Age at interview: 47
Brief Outline: Julian experienced a lot of stress when he was 40 during a marital breakdown and family illness. He felt no emotion and felt that antidepressant medication did nothing for him. Julian requested to have ECT as he felt increasingly desperate for something that might help. Initially he improved quickly, but then went downhill two weeks after his ECT had finished.
Background: Julian is medically retired having worked in defence electronics. He is divorced and has a son. He describes his ethnic background as White British.

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When Julian was 40, he experienced two stressful events. He left his wife and his Dad was diagnosed with terminal cancer. He remembered feeling angry about a lot of things. Julian became paranoid as a result of events in his marriage. He also experienced psychotic symptoms, for example, whilst on holiday to America he thought a member of the CIA was driving a taxi. He found it strange that in between the times when he was psychotic, he could be very coherent. Julian remembered getting messages from the television and from the news. He felt ‘no emotion’ and no longer felt human - as if his life was “on hold”. He started taking antidepressant medication which he felt did nothing for him. He experienced episodes of self-harm and “waves of terror” that seemingly came out of the blue. Julian was prescribed anti-psychotic medication (olanzapine) that stopped these extremes, although he felt it ‘stopped everything else as well’ as well as causing weight gain. He then took venlafaxine, another anti-depressant, which he also felt did nothing. Julian became increasingly desperate and thought of trying ECT although he had no idea how ECT worked. His life consisted of staying at his aunts, and going to his mum’s in the day. He wanted to go to hospital as he felt that there people would notice he was unwell, whereas when he was living at home he was just ‘pumped full of drugs’. 

Julian requested to have ECT and doesn’t think that anyone told him a lot about it. Julian said that having ECT wasn’t anything like he imagined. He found the most painful bit was the insertion of the cannula into his arm. People explained that because he was given a muscle relaxant he wasn’t ‘thrashing around’ during the treatment. He had about 6-7 treatments and remembered his friends coming to visit him. His mother and step dad visited every day and his son also visited him during this time. Julian remembered going from an almost vegetative state to ‘coming alive again’. Not only did he start to feel alive but he also felt happy to do things - like seeing friends and going dancing. Julian said that he felt completely cured for about a fortnight then he went downhill again and felt suicidal. He then took seroquel, lithium and an anti-psychotic.   

Julian has had a lot of problems with his memory but doesn’t know the precise cause of this. He has also experienced a cocktail of different side effects from the different drugs he has taken. Now Julian feels that having ECT is like ‘throw[ing] all the bits in the air and [hoping] they will come down in a better order’. He feels lucky that there are some treatments that reduce the severity of his condition and that he can function.

When Julian left his wife and his dad had terminal cancer, he became paranoid and imagined the CIA were all around him. He did have moments of being rational when he remembered being psychotic.

Yes, when I was 40, or just before I was 40, I left my wife and at the same time my dad had terminal cancer. And because of things that had happened in the marriage I became very paranoid. You, you know, it wasn’t paranoia out of, you know, it didn’t just sort of come out of nothing, it was paranoia based on things that had happened. Which I guess is kind of interesting because you think maybe when people talk about paranoia it’s completely sort of free-floating. Whereas it certainly wasn’t in my in my circumstances, or at least not to start with. 

And then I went away on holiday to America. And when I came back I can remember thinking that, well, first of all that the taxi that picked me up had CIA, had a CIA driver in it, and I was convinced when I checked in that, that the people there were part of the CIA. Yes, it was quite, it was quite bizarre. And I suppose the bizarrest thing was that I was still coherent enough that, that in between the times when I was psychotic there were periods where I was completely coherent and could remember being psychotic. And I kind of went downhill from that point.

And I can remember getting messages from the television and, not just the news [laughs]. Yes, so it was, well, I wouldn’t say it was an interesting time, it was a terrible time. And kind of from there it, it got worse. I became, well, I became incapable of doing anything at all. And I guess when you get a very deep depression you kind of cease to feel anything at all. It’s this complete sort of, I mean I think emotion is part of the human state and I felt no emotion at all, complete nothingness. And in a sense you’re no longer human when you feel that. You, you know, it’s as if you’ve kind of like stopped being. So, you know, I felt like my life was completely on hold.

Julian felt that waves of terror and anxiety made suicide seem an entirely rational choice.

And I think possibly the worst aspect of, of being ill wasn’t the, wasn’t the depression but the, well if I call it anxiety it just doesn’t do justice to it. I mean I would just sit say in the living room feeling completely miserable and then suddenly I’d get like these waves of terror from absolutely nowhere, just totally out of the blue, you know, just come, come right over me. You know, it was like, it was like the most terrifying experience you’ve ever had, but you couldn’t say it was due to anything. It was just murder really. 

And it’s not, it’s not something that’s illogical either. You, you know, I guess I’m quite a rational person actually and, you know, people think, ‘Oh, well, you’re sort of ill and you’re overcome with this kind of nonsense about, about wanting to kill yourself.’ Well, it’s not like that, or at, or at least it wasn’t for me. I mean it was entirely rational that where I was I’d reached the end of the line. I was, it was unbearable to have the anxiety, it was unbearable not to feel human and there really was, you know, it was unbearably painful. And it, you know, it would have been a relief, a release not to have to suffer that. I mean you wouldn’t put a dog through that. So there was nothing, there was nothing un-, you know, it was entirely rational. And it, it wouldn’t have, I know a lot of people say about like the impact it has on people that are left behind. But it really shouldn’t have a negative effect on them. It’s not their choice. It’s nothing they can do anything about. It, it’s their loss if they have to deal with that, you know, it’s them that’s lost something. They shouldn’t feel like they’ve failed in any way. 

Julian had a kind of high after the ECT treatment but then went downhill after two weeks and was ‘more suicidal’ than he’d been before, although lithium helped him recover.

All I remember is that I was kind of well. I mean he described it as being kind of high. Whatever, it had quite a beneficial effect that was very short-lived. And, so it was like being given a tantalising look into what it would be like to be better. And in a way that was very difficult to feel, it was very difficult to cope with, that when I then went downhill again, having reached the treatment of last resort, well, that was it, I was finished. And I probably became more suicidal than I’d been before. In fact I guess I’m quite lucky to be here really, yeah, I guess it was quite close to just finishing it.
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