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Colette

Age at interview: 28
Age at diagnosis: 19
Brief Outline: Colette first experienced depression as a teenager but didn’t seek help from her GP until she left home at age 19. Her GP prescribed fluoxetine. She took this for a short while, but did not find it helpful. She has tried a several antidepressants at different times but has decided not to take them again and prefers to use other strategies like exercise and diet to improve her mood.
Background: Colette is single and works as an emergency care assistant. Ethnic background: White British

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Although Colette experienced depressive moods when she was a teenager, it wasn’t until she moved away from home at age 19 that she sought help from the GP as she had begun to feel very depressed, including having what she called ‘nasty thoughts’. Although she was prescribed an antidepressant and offered counselling from a voluntary organisation, she didn’t take this very seriously at the time, and was erratic about taking the medication, eventually stopping altogether.
 
Over a period of time Colette has tried several antidepressants including fluoxetine, venlafaxine and mirtazapine. One made her feel angry and aggressive she worried about the effect it had on her. Eventually she was prescribed duloxetine which she took for around two years and she feels that this was the most effective medicine in terms of improving her mood. She eventually reached a point where she felt stable and discussed stopping taking the medication with her GP but this proved to be more complicated than she had expected as she experienced severe withdrawal effects during the time she was reducing the dose.
 
‘ It took me a long time to wean off it… my head would spin one way my stomach was spinning another it was a bit of vertigo you end up with a bit of an odd twitch because my head would spin kind of jerk out a bit just even though we were still weaning down very slowly at first even then it was still too fast and I just basically ended up curled in a heap on the sofa because I couldn’t move, to try and move would make my head spin… it took me months to come off of it, absolutely months to come off of it’.
 
After stopping taking duloxetine Colette felt well, but after a time began to feel a dip in her mood, and returned to see the GP who suggested that she went back on to antidepressants. Reluctantly Colette began to take duloxetine again, but this time it did not seem to be as effective at improving her mood and she decided that she would prefer to manage without taking antidepressants. She says without antidepressants she feels better than she has done for a long time, and hopes to continue to manage her life without medication. Although Colette feels that they can be useful as a means of helping in the short term, she is not keen to rely on them in the longer term.
 
Colette has benefited from one to one Cognitive Behavioural Therapy (CBT) provided by a CPN (community psychiatric nurse) from the local mental health team, and has also spent time talking to a psychologist. She feels that over time she has developed a greater sense of self awareness that helps her deal with the difficult feelings she sometimes experiences.
Recently Colette has started to think more about how diet can affect your mood.
 
‘I have looked into more natural forms of getting the same kind of drug serotonin levels and that, things like bananas there was a research done that pro biotic yoghurt drinks may be helpful so I started taking, I have recently started taking pro biotic yoghurt drinks and eating lots of bananas and that’s supposed to make you feel a little bit better so if I can manage it naturally. At the moment I feel so much better for not being on the medication and for using the natural alternatives, I actually feel so much better within myself, I’ve been smiling.
 
Colette feels it’s important to be open about mental health issues with friends and has found that by being honest and telling people about her experiences that she has been able to help others who have come to ask her for advice or help.
 
‘Most of my friend group, friendship group do know about the antidepressants and the counselling. With my friends it’s not something I tend to hide; as a consequence you meet other people within our friend group who are able to come to me for advice which is quite a nice feeling actually’.
 

Collette explains how she reported side effects using the...

Collette explains how she reported side effects using the...

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I don't pay too much attention to those given my job anyway I tend to look up in the medical books to what they are and what the side effects are and what yellow cards are on them.
 
It’s the side effects that they don’t tell you about, the leaflets are usually quite good in fact the leaflets sometimes have things on them that the books the doctors look at don’t which is something me and my GP have kind of discussed with the duloxetine because there was like one side effect listed on there is not what is listed in the book.
 
What did the doctor say about that?
 
Well it’s not reported or something some, it’s on the leaflet comes with the drug.
 
You mentioned yellow card what, tell me what you know about that.
 
The yellow card scheme is where patients can report side effects whether they’re listed or not they can report them and say that they’ve taken that medication and that they’ve, it’s had this effect on them and it means they can keep a tab on what side effects are going on and so how likely you are to get that side effect.
 

Collette changed from mirtazapine to duloxetine, which...

Collette changed from mirtazapine to duloxetine, which...

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On the mirtazapine it kind of had an adverse effect and I became very aggressive and even at one point raised my fist to my partner at the time, my ex-partner now. I didn’t actually strike her thankfully but went back to the GP’s going there is something very wrong, I know I have a few anger issues but I’ve never done that before, that is so out of character, you know, I was shocked I did it, my partner at the time was shocked I thought oh this isn’t right. So we did a quick change over from mirtazapine to duloxetine. All the while I then started doing CBT with the mental health service but it didn’t go so well so we ended up doing art therapy as well, finished the CBT then started art therapy which went even worse, and then we started psychoanalytical therapy which didn’t go too bad. I was on the duloxetine for two years, actually stuck to this one stayed on it for two years got to the point where I was feeling a lot happier with everything and was ready to try to come off it with this with the support of the GP and we discussed it and discussed weaning off of it which wasn’t too bad, it took me a long time to wean off it, the physical side effects from withdrawal weren’t very nice.
 
Can you describe them?
 
Well my head would spin one way my stomach was spinning another it was a bit of vertigo you end up with a bit of an odd twitch because my head would spin kind of jerk out a bit just even though we were still weaning down very slowly at first even then it was still too fast and I just basically ended up curled in a heap on the sofa because I couldn’t move, to try and move would make my head spin.
 
