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Andrew

Age at interview: 50
Age at diagnosis: 49
Brief Outline: Andrew had been feeling out of sorts for a couple of years losing interest in things he used to enjoy and finding life increasingly difficult, before he saw the doctor who diagnosed depression and recommended taking citalopram alongside having a course of CBT (Cognitive Behavioural Therapy). It took about six weeks to begin to take effect, but he found that the medication helped him enormously and he now finds life enjoyable again. He is still taking citalopram and has no plans to stop at the present time, although he says when he is ready he will talk to his GP about how long to continue taking it for.
Background: Andrew is married and has two young children. He works in communications at a university undertaking health research.

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Andrew found himself becoming increasingly disinterested in things, he found his work very stressful and he wasn’t participating in family life as much as he used to. Andrew suffers from regular migraines for which he takes beta blockers, so wondered whether they may have been having an adverse effect and if his low mood might be a reaction to that medication - he had read that depression could be a side effect from beta blockers. He eventually went to see his GP and told her how he had been feeling. He felt surprisingly relieved to hear that the doctor thought he was depressed, and that his negative thoughts and behavior were symptoms of a illness rather than a failing in him as a person. Although he had known things weren’t right for about two years he hadn’t spoken to anyone about it as he feared that being diagnosed with a mental health problem might jeopardise his family or work life.
 
Initially he was offered a course of CBT (Cognitive Behavioural Therapy) which he attended, and found very helpful. A few weeks later he saw a new GP that who felt that Andrew would benefit from a course of antidepressants, and recommended that he try citalopram. Andrew feels that it is the combination of therapy and medication that helped him start to feel more himself. He was encouraged by the fact that his GP spent time talking to him about the antidepressant and gave him information to read, but whilst he recommended that Andrew might find it helpful, it was Andrew’s decision.
 
Andrew had concerns about taking medication that can affect your mind, but felt reassured by his doctor who was supportive and willing to talk to him about how he was feeling at any time. In the past he had not had much to do with doctors, but felt comforted by his GP’s response to him;
 
‘It was important to me that I felt that he was going to be there and help me through it and he had said as much to me that that I could go and see him whenever I wanted to and I should make sure to ask for him …. that you know he would be there to help if needs be. I took enormous comfort and encouragement from that because I was a bit worried about being alone with tablets that could affect your mind’.
 
Andrew had been pre-warned by his GP that it might take around 6 weeks for the medication to begin to take effect and it might take a while for him to adjust to them. He recalls for the first six weeks or so he felt that he wasn’t himself at all, ‘it wasn’t me; it was like watching someone else’. After around 6 weeks Andrew began to feel more calm and after a couple of months started to be able to think more clearly, and to feel he could begin to participate more fully in daily life again.
 
‘I think that the combination worked for me… the CBT was incredibly useful in the practical day to day things which, which helped me deal with situations. But the tablets have helped the sort of underlying cause that has allowed me to embrace the CBT kind of perhaps better and be more open to it.’
 
Andrew has been very consistent in ensuring that he takes his citalopram tablet every day as prescribed because he very much values the positive effect it has had on his life. He is a little concerned at the moment about the potential possibility that the GP will suggest he stops taking it at some point in the near future and feels nervous about the prospect of managing without the medication.
 
‘I feel at the moment, if someone said to me to just take it for the rest of your life I’d say thank you very much.’
 
Andrew feels that having a diagnosis of depression, and taking antidepressants, can be viewed negatively by other people, but is now much more open to seeing depression as a recognised illness, and that his symptoms were not imagined, or exaggerated. He says that one of the most important things he has learned is that depression can be treated and that now he knows the signs and symptoms and would feel confident to seek help in the future if he needed to.
 
I know because I’ve been depressed I could become depressed again but I don’t want that to happen and I like the person that I have become again, I just want that to carry on. And if that has to be with drugs so be it.’
 

Andrew was relieved when his doctor diagnosed depression...

Andrew was relieved when his doctor diagnosed depression...

