s the usual thing of, you know, the people who post reviews of shops are the ones who, you know had bad service and whatever they bought was broken and so I found that you just, I’ve read some of the forums and it’s so depressing to read and they’re full of people criticising different drugs and so on. So I tend not to look at forums very much.
 

Stuart thinks doctors should give people a wide range of...

Stuart thinks doctors should give people a wide range of...

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I would like to see people giving patients more options so giving them more information in terms of where else they can go for help and certainly more GP’s that have in- house counselling and therapy. But I think the biggest problem with going to a GP when you’re depressed is you come out and you feel bereft, you feel that okay he talked to me for, or she, she’s talked to me for ten minutes they’ve given me some drugs but that’s it. What now if the drugs, the drugs might work they might not. Whereas actually there’s a whole world of support out there and if the GP’s and the medical profession can act as a, a sort of gateway to not just the drugs but all the other places that people can go and, you know, like your website just knowing other people’s experiences. And actually if you went out of the GP’s surgery with a pile of leaflets and a pile of internet addresses and phone numbers you’d think ‘wow this is great. Yes I’ve got some drugs and I’ve got all these other things I can do as well’ and it would, I think because depression is about negative thought patterns, if the medical profession can do something to send the patient out thinking positively, you know, that’s a start.
 

Stuart takes an antidepressant as a preventative strategy...

Stuart takes an antidepressant as a preventative strategy...

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I think I’ve, you know, if you look at the research on drugs if you look at the clinical trials which are done comparing drug treatment to placebo has two thirds…. is it two thirds of the effect of the drug so, you know, most… I think the medical profession is now coming to understand although the pharmaceutical companies aren’t keen on it, that a large part of the effect of the drugs is the placebo effect. Either through the, the feeling of relief that, you know, providing some hope that things are going to change or through not just and that, and that can just reduce, just by reducing the stress hormones in your body can be beneficial or just by if you’ve got more hope you’re more likely to do things that are going to help.
 
Is that where you fall into that category?
 
I seem to yes.
 
Its sounds like it from what you’ve spoken.
 
Yes, yes that rings very true with me I haven’t seen great benefits over the years apart from venlafaxine that I can put down to ‘that was the drug’. and so I think most of my, my benefit has been a placebo benefit and I think the big problem with drugs at the moment is that the pharmaceutical companies don’t like to acknowledge that and so we’ve still got this view that ‘if I take this drug it’s going to be some kind of wonder cure’ you know, people believing that. And I think it’s just not, we don’t maybe one day we will have that drug but we don’t have it now and it seems. Well from my personal experiences it seems to be, it’s one of those illnesses that needs a protracted period of time and effort, a combination of drugs and therapy to really knock on the head, if you ever can, and certainly sort of chronic depression and that's not the message of course that the drug companies have put out over the years. and I think there is still this, there is still this big problem of relying too much on the drugs and having to because the doctors only got ten minutes and their limited, counselling service although it’s getting better is limited counselling on the NHS.
 

‘Taking antidepressants is just something I do now...

‘Taking antidepressants is just something I do now...

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So basically I’m now on antidepressants really as a long term preventative measure so the GP’s that I’ve spoken to have said well if you’re happy to be on them given that you’ve had depression all your life you, and you’ve got a drug now that doesn’t have serious side effects you might as well stay on it. And so taking antidepressants is just something I do now.
 
Over the years my depressive episodes have got shorter so in the past they could last months even years just being on average in a very, very low mood.
 
For me depression is about, it’s almost like a switch in my brain I can feel it when it, when it happens it’s shutting down, it almost feels like my brain is working in a different way you just want to, want to withdraw, you want to be away from the world, you want, and nothing seems to matter so, you know, technically I understand it’s called allodynia but it’s basically the feeling that there is no pleasure there is no point in things even things that you supposedly enjoy, you just feel you end up doing things because you know you should do them rather than because of any pleasure in things. And so that, that feeling of lack of pleasure and just wanting to be shut away and be left alone and it’s for a large, at times it almost feels like a living death you sort of don’t feel that you’re really alive which is where the suicidal thoughts come in for me which I still get although they’re easier to manage now you know I’ve never actually got to the point of doing anything but and so it’s now, now at the point where it’s, it’s pretty manageable and I’ve also changed, changed jobs so I’ve moved I’ve moved away from the fairly high powered job that I had before in industry and I now teach three days a week which I really enjoy despite all of the hassles there are with the bureaucracy of teaching. and I’ve now got to the point where I’m sort of getting, I’ve got quite involved in various trying to help other people who are struggling with depression, mental health and trying to do, I recently did a charity walk around England two and a half thousand miles which was basically a campaigning walk tied in with the campaigns that all of the mental health charities are running at the moment to try and reduce the stigma associated with mental health problems. Because a lot of my issues are worse than they needed to have been because if I’d been diagnosed as a teenager and treated earlier then you know, things would have been very different. 
 

