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Ivan - Interview 01

Age at interview: 58
Age at diagnosis: 52
Brief Outline: Ivan was diagnosed with depression in 2004, but his symptoms began to manifest as early as 2000 when he left his former career as a speech pathologist. He attributes his depression to several factors including the deaths of several close family members, his marriage breakdown in 1993, and the demands of migration. He has been very well supported by his partner, family and friends, as well as his GP and a psychiatrist. Antidepressants (fluoxetine) and his Christian faith have also been helpful.
Background: Ivan is a retired speech pathologist who migrated to Australia from Croatia. He is divorced with two adult sons and lives with his current partner. He enjoys working part-time at a radio station, gardening and the arts, and is a Christian. Ethnic background' Croatian.

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Although Ivan’s experience of depression was enormously difficult and in his words ‘could have killed him’, he now feels that it was an important turning point in his life. His early childhood in Croatia was simple and happy, spent on a beautiful island in the Adriatic Sea in the company of his beloved parents, grandparents and brother. Ivan’s grandparents and father died in the space of 15 years, while he was still relatively young, and these were difficult losses – particularly his father who died when Ivan was just 21. Looking back, he thinks the grief he experienced then left its mark on his subconscious.
 
In his mid-30s, Ivan, his wife and two young sons decided to migrate to Australia due to the collapse of the former Yugoslavia and the accompanying instability and economic deterioration. Although this process went relatively smoothly, his wife found it difficult to adjust to her new surroundings, and within five years their marriage had broken down and she returned to Croatia with the two boys. The separation was amicable and Ivan continued to support and stay in contact with his sons, but was filled with rage at his ex-wife for many years. When his sons were teenagers, they came to Australia to visit him, and with their parents’ blessing, decided to stay. For Ivan, this was a precious second chance at fatherhood, and he later came to accept his ex-wife’s actions.
 
However, the strains of leaving one country to start a new life in another, the marriage breakdown and separation from his children, the frustration of not being able to get ahead financially, and his busy professional life as well as extensive involvement in the Croatian community – compounded by the residual grief from his early losses – eventually exacted a price. In 2000 Ivan resigned from his position as a speech pathologist, in part because he felt he had achieved all he had wanted in his career, and partly because something was changing within him. Having always been very social and active, generous with his time and knowledge, Ivan began to withdraw, become easily irritated, lose interest in the things he had formerly enjoyed, and occasionally entertain thoughts of suicide, when his feelings of the meaninglessness of life overwhelmed him.
 
It was not until 2004 when a frightening hallucination prompted Ivan to see his GP that he was diagnosed with depression. His treatment involved a year of regular visits to a psychiatrist, and experimenting with antidepressants until he found the right medication and dose. His partner remained enormously supportive and understanding throughout, as were his family and friends. Having worked hard at overcoming his depression, Ivan now feels he has attained a measure of peace and maturity previously unknown to him, and is accepting of and content with the life he has lived and created.

 

 
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Ivan saw depression as influenced by the nature of the contemporary world we live in, of global...

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I am not an expert but only someone who has experienced this, who has been a patient and a witness…I have seen so many people who show the symptoms of depression. I am aware that many people from migrant backgrounds, and this is probably the most multicultural country in the world…I think that migration and the process of adaptation to different cultures is so demanding and requires so much physical and mental effort and a person has to survive immensely traumatic situations to fulfil all the requirements and perhaps with these immense global migrations and requirements and desire for something better, a man becomes discontented with simple small things. And I am sure that this discontent reflects the biochemical structure of our brain and our body. It is very likely that serotonin, adrenalin and other defence mechanisms in our body suffer. 

 
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Ivan described his experience of being diagnosed with 'general clinical depression' by his GP.