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I was enormously encouraged that he didn’t just say here’s some tablets go away and take them, think about it. And he gave me a couple of websites to look at to just looking at possible side effects and how it might work and that sort of thing. so that gave me enormous encouragement with him as a doctor I have to say that he was actually thinking about me and what was best for me. and then I came home and talked to my wife about it and it was about November, October or November and I remember thinking the doctor said the first month on this treatment can be pretty grim or not, you know it can highlight some of the worst aspects of, of the depression, it can be a problem. and I remember thinking Christmas was coming up and I was feeling awful and I didn’t want to mess up Christmas and so I thought if I start now with the tablets, if I’m lucky I’ll get the month or six weeks in of not feeling so good and they might actually start to kick in the benefit for Christmas. And I just thought with the children around I came to the conclusion I didn’t want to waste any time and I’d spent enough time feeling, you know, unwell and if they could provide, if there was a treatment that could help then I would go on it.
 

Andrew felt guilty that he wasn’t working productively...

Andrew felt guilty that he wasn’t working productively...

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That first month or so when you were starting to take the citalopram, how easy or difficult was it to continue working normally?
 
It was so I could get up and get to work, it was actually, it coincided with downtime at work, because I work in a University and the Christmas period is very quiet, people go away for weeks, it’s not just like taking the odd day.... I took a fortnight off or maybe even three weeks off over the Christmas period. So I could get myself into work, you know, maybe I wasn’t shaving as much as I used to and I was leaving here a lot later.
 
I was quite lucky that I could do that, you know, controlling my own diary. but it could have been, it would have been a lot worse if I’d had, I don’t see my boss on a day to day basis, I’m left to get on with it and I think I was just able to wing it a bit. That would have been picked up at some point but so I could come and go as I pleased I’d also come home a bit early or take a little longer lunch break.
 
Would you see that as a weakness or as being able to be kind to yourself?
 
Well I think that was a weakness then but in hindsight I just think, you know, we all owe it to ourselves to take things quietly when we can because we all give more than we ought to when it’s busy, you know, and we always forget when we’re really busy and how many hours we put in then and then carry on working and so I said to myself now ‘be kind to yourself, think about the hours you put in, think about’...
 
So work/life balance is a completely other thing but it’s a massively important one and I think what I’ve learned is that you need time to think about your mental health and you need time to take your tablets and deal with treatments as they come along, it’s no good rushing it.
 

Andrew’s doctor warned him there might be some side effects at the start...

Andrew’s doctor warned him there might be some side effects at the start...

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The first six weeks was an odd experience, well no the first month, was quite an odd experience and I think my wife was a bit concerned about me.
 
In what way was it an odd experience?
 
I really felt like it was me, you know, like I was acting someone else’s life, it was like watching somebody else. And so I could sit completely still for half an hour and not even, not even know that I’d done it, you know?
 
So would it, is it like a sort of bit spaced out?
 
Yes it’s just like being spaced out yes. Well I’ve never really done drugs but it’s like being- just what you’d imagine it to be, just like you’re somebody else, your movements feel a bit odd I thought, because everyone’s different I’m sure you know it affects people quite differently I could be at work, we can talk about work in a minute if you like.
 
Yes.
 
But I could be at work and I could sit in front of the computer… and I’d be thinking… nothing really, you know, it just come to a halt almost. And a kind of warm feeling in my head and I mean they were the main sort of, I didn’t have any sleep problems, some people report difficulty sleeping I never had even with the depression I never really had sleep problems, I could sleep, probably found I was sleeping a lot well certainly sleeping a lot more with the depression, or nodding off falling asleep, feeling very tired. But with these things they didn’t seem to affect me, just a kind of slowness and you know that kicking in quite a lot. But I don’t get that now, I don’t really remember when it finished but I know after, certainly by about Christmas I was definitely feeling there was a massive change in, already then, in the way that I was dealing with the family, how calm I was.
 
