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Tristan

Age at interview: 38
Brief Outline: Tristan’s wife had her first major episode of depression after the traumatic birth of their first child. She was admitted to hospital following an overdose and was soon offered ECT, age 33. Although at first she responded dramatically to ECT, she relapsed 6-10 weeks later. Tristan’s wife is now recovered and they have had another child together.
Background: Tristan is a paramedic, and lives with his wife and two small children. He describes his ethnic background as White British.

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Tristan met his wife in university and they married in 2000. His wife had had a history of depressive episodes the first of which was during her ‘A’ Levels. These depressive episodes have been usually associated with particularly stressful times. 

However in 2008 she experienced very acute depression after the birth of their first child. Tristan said that in the lead up to the birth, she seemed happy and that the pregnancy had gone well. His wife had a very long labour and didn’t sleep for two nights. She also lost a lot of blood during her delivery and had to have a blood transfusion. Tristan was left alone with the baby whilst she was resuscitated. When she returned home she looked exhausted, but Tristan expected her to begin her recovery from then on. They got extra help at home and ended having someone look after the baby for quite a lot of the time. His wife, however, still really struggled to sleep. By the end of the month Tristan said that his wife started to develop symptoms of ‘not being normal’. She appeared to have very anxious and delusional thoughts. Tristan said that she never had hallucinations as such, but that the way she saw the world was very negative. 

Tristan said that they saw the GP, and then a psychiatrist, relatively quickly. His wife had developed puerperal psychosis and was significantly delusional and psychotic prior to being given ECT. They tried to manage at home and tried ‘various drugs’. Tristan said there was very little progress and he became reluctant to leave his wife by herself. His wife tried several times to harm herself and took an overdose. She was sectioned after taking the first overdose and spent some time in a local psychiatric unit. Tristan thinks it was during this admission that ECT was offered as a treatment. His wife was ‘fast-tracked’ into ECT due to the perceived urgency for her to bond with her new baby. His wife had six treatments over six weeks. He noticed a big difference in his wife’s mood after only 2-3 ECT treatments and up until then Tristan had no idea whether his wife was ever going to get better. She did, however, have a relapse about 6-10 weeks later – a development that Tristan found very hard. 

Tristan felt that he and his wife took all the decisions about ECT together. Tristan was positive about ECT in the first instance, even though he had various reservations. He doesn’t think ECT was a well-understood treatment and didn’t know whether it was going to have a long-term impact on his wife. He can remember the consultant being positive about ECT, and was told repeatedly that the side effects on memory would ‘more than likely be short-lived’ and that there would be no long-term effects. In hindsight, Tristan would have probably wanted to see more of the evidence to back up what the consultant told him. Instead he felt he was being ‘sold’ the treatment. Tristan said that in some ways he was given a lot of information as he was told about what was going to happen in a lot of detail, but that the general approach of the staff was to speak to his wife as ‘less than an equal’. Tristan was shocked at being separated from his wife when she went into hospital, as up until that point he had been with her all the time. He felt the weight of the decision for her to have ECT and wondered whether he was making the right decision at the time.

Tristan said that the short-term memory loss from ECT was very noticeable and disturbing, particularly when he didn’t know that it would revert back to normal quite quickly. He said that she returned to her ‘normal self’ really quickly and that the psychotic thoughts disappeared. However there were one or two instances where she reacted with ‘an almost euphoric state’. Tristan thinks the biggest breakthrough was her change of medication and also the sedative effect of the medication that allowed her to sleep. He thought that sleep was a huge factor in her recovery. Now she is on an antidepressant that seems to suit her. He said that his wife told him that this medication took something off ‘both ends of the spectrum’ of sadness and happiness. Tristan thinks his wife has nearly totally recovered and her memory is 95-98% of what it used to be.
 
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Weeks after a long and difficult labour Tristan’s wife had delusional thoughts that she was going to die and was being watched. She felt she was connected to God and people around her weren’t who they said they were.

