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Sharon

Age at interview: 37
Age at diagnosis: 22
Brief Outline: Sharon was diagnosed with post- natal depression after the birth of her second child. Since then she has experienced episodes of depression periodically and has tried a number of different antidepressants. She currently takes Prozac (fluoxetine) and feels it helps keep her mood stable, although she now also finds other ways to cope with difficult times.
Background: Sharon is divorced and lives her two children. She works as a Lab Technician in a university. Ethnic background; White British.

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Sharon was first diagnosed with postnatal depression when she was 22, after the birth of her second child. She was prescribed Prozac (fluoxetine) at that time and after a few months felt an improvement in her mood but it didn’t last. She experienced unwelcome side effects the first time she used Prozac (fluoxetine) - vivid dreams, and heightened feelings of anger and aggression. She was changed to sertraline but again felt that it did very little to improve things. She was referred to see a psychiatric nurse (CPN) as her GP felt that she ought to think about stopping using antidepressants, and that talking to someone might be more helpful. After having counselling and talking through some of the issues that she felt had impacted upon her emotional wellbeing over the preceding years there was a period of about 2 years when she felt well, and hoped that depression was a thing of the past, but when she began to notice her mood dipping again returned to see the GP. This time he prescribed lofepramine which is one of the tricyclic group of antidepressants, but experienced unsettling side effects such as feeling ‘drunk’, ‘restless legs’ and blurred vision.
It hit me like a ton of bricks….I used to take them in the evening and I felt drunk…. She tried several other tricyclic antidepressants including dosulepin and doxepin, adjusted the dosage, and the time of day that she took them, but never found them effective.
 
Difficult life events have taken their toll on Sharon over the last few years including problems at work, a divorce, and being a single parent. She tried several other antidepressants. Citalopram made her feel numb. ‘I just became very, very numb on it… I didn’t feel anything at all. I didn’t feel happy or sad or hungry or tired…. Absolute nothingness’. Mirtazapine ‘was horrendous, absolutely horrendous….. when I first took it knocked you out and it was lovely and floaty and wonderful but I could not function. I gained two stone in weight and I just felt awful, like I wasn’t getting anywhere, it didn’t make me feel better at all’.
More recently Sharon has been seeing a CPN on a regular basis, and she has seen a psychologist. The CPN put her back onto fluoxetine. It seems to be antidepressant that works best for her now. The combination of taking an antidepressant alongside having talking therapy has been most helpful for Sharon. She has also taken a ‘Mindfulness’ course which she feels has helped her to be more focused in her thinking. Talking therapies have helped her to more easily recognise signs that her mood is dipping and to be more attentive to her thinking. She now feels more able to talk to her friends and colleagues so that they can help her when she’s struggling. ‘The Prozac has taken the edge off my feelings to help me feel…. I don’t like to say ‘normal’, but to feel ‘normal’ emotions in a normal range when it’s appropriate, which is something I felt I didn’t do at all before…. And I’ve got control back’.
 

Sharon has had several episodes of depression and sometimes...

Sharon has had several episodes of depression and sometimes...

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Sometimes to be fair, sometimes I wasn't bothered. It was like, "Oh just give me the tablets and that will do," and I didn't want to talk to them but that's not necessarily the right approach. I think maybe they should have probed a bit more, asked a bit more because that's what helped. It's, it's the talking about it, discussing it and talking about different approaches and different things and different ways of looking at things that has helped ultimately and if that had been done ten/fifteen years ago.
 
Mm
 
It could have made such a difference.
 

Sharon has experienced recurrent episodes of depression...

Sharon has experienced recurrent episodes of depression...

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The doctor said to me, "How are you?" and I just burst into tears and said, "I hate it, I hate kids, I can't stand it, I can't do it anymore." And he said, "Ah take these tablets," basically [laughs] and started me; had a little discussion and started me on fluoxetine, twenty milligrams to start with and I thought ok, fair enough, it's enough just to get me out the dip and pick me up a little bit. Didn't notice any initial side effects. I had one panic attack which I'd never had before and that was, that was a bit odd but nothing else from that. Initially they kept me awake a bit and I had got very vivid dreams, very, very vivid dreams. So sometimes I didn't know if they were real or not. I had to sit back and think about my dreams and look for something in them that was random, like an elephant or something to work out, "No that was dream," and I stayed on that, I think it took about two months and I felt much better and my husband at the time said, "This is you, you're back to your old self, for Christmas."
 
I felt much, much better. And then I think I had to go; keep going back to the doctor for checks and I was on them for about six months to eight months till the summer, this is over Christmas ....and he said, "Start coming off them in the summer because the weather's better and you might feel a bit better which I did gradually and that was OK but then I got to the September/October and then started dipping again and I ignored it and it got worse and worse and it took two months for me to phone the doctor and make an appointment and he put me straight back on fluoxetine. And from then I've just sort of every time I've tried to come off one I've been OK for a while and then I've dipped again.
 
I was getting concerned, I started a… I moved and went to a different doctor who tried various different medications.
 
