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.
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.
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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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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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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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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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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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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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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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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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.
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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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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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.
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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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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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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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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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.
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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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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