Stuart recommends a website that helps track your mood

Stuart recommends a website that helps track your mood

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Will you explain what the mood diary’s all about?
 
Yes I, since that first episode every day I keep a record on a one to five score where three is okay as sort of the average how I’ve felt on average that day and then I just put that into a spreadsheet and just produce a little graph from it so I can see what’s happened over the year. I now use a website called Moodscope which does all that for, you produces all the graphs and Moodscope’s very good because it also, you can set it up to send an e-mail to someone else so I have it set up so that every time I, they have a questionnaire for determining your mood, but every time I do that and get a score it gets e-mailed to my wife [name] And actually that works well for a depressive because when you’re going down sometimes you start to withdraw and actually you may not talk about it but [wife] will know that I’m going down and so she can, she can sort of step in and say ‘Look your scores are going down we need to be aware of that,’ and ‘What’s happening?’ and so.
 
That sounds really useful.
 
It is, very yes.
 

Stuart walked 2500 miles to raise money for mental health...

Stuart walked 2500 miles to raise money for mental health...

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I did the charity walk around England I now do a number of, you know, I’ve been asked to do a number of talks to various groups locally. I talk about the walk but I also mainly focus on my experience of meeting people with mental health problems and talking to people with mental health problems. And also just a bit of education in terms of how prevalent it is so the groups vary from next week I’m talking to some HR professionals, people who are involved in companies and through to public talks and Rotary and various different things. So it’s really just trying to do a little bit in terms of breaking down the stigma and just saying ‘hey, you know, I’m a mental health patient but I’m not that’, well maybe I am a bit strange but, you know, it’s normal almost.
 
Yeah…
 
Yes, yes.
 
So when you did the walk did you just, when you stopped off each day did you just chat to people or?
 
Well it was varied... I did, I met up with some, various groups along the way but a lot of it was talking to people, a lot of it through I was walking with my puppy, my springer spaniel, so dogs are great ice breakers so I had a lot of conversations where people would stop and pat the dog and talk about the dog and then say ‘what are you doing’ and, ‘I’m walking two and a half thousand miles’, ‘why are you doing it’.
 
That actually brings to mind two things I was just thinking off the top of my head. One is that you were walking miles.
 
Yes.
 
How many miles was it?
 
Two and a half thousand.
 
One of the things that is often suggested to help with depression is exercise.
 
Yes.
 
And do you feel that that was helpful?
 
Absolutely walking has been one of my main ways of, of dealing with it, one of my main therapies if you like. So I know that when I’m feeling down if I go out walking, unfortunately it seems to have to be a reasonably long walk, you know, a stroll around the park doesn’t do very much, I have to sort, but if I’m on a, you know, a reasonable hike then that seems to have some kind of calming effect on me.
 
And then the other thing that came to mind was pets.
 
Pets yes absolutely.
 
You know how the combination of both there but they do say that they’re good company and…..
 
Yes and actually I was doing this walk for eight months and living in a camper van and my wife was joining me one week a month and meeting up with various people but if you look at my mood diary for those eight months it’s very consistently above average for precisely that reason. And also that I had a, a very clear sense of purpose, you know, a sort of project to do and you know why you’re doing it, it’s not like going to work in a job where I’m just going there to earn, earn the daily bread for instance and being out in the fresh air and walking every day and having the dog. And these are all good things for mental health.
 

Stuart reflects, ‘there are some GP’s who aren’t just not interested...

Stuart reflects, ‘there are some GP’s who aren’t just not interested...

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I think a lot varies depending on the interest of the GP, the GP who referred me to the psychiatrist she had a special interest in mental health that was her, her area and so for her I was an interesting case whereas for the average GP I’m just a, you know,’ this is someone whose suffered from depression all his life. I don’t have the tools to cure him’ you know, in the medical world, you know, we’re not at the state of knowledge where… there’s nothing any GP can give me that’s going to, that’s going to cure it.
 
So do you think the GP’s are whole, mainly focused on giving out cures for things rather than talking to people?
 
Well yes I mean that’s my, my feeling and that’s the, that’s the way the training traditionally is for GP’s and I, I know from talking to GP friends certainly, you know, that there are some GP’s who aren’t just not interested in mental health problems because it’s not a disease you can get hold of and fix. it’s so intangible and so difficult.
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