Because I didn't think the Prozac was working, I felt very angry a lot of the time on it, not as depressed but very angry. So I think I tried the Seroxat next which didn't seem to make much difference but again six months and then came off it. I went to see the community psychiatric nurse, it was the first time, when I'd moved up here because my doctor's had decided, "Oh you've had enough of these pills, you need to be off them now. Go and see them, talk to them, you'll be fine." So what was initially supposed to be a six week session turned into six months and I managed to come off the antidepressants again and was off them for two years which I thought was great and I was doing really well and then it hit again.
 

Sharon felt she was ‘just going through the motions’ when she...

Sharon felt she was ‘just going through the motions’ when she...

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When you went on the Tricyclics then did they alter your mood? Did they have an effect?
 
Mm they sort of doped me up really.
 
So you felt a bit blank did you?
 
Yeah, yeah. But I wasn't, I didn't feel that I could function and carry on normally. I didn't feel alert, I felt very sort of floating, relaxed and - which was nice and sometimes it was very nice to not feel anything but you can't go on like that, like it's not how you live.
 
And how, yeah I mean how did it impact on your day to day life would you say?
 
I functioned, I just, I got up, I fed the children, I took them to school, I'd come home, I'd sit – just sit with no music, no telly or I'd sleep and then I'd pick the kids up and make them dinner and put them to bed and then I'd go to bed and I did that for months.
 
So did you discuss that aspect of it with your doctor at all?
 
I don't think so no, because I don't think at the time I thought about it. I was just going through the motions.
 
Because when you're in that state it's quite hard to actually think about it clearly.
 
Yeah because, because your thinking's different anyway and it was, it was just, it was like being in a permanent state of drunkenness I suppose just mildly. But, so you weren't that bothered because it was, it was OK because you weren't feeling bad, it didn't matter that you weren't feeling good either and you just carried on with it.
 

Sharon found antidepressants affected her sex life. ‘With the...

Sharon found antidepressants affected her sex life. ‘With the...

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With the majority of them I just wasn't interested at all, not in the least, didn't bother me one bit. With the fluoxetine and some of the other SSRIs it's like everything's plugged in properly but it's not switched on.
 
Good way to describe it....
 
So it's, yeah you can have urges and feelings but they weren't culminating anything no matter how hard you try which can be frustrating and then you think, 'Oh I can't, what's the point?'
 
And quite upsetting I imagine or not? Perhaps you weren’t feeling enough to be upset?
 
I wasn't too upset because I knew that was a side effect, well I'd read sexual dysfunction and then discovered what that was I suppose but I think for my husband it was probably quite frustrating and I did spend time explaining to him that it wasn't him, it was the medication you know, it's part and parcel of having that and the higher the dosage the worse it, the worse it got.
 
Was that ever something that you discussed with your doctor?
 
No, no.
 
Would there be a reason? Because it's difficult?
 
Because I think because it was more important to, to be well.
 

Sharon felt puzzled that ‘different doctors would switch them...

Sharon felt puzzled that ‘different doctors would switch them...

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From some tablets that I've been on I've changed straight over from one day, one tablet to another day, another tablet. Other ones I've had to come off completely and then wait a few weeks and then start gradually.
 
Which ones, is it, was it the SSRIs that you had?
 
The SSRIs, I went from SSRIs straight on to the tricyclic.
 
And so when you say you started taking them the next day at the dose, at the dose that you've been prescribed…?
 
Yeah, yeah I literally just to switch over.
 
And how did that work out?
 
Well I wasn't sure about that, I was, but I trusted the doctor. I thought, 'Well I don't know because it's a different type, it's a different thing…’ Wasn't quite sure, I expected to feel a bit odd and maybe go a bit haywire for a few weeks. The only time, it was only recently when I came off the mirtazapine, went onto the Prozac again that I had to come off the mirtazapine completely and the doctor said it's going to be bumpy ride but it wasn't too bad.
 
It wasn't too bad so the only time I expected it to be or was talked through it that it was going to be horrendous that it was, it was quite concerning how different doctors would switch them over differently.
 
And how did you, what, how do you make sense of that the differences between the different doctors?
 
Well until you've tried another doctor that's done it a different way and they say, "Oh no you shouldn't do it like that," you don't know.
 
Because you're kind of in the hands really aren’t you?
 
Yeah, yeah especially when you're feeling as low as you are at the time anyway you just do as you're told and hope for the best.
 

Sharon saw her CPN (Community Psychiatric Nurse) for talking...

Sharon saw her CPN (Community Psychiatric Nurse) for talking...

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The CPN was the first one and I think, I think the main thing I got from that was to accept that there had been things in my life that had happened and even though I thought they weren't big major issues they'd all sort of come together over the years and built up and built up and it did help towards me feeling bad. I used to feel very , I was a terrible mother, I was awful because everyone else can cope, everyone else loves their children, everyone else misses them and I didn't and I thought that was me and I was wrong and I was bad. So it helped me look at things differently .
 