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She started off thinking about a normal worry in a normal way and then her assumptions about that thing would be the worst possible assumption and then it would go beyond that to a completely unreal interpretation of what the consequences of that thing would be. And ultimately it ended up with quite florid ideation about thinking that there was ideas about, a lot of it was to do with God and religion. I think she felt that she had done something to deserve this situation. She thought that [name of daughter] was going to die she thought that that she was being punished, I think she thought that, I think she thought that she was in direct contact with God at one point. She felt that she was being watched, that there was sort of surveillance everywhere I can’t remember a lot of the details now, and she felt that, I think if I remember rightly, she felt that the people around here weren’t who we said we were so at times she didn’t think I was who I said I was and she didn’t believe what we told her, she wasn’t able to be convinced. I can’t remember.
 
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When his wife had post natal depression Tristan said that she had tried several times to kill herself when she was living at home. ECT was brought forward because of the need for a quick treatment.

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And it was talked about the possibility of having ECT as potentially a quick fix and that perhaps it, that it should be brought forward in comparison to the normal routine because I think it is seen as quite a last resort treatment. It was thought that it could be reasonable to bring it forward compared to normal because of this added impetus of wanting her to be better quickly in order for her to form a bond with the baby. And the during all this period [name of wife] had several attempts to kill herself, or to harm herself, including trying to take overdoses. She did take more than one overdose - pouring water all over an electric socket and sticking her fingers in the socket, drinking bleach, I can’t remember all of it but various things that every time it happened we had great big debates over the best thing for her, whether she ought to be admitted into a psychiatric unit, or whether we could manage her at home and for a long time we decided that we would manage at home. She was, she had someone with or near her all the time so we were usually able to limit the effects of any attempt she had to harm herself pretty quickly. But yes we were terribly worried obviously about the potential for her to harm herself that was another reason to want to act as quickly as possible. 
 
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Despite getting a lot of positive information from his consultant about ECT, Tristan was concerned because this didn’t seem to fit with its use as a last resort treatment.

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I can. I remember the consultant talking to us about it and being very positive about it we were told repeatedly that the effects on memory would more than likely be short-lived; there was very little apparent evidence for long term effects which went against some of my previous understanding of it. which wasn’t very developed but had heard things and bits and pieces over the years and my understanding I suppose was that there was potential for it to have a more long-term effect on a person’s personality. So that I suppose I was reassured but also concerned that there seemed to be a bit of a mismatch between what I was hearing, it didn’t necessarily seem like it was really giving me the worst-case scenario. It was a very upbeat interpretation of the situation that there wasn’t much to be lost and that didn’t really fit with me as to why that would be a last resort treatment if it was, if it had a little risk and was often successful I thought it would be used more frequently so it didn’t quite add up to me and I was quite concerned about it.
 
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Tristan felt huge relief when ECT appeared to work dramatically for his wife. However, his wife had a relapse 6 to ten weeks after the treatment and he thought that antidepressant medication helped improve her well-being in the longer term.

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She had a course of six treatments over six weeks which is about the shortest course I think that you can have. It worked dramatically well but everyone said at the time that you have to be careful I think there’s a theory that if you have a long course of treatment it’s less likely that you’ll relapse, but there is a high likelihood of relapse anyway if there’s a problem with the treatment. And but she was quite well for a little while after the ECT. And it did feel like a huge relief at the time and up until that point I had no real strong idea as to when or if [name of wife] was going to get better so just to see the possibility of her being better for the first time since [name of daughter] was born was huge relief and I was immensely grateful for it and felt very positive about it in many ways despite some previous reservations. but then unfortunately she did relapse I think it was probably six to ten weeks later, she had that window of being better and then she got worse again which was quite crushing at the time.

And at, but at that time I then felt that this wasn’t the solution that just going back to ECT for various reasons I’ll go into in a minute wasn’t going to be the long-term solution and that we would, actually she went back into a psychiatric unit and she tried a different drug and this drug suited her much better, it was a drug she hadn’t been on before and she was able to get, she started to get better on the drug and we decided that we would stick with that, persevere with that and that was what, you never know conclusively but I’m sure that was what got her better, and got her better properly in the long term.
 
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After a bad experience the first time around, when Tristan’s wife had her second baby, mental health services were ready to provide support for her after the birth and it made a huge difference.