Actually I’ve looked at some since, I looked at some forums on line where people have thinking about going on treatment or have just started. And I didn’t want to feel any worse and it did make me feel this in this odd place but it didn’t last long and I just thought I’ve got to do this, you know, I’ve got to. And the doctor had kind of underlined this to me that, he said you may not you may just find that you’re fine but he had said that it may make you feel a little bit odd at first. So I was primed and now all these months on I just think thank goodness I carried on, you know, and I really glad I persevered with it really, you know, I wouldn’t want to be in that place now.
 

The doctor was happy to issue a repeat prescription...

The doctor was happy to issue a repeat prescription...

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I haven’t seen my GP for a couple of months… well I’ve seen my GP about my migraine actually but not specifically about this. basically he said come back whenever you want and I’ll be more than happy to see you, if you get on with it okay, you feel you’re getting on with it okay, do that but at some point in the future there will have to be a review.
 
So you are on a repeat prescription?
 
I’m on a repeat prescription now so they know that I’m taking tablets, I haven’t gone back and said I think it’s time for that review.
 
Just slightly wary about that it sounds like.
 
I am a bit but I think, whilst they’re happy to keep with the repeat prescription without seeing me I’m happy to just stay on the tablets but I think after the summer I will go back and have an appointment just to talk about how I’m doing just so he knows and that they don’t forget me. I don’t think they have forgotten me.
 
I suppose that’s an opportunity to talk about your concerns about how long to be on them for?
 
Yes absolutely and he said a lot of people who go on come off too quickly and then they end up going back on again. So he said just see how you get on and of course and in due course, I don’t think it’s the case but I do think that like getting them on repeat prescription, because in my mind I’m thinking he’s conscious of who I am at least and maybe thinking oh yes it’s that guy who came in.
 

Andrew went to a group based CBT programme, and said it was...

Andrew went to a group based CBT programme, and said it was...

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For the first time I acknowledged with him that I was depressed and he said I should think about going on some treatment for that. But I was starting the Cognitive Behaviour Therapy at the same time so I thought I’ve give that a go. But then I just thought no, you know, I do think that’s going to be helpful but I admitted to myself that actually I’m in a pretty horrid place and I just want to get out of it as quickly as I can so I also went on the treatment. And I should say the Cognitive Behaviour Therapy with Talking Space it was called let’s get it right, was really helpful and really good and I’ve benefitted massively from that but I think in combination with the treatment I have really turned around a lot in the past six months and now I look back and I think what a terrible place I was actually in and how there is life and a good life to be had, you know.
 
I think that the combination worked for me and I think the CBT was incredibly useful in the practical day to day things which, which help me deal with situations. But the, the tablets have helped the sort of underlying cause that has allowed me to embrace the CBT kind of perhaps better and be more open to it. I have to say when I, when the first, the first thing I went to at CBT was a group meeting so the doctor said you can go along on this course, sign up on this course and I did and the first thing I did was a group meeting and I came out of that really feeling terrible, really thinking this isn’t, this isn’t for me. You know I wasn’t expecting it to be such a large group of people and we were talking about, you know, ways you might, you know, ways you might approach fixing the dishwasher or something practical, and I thought oh my God why am I here these people clearly have no idea how I feel this has got nothing to do with my life, you know, and how can, you know, a group of forty people.
 
That was a lot.
 
It was... about 36 people, you know, how can we, how can we kind of deal with it. But it was a relief to see so many people there, you know, with the same sort of symptoms because it didn’t occur to me it could possibly be so common. But anyway I came out thinking that and then I looked at their website and I went for a one to one with the councillor who would see me through it and I spoke to her and I thought just give it a go, you know, just let’s see what’s on offer, nothing ventured nothing gained. And I found talking to her was very useful and having someone again there who would support you through it seemed to me to be a good thing. And I did the first, you do an online system and I think you have eight tutorials and stuff you do during the week.
 
And the first two I thought oh, you know, I’m still not sure but as I did it because I persevered and I spoke with her, after about week four I just thought I can see where it’s going, you know, this is , it starts here [talking over] but it takes you through. And what I, when it kind of clicked with me after maybe week four I actually got quite excited about it and I wanted to do it and I wanted to do the tutorials.
 