And do you think that being on medication that you could think about those things more easily?
 
Yes, yeah, yeah. We touched on cognitive therapy which I have tried since. At the time it all seemed very, well if you're feeling OK yes that's going to be very good. If you're not feeling OK it's going to be very difficult to challenge your negative thoughts because they're your thoughts, you don't see them as negative thoughts that's just how they are .
 
It's a distorted reality isn't it but you can't…
 
Yeah, yeah.
 
When you're in that position it's very hard to recognise that.
 
Yeah when you're well you can see how it would work. When you're not well it's, it's quite difficult to put into practise. But I think the medication certainly helped me to be able to talk a bit more and listen a bit more and think and reflect on things that have been said and subsequent therapies definitely.
 

Sharon’s therapist encouraged her to talk to other people about...

Sharon’s therapist encouraged her to talk to other people about...

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Another thing that the therapist taught me is to look out for signs of how I act, how I react and how I think about things and I can tell when I'm not quite right and having discussed that with my friends as well, my colleague at work, we're good friends, she knows just from when I walk in or even from a text message and my current partner will know if I'm not right because they know the signs to look for and then they can jump on it straight away and say, "Well hang on, you know, are you OK, are you struggling?" And I've learned to say, "Yeah I am struggling today," rather than just say, "No, no it's fine, it's fine," but admit that you know you can’t do everything all the time.
 
And you say you've got a new partner?
 
Yes
 
And is it easier to be with somebody that understands?
 
He's, I was very open with him right from the start and he said he wanted to know everything so I told him everything and he stayed, he didn't run off. He's very supportive, he doesn't know always know what to do but again he'll say, "I don't know what to do," rather than just ignore it or be quiet. Any reading or anything that I've pointed him to, to help he'll look at, he'll engage with it. He'll ask, he wants to know how he can help and what he can do.
 
Mm. Sometimes it's and people say you know it's not that you want someone else to fix things for you but just to hear you and listen.
 
Yeah just to listen and hear, not just let it wash over.
 

Sharon’s CPN helped to integrate other therapies into her care as well as antidepressants.

Sharon’s CPN helped to integrate other therapies into her care as well as antidepressants.

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The first session was really odd because we were given an object that we had to look at and it was a raisin.
 
And I thought; I was looking at other people and they were looking at me and we're thinking, 'What are we doing here? What, how on earth is this going to help?' It was a twelve week course so a couple of hours a week and you had homework to do. Based on Buddhism, meditation and things like that so I thought, 'Oh shit, airy fairy stuff whatever,' but it was very good, it was very good. It helps you focus and take time out and step back and assess situations for what they are and it helps with a lot of things other than depression but I found it very helpful for me especially if I was feeling overwhelmed in a situation and normally I'd have just burst into tears and that's it I can't cope. Just to do a breathing exercise for example that's a couple of minutes, step back, look at the situation and think, 'OK this is what you can do, this is what you can't do, what's the point in, in worrying or is it worth doing something? Should you act or not? Accept the situation for how it is and carry on.' And it enabled me to do that quite a lot and it's something that I've continued to do.
 
How does it feel doing that kind of thing in a group?
 
I'm not, I'm not a great one for group work but I thought I'd try and everybody; it was, everything was confidential, you didn't have to share anything you didn't want to share so you didn't even know why other people were there. And you can help each other I think, you always get a few that are more talkative than others but you could share your experiences of doing the practises and you’d quite often find that somebody else felt the same as you did for one or somebody felt something totally different and you sit and talk about it and how you can change your approach or how it could be useful in day to day life. And sharing what we'd been practising at home and what we'd used it for and things so it was OK and we'd; definitely there was some sort of bond there between a few of us. Not that we've seen each other outside but yeah it was OK, it was OK.
 
Doctors are very good but they're a jack of all trades whereas the mental health nurse specialises in mental health and I think it's very easy for the doctors to just, "Oh well we'll try you on another one," and not to look at what effect it is having, what emotional effects it's having or not dealing with and trying to interlock it with other therapies, that's certainly what the mental health nurse did was put it alongside psychotherapy and the mindfulness and bring them all together and use them altogether and I think that's been the key to not just have therapy or just have anti-depressants but to use it all because I think for me definitely you need the anti-depressants to get you up to a level that you can engage and make use of the tools that they can you provide you.
 

Sharon’s CPN helped to integrate other therapies into her care as well as antidepressants

Sharon’s CPN helped to integrate other therapies into her care as well as antidepressants

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Doctors are very good but they're a jack of all trades whereas the mental health nurse specialises in mental health and I think it's very easy for the doctors to just, "Oh well we'll try you on another one," and not to look at what effect it is having, what emotional effects it's having or not dealing with and trying to interlock it with other therapies, that's certainly what the mental health nurse did was put it alongside psychotherapy and the mindfulness and bring them all together and use them altogether and I think that's been the key to not just have therapy or just have anti-depressants but to use it all because I think for me definitely you need the anti-depressants to get you up to a level that you can engage and make use of the tools that they can you provide you.
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