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We haven’t required the services that were in place ready for her but it was so nice to know they were there to have that reassurance and everyone was brilliant they were all really understanding all of the mental health team and [name of wife]’s just recently written them a letter actually to thank them all. But yes it just went extremely smoothly and we’re very, very grateful for that because it needn’t have necessarily been that way, but yes didn’t need the caesarean after all which was good.

And what type of services were set up in place ready to go if you…?

Well there were mental health services attached to the hospital because obviously we’d moved to a different are so this was in [place] now and they, I think they, some of them had particular responsibility for puerperal psychosis and they, so they were going to be available, I think the main issues was being available and been aware and so they were going to be available in the time immediately after the birth. And then [name of wife] had also been introduced to the community mental health team local to us and they were also kind of sort of ready and waiting to step in once [name of wife] was home. And the mental health team at the hospital said that they would also be available for input as well for a little while after the birth as well. So it was just mainly everyone being aware and being ready to provide some input as it was needed.
 
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Tristan said the hospital was a strange, but mostly calm environment for his wife and she responded to it very positively. Higher doses of medication allowed her to get the rest she needed.

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It was obviously a very difficult thing to do for her to go in, although she didn’t have any choice in the end, it was it’s a, it’s not a very comfortable environment in some ways because it’s full of people who’ve got very serious problems a lot of whom are on a great deal of medication so it was a strange place to be. A lot of people talking in very erratic and nonsensical ways, but [name of wife] responded to it very positively. It’s actually quite a calm place the majority of the time and she felt very safe the fact that she was there got through to her she understood where she was and she understood certain things about it. She was, although I think the people we spoke to before she went in suggested that her treatment was likely to be very similar in the unit to what it was at home, in reality I have got the impression that well certainly in [name of wife]’s case she was treated more aggressively with medication including sedative medication in hospital than she ever would have been at home. and that was good for her and the big, big breakthrough was that she slept and they basically medicated her up to the eyeballs at night and she slept and as a result of that she was quite groggy for a lot of the day, took her quite a long time to recover from that but for both of us that was actually the first real progress because it was the first time she’d slept properly since she’d had [name of daughter].
 
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Tristan found although he and his wife discussed ECT the decision was down to him and he didn’t feel overwhelmed. The staff were very supportive and they were shown the ECT suit

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Well I guess it was probably part of the reason I was worried about it because I felt responsible for the decision. But I did feel that we were making the right decision at the time and I don’t regret it, although I have concerns about it. But yes, no I felt it was the right thing for me to be involved with it and I accepted that responsibility, and I didn’t feel overwhelmed by it.

And was the sort of physical process of, or practical process, of ECT explained to you?

It was. Yeah

You know when it was going to happen what was happening?

In many ways they were very, very good they did explain a lot of things to us, as I say it was more the way it was couched, rather than a lack of explanation. And the people at the centre were all very supportive and they did explain to me exactly what was going to happen. We went through together and went into the room where the ECT took place, before it happened and were introduced to the environment and the equipment and everything and shown how it, not demonstrated, but we were told all about it I think possibly on a separate day to when it did actually first took place.
 
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Tristan said health professionals are influenced by a patient’s opinion. He warned against swaying doctors’ medication decisions too much: medication, given time to work, can have a more long lasting effect than ECT.

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I think, I suppose one thing referring to something I said earlier was, is perhaps, it’s very easy to say, but perhaps not to try and influence health professionals too much about how, what medication they’re going to prescribe. I think they’re probably best left to their own devices, give them obviously the information they need to make the decisions but not to try and sway then to change medication regimes, more regularly than they need to be changed because they do take a long time to imbed and to start working. And although health professionals are obviously aware of that and will tell you that they did seem to me to be relatively ready to do what you asked them to do or in this case what [name of wife] asked them to do. And yes I think it’s better if you can resist changing medication more than you have to. I think my message regarding ECT would be that I definitely can see it’s place and it was a hugely positive thing for us at the time but that I do still have a lot of reservations about it and my personal opinion which isn’t necessarily a very scientific one is that if it can be avoided I think that pharmaceutical remedies, when they work, can be more long lasting. Yes and less prone to relapse, that’s my personal experience.
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