Andrew’s GP gave him lots of information including websites...

Andrew’s GP gave him lots of information including websites...

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I was enormously encouraged that he didn’t just say here’s some tablets go away and take them, think about it. He gave me a couple of websites to look at to just looking at possible side effects and how it might work and that sort of thing. so that gave me enormous encouragement with him as a doctor I have to say that he was actually thinking about me and what was best for me. and then I came home and talked to my wife about it and it was about November, October or November and I remember thinking the doctor said the first month on this treatment can be pretty grim or not, you know it can highlight some of the worst aspects of, of the depression, it can be a problem. and I remember thinking Christmas was coming up and I was feeling awful and I didn’t want to mess up Christmas and so I thought if I start now with the tablets, if I’m lucky I’ll get the month or six weeks of not feeling so good and they might actually start to kick in the benefit for Christmas. And I just thought with the children around I came to the conclusion I didn’t want to waste any time and I’d spent enough time feeling, you know, unwell and if they could provide, if there was a treatment that could help then I would go on it.
 
Did you feel like the decisions you took were made jointly between you and your GP?
 
Oh absolutely and I think that’s really important because also I felt that if I’m going to go on the treatment that may affect my mind in some way, you know, I wanted to, I wanted to be able to trust the doctor and know that, you know, I was an individual to them and that If I come in and say I just feel terrible, you know, help - don’t dismiss me but sit down and talk to me, you know, and let me tell you how I feel. So I wanted to I wanted to know I could have a relationship with the doctor which, you know, I never had had before. And I suppose men more than women don’t go to their GP, I mean I’d never had this relationship so it was important to me that I felt that he was going to be there and help me through it and he had said as much to me that he would that I could go and see him whenever I wanted to and I should make sure to ask for him that you know he would be there to help if needs be. And I took enormous comfort and encouragement form that because I was a bit worried about being alone with tablets that you know affect your mind or could affect your mind.
 
In terms of the information it sounds like you were given a reasonable amount of information by your GP and was that easy to kind of work through and understand and think about?
 
Yes I think there was Patient.net or something that he gave me to look at. But that was kind of sufficient for I could read around it and think about it. But when I was doing the course you know alongside that, what that course has is little video clips of people talking about their experiences. And I actually found that very useful.
 

Andrew has conflicting feelings about taking an antidepressant

Andrew has conflicting feelings about taking an antidepressant

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I never forget to take this tablet and I think it’s because I think it’s been so valuable in helping me feel better. My big concern is that I go to the doctor in a few months time and they say we think you should come off it because, I’m really nervous about that and I’d like to stay on it for at least a year more, you know, and I, because I know by then I will have been on it for so long that it becomes a crutch and you think I can’t survive without it. How I feel at the moment, if someone said to me to just take it for the rest of your life I think I’d say thank you very much.
 
Because it’s keeping you stable?
 
I feel it is and obviously if I came off it then we’d know and maybe I should come off it at some point and try and see how I do, knowing that if I go back to the GP and say please can I start it again they’ll let me do it. And as well I’m, worried about -like the expense of it I’m worried about becoming an expensive burden to the community because really I’m 50 I’m generally in good health, you know, I’m working and I think oh I don’t want to be a drain or, you know, on drugs that are required for cancer treatment or something like that. But the more I’m on the treatment the more I realise how ill I was and it was a physical illness and not something that I just made up to get some attention.
 
Is that something that you kind of felt quite strongly before, that it could be that yes?
 
Yes, I suppose yes because it just, when I went to see the doctor is it just that I’m an ineffectual individual who’s not good at his job and not a great dad and that I’m, you know, and that I’m pretending I’m depressed to excuse all that? And he said well that’s what the depression is doing to you; it’s the other way round.
 

Andrew recalled ‘Someone saw that there was citalopram...

Andrew recalled ‘Someone saw that there was citalopram...