Quite alarming actually
 
It was, it wasn’t nice it took me, as I say, it took me months to come off of it, absolutely months to come off of it because actually it was so, so slowly in the end the last little bit was the worse.
 

Collette always takes her antidepressant in the morning when...

Collette always takes her antidepressant in the morning when...

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The ones I’ve been on have been stipulated as to what you do but I’ve always taken mine in the morning because I know that’s the, you know, I’m always up I’m always having food so it’s always a good time for me to eat and take the medication because in the evening, you know, I might not have an evening meal I might have it early or I might have it late so the morning works better for me.
 

Collette had withdrawal symptoms when she stopped taking...

Collette had withdrawal symptoms when she stopped taking...

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I was on the duloxetine for two years, actually stuck to this one stayed on it for two years got to the point where I was feeling a lot happier with everything and was ready to try to come off it with this with the support of the GP and we discussed it and discussed weaning off of it which wasn’t too bad, it took me a long time to wean off it, the physical side effects from withdrawal weren’t very nice.
 
Can you describe them?
 
Well my head would spin one way my stomach was spinning another it was a bit of vertigo you end up with a bit of an odd twitch because my head would spin kind of jerk out a bit just even though we were still weaning down very slowly at first even then it was still too fast and I just basically ended up curled in a heap on the sofa because I couldn’t move, to try and move would make my head spin.
 
Quite alarming actually.
 
It was, it wasn’t nice it took me, as I say, it took me months to come off of it, absolutely months to come off of it because actually it was so, so slowly in the end the last little bit was the worse.
 

Collette said the CPN knows more about mental health...

Collette said the CPN knows more about mental health...

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Yes I said to him look this isn’t making any difference really I’m still feeling really low and I’m still having very bad thoughts, you know, and I’ve been on this for the best part of a year now, so why don’t we try something else. So he came up with a couple of suggestions and we actually worked through the pros and cons of each drug that he came up with.
 
And the pros and cons meaning what?
 
The side effects of the drug over the benefits of the drug because we obviously we’d looked at sertraline but we also looked at using in conjunction with the duloxetine quetiapine and he explained the drug and the side effects, well potential side effects and we decided in the end that Sertraline was a better option.
 
Is it quite helpful then to have another person that you can go to for support or advice rather than always just having the one person with their own take on things?
 
Yes different viewpoints give you a much wider, I don’t know experience, what might affect me might not affect you and to get different people’s experiences of it gives you a broader vision and you get to see more of how is this happening but this person coped this way and this person coped this way well maybe I can try a bit of both.
 
And I suppose of course a CPN has quite a wide experience of people who are experiencing mental health problems whereas GP’s aren’t quite so specialised necessarily are they?
 
No well that’s part of the problem the GP and I have had with the medication because she doesn’t have the experience of the mental health drugs whereas the CPN since, particularly since doing his nurse prescribers course does have the experience of the drugs and, you know, he sees the patients and he sees what side effects they have.
 

Collette stopped taking antidepressants with the help of her...

Collette stopped taking antidepressants with the help of her...

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Yes I’d become feeling a lot better within myself and whilst that could have been the medication that was doing that I wanted to not be dependent on medication so yes that’s when we made the plan with the GP to come off of it slowly and obviously with seeing the GP regularly to make sure I wasn’t slipping.
 
And when you said that you wanted to see if you could do it by yourself without medication where you doing other things to sort of keep yourself more buoyant, did you get work out different strategies to cope with your moods?
 
No I didn’t really. I have looked into more natural forms of getting the same kind of drug serotonin levels and that, things like bananas there was a research done that pro biotic yoghurt drinks may be helpful to I started taking, I have recently started taking pro biotic yoghurt drinks and eating lots of bananas and that’s supposed to make you feel a little bit better so if I can manage it naturally.
 
So do you feel like you can notice any difference or any effect when you eat those kinds of foods?
 
At the moment I feel so much better for not being on the medication and for using the natural alternatives, I actually feel so much better within myself, I’ve been smiling.
 
Is that, do you think that slightly related to just the pleasure of not being reliant on a medication?
 
Possibly.
 
Yes.
 
It’s a good feeling not to be reliant on it.
 
People say it’s quite difficult to sort of separate out, you know, whether it’s the drug that’s made them feel better or…
 
Yes it is.
 
Or in your life, things might have improved in your personal life?
 
It’s very hard to separate it I think particularly where they were concerned this time was because there is so much going on in my personal life at the minute they were really concerned about me not taking any medication but I feel better for not taking it.
 

Collette works for the emergency services. She used her own...

Collette works for the emergency services. She used her own...

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If you turn up at an emergency and somebody is suicidal or something does that. Do you feel that makes it more helpful for you to deal with it?
 
I think that makes a big difference it’s something that’s hotly talked about at the moment within the service but I think it makes a big difference, I have turned up to a patient that has overdosed and well the crew mate that I was working with was just take her to hospital, she was going ‘I don’t want to go’ but he said ‘well either you go to hospital or we call the police and they take you to hospital’. I was like’ hold on a minute let’s just sit down and talk’, we ended up spending quite a long time with her but she, when we were talking to each other I said ‘so, you know, come on tell me what’s going on, what are you doing you’re obviously on medication are you doing any talking therapies’ and it turns out she was doing CBT and she was following a programme that I had used myself so I was able to sit down and go right let’s start at stage one and what do we do at stage one right next, what’s the next thought, what’s the next bit and we went through it until she come down and we ended up not taking her to hospital.
 
So your experience helped you to be able to get her to calm down and deal with it in a calm way.
 
Yes I like to think so anyway.
 
That’s a real benefit isn’t it, I mean I know it’s horrible having depression but at least if you can help some other people it’s nice.
 
Yes I think that’s my calling in life to help other people.
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