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Some family members know I didn’t tell them but I wouldn’t not tell them. Someone saw that I had, there’s a, there was citalopram sitting on the shelf and she’d had it herself and she said to my wife ‘Oh who’s on citalopram?’ and she said ‘They’re Andrew’s.’ So my wife’s family know, they’re the family I see more often we don’t really see my family that often so they know, fine I don’t mind them knowing at all.
 
Well I haven’t, you see I haven’t avoided telling her, and I would tell her but we pop down there for half a day and really, you know, there’s not really discussion, there’s discussion about the kids and stuff but never that, sit down and have half an hour to say how are you getting on...
 
And well I mean if, I don’t mind people knowing and I would tell them but then I don’t know I feel there’s a bit of weakness there. I did tell someone at work and I work very closely with one of the professors, he’s enormously busy and I take on a lot of his load. And I spoke to the administrative worker at work and said did she think I should tell him that I’m depressed and that I’m on this treatment. Particularly as I wasn’t sure how the treatment was going to make me feel and I was at work the first few weeks and I was feeling bloody awful, you know. And she said I don’t know whether you should tell him or not, what do you want to do? And I said I don’t know because I don’t know what I want out of telling people at work, do I want them to treat me differently? Do I want them to take into account some odd behaviour they might have... they had noticed, or do I want them to think that I might not be as productive as I normally am? And I couldn’t answer that question in my head, I didn’t, I couldn’t think through what it is I might want from them. You know if you’ve got a broken leg you can say well I can only.... I need a taxi to work.
 
You can work out what are your limitations.
 
Well yes if I’d been diagnosed with cancer – well, there would be three days a week I can’t come in because I’m on my treatment but I’ll try and get in for the other two but I would appreciate it if people knew. But perhaps I don’t want them to keep asking me about it when they see me in the coffee room really, you know, I mean there are different ways people want to handle it. And I don’t want the ‘Oh’ that ‘Oh.’
 
Yes that sympathy thing.
 
Yes. Nonetheless I do think it would be useful if they knew that somebody like me has been unwell with depression and has also had the treatment so I do feel as it’s a bit of a copout but I didn’t tell my boss and I just kind of tried to handle it as best I could myself.
 

‘At work I knew another person who was interested in playing...

‘At work I knew another person who was interested in playing...

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I’ve started to play the ukulele and so I go to this thing on a Monday which I would never have done when I was depressed at all - never have dared go along to something like that because I, you know, would have been terrified about what they thought of me which is ludicrous because everyone who has a passion wants to share it so if you have a passion going along to a club but shares your passion because people just embrace you so anyway. So I thought let’s start a club at work I knew another person who was interested in playing the ukulele so we sent an e-mail around and suddenly ten of these people who were interested in playing the ukulele, came out of the woodwork, came along and so we’ve got a group that’s going to meet weekly.
 
And that sounds like something you, you know, like you said you would never have organised when you were feeling.....
 
No I would never have organised it.
 
When you were feeling bad.
 
No, no, no, no.
 

‘I really valued feeling cared for and that someone took an...

‘I really valued feeling cared for and that someone took an...

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Because I had a good experience with the doctors; I think that they levelled with me. They......being told I was depressed, you know, clearly being told that was the case and all these other things that were going through my mind were a symptom and not a cause felt good to me. I think the doctors spent time with me I never felt rushed at all and we talked about me and my emotions and how I felt and I really valued that. I really valued feeling cared for and someone took an interest in me more than anything else. And I think I may not have taken the tablets if I’d come out of there thinking ‘Oh it’s just another patient to be given drugs to shut up,’ or whatever.
 
The doctor who prescribed the treatment said think about it, you’re not under pressure but from where he was sitting he thought it would be a good idea, but he didn’t want me to do it unless I thought that it would help me. And yes I just felt looked after, I felt that they took an interest in me and I felt if it all went pear shaped they would be there to help me out.
 
You felt well supported.
 
And if it went well - fantastic. So I had a really good experience from the general practice I should say.
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