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I remember that my GP showed me a brochure, a plain brochure about depression, asked me to read it and tell him which of the listed symptoms I could recognise. And of course I ticked all the listed categories which were typical for general clinical depression. Then we took my blood sample for analysis. What did he do, how did he do it…
 
I assume there are some alternative methods - but then it was easiest to apply the classical method, medication, biochemical substances ‘Here is a tablet for you, your serotonin will be increased, you will be better, but it would be useful to find yourself a psychiatrist. It would be good to empty your soul or perhaps fill it with new ideas and see where you can modify your life’. Certainly, as a person of similar profession and experience I had nothing against his suggestions. Everyone needs a shrink in our world, which is demanding, difficult, and very often troublesome, it was good… 
 
 
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When Ivan got better, he sometimes felt he was getting too much support from his partner, but he...

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It even irritates me now, but when it was important [partner] was with me almost 24 hours a day and it was her care, physical presence and care, it was the most wonderful thing feeling that a person understands you and this feeling is not simple, because you are not yourself, ‘Something strange is happening, who can understand you, hey, come on, compose yourself’. But she did understand. It is not an immense affection and because of our love and in the name of love…no, she is generally a very gentle and caring person, but now it irritates me sometimes, those phone calls ‘Is everything all right?’ ‘Of course it is!’ A bit too much which becomes a bit too hard. Yes, I am getting together, so what…and her care in those days was something I needed. I needed someone to understand me and not to tell me what to do or to force me to go to the shopping centre, in a claustrophobic, crazy ambience, no, but to say, ‘Come on, let’s move out’…you know. 

 
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Ivan found maintaining his small vegetable garden and sharing his produce with neighbours...

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I live in [place name], beautiful suburb, beautiful trees, green parks, beautiful birds wake me up every morning and my dog, we go for a walk, we have a tiny community garden which is a role model to all the others. We are surrounded by older people and they are always surprised how such a tiny garden produces everything. Their gardens - they are mainly from Asia - grow only bok choy and cabbage, the entire garden is just that, bok choy. We are growing everything, onion, silver beet…it is our recreation. It brings so much pleasure working in a garden, looking for new fertilisers, and tools, in my 58th year I found peace and tranquillity. One more thing…I am a believer, declared and definitely, I would say, a justified believer since 1996 when something significant happened and confirmed me as a believer. Faith partly influenced my rehabilitation and contributed to my recovery. I mean, we can discuss this but there is no need. I have found myself there. Not everyone would find himself there but it helped me.

 
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Ivan spoke about why he thought his therapy was successful.

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My psychiatrist was a wonderful man, an Australian of Ukranian descent, an older gentleman who revealed to me the most wonderful secret. My GP didn’t tell me, but my psychiatrist did. He said' ‘Depression can be defined simply as a “basket of misery”’… I was astonished and actually agreed with his definition.
 
Well, I went to the psychiatrist for about a year, once a week and then once a fortnight for about an hour or 45 minutes and everything was based on conversations, my confessions, discussions, simply search for conflicting situations in my brain. Anyway, I think it was helpful to release myself, to have someone to talk to, someone who had listening skills, who knew how to suggest directions and who was not my family, not a loved one, not a person I knew but a professional who was unbiased. That was probably the only reason it was successful. Besides, he was a very kind, engaging, decent, quiet, calm, composed, mature man who had experience and umm…the very fact that he defined me as a ‘basket of misery’ was more than a revelation. I was actually waiting for someone to tell me that.
 
 
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Ivan talked about the realisation that Australia, not Europe, was home, and of the legacy of...

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I think I have found my home. Australia is my home and I have accepted it. Perhaps one of the causes was that I had a subconscious feeling' ‘I should go back, where my roots are, I should go back to Croatia and retire there’. Yes, very likely. It was like something I never achieved…but today it is clear. Some four years ago we were in Croatia and I finally realised that this (Australia) was my home.
 
I have definitely not returned to the stage I was at before depression. I had unbelievable skills, energy and will…with extra kilos, my energy and…umm, my abilities have become limited, and I don’t have any need to compete, to prove something, to achieve. I think that everything in my life has settled. I think I am in a period of spirituality, thinking, quiet conversations, long walks…one would say, yes, a retired person…no, I think it is maturity and it makes me happy. I feel full, excited and happy because of qualities I have.
 
I have reached the stage when I can control my life, my way of life. I don’t know what will happen tomorrow but my experience of depression was so significant in my life that I can take it as the most important experience in my life. I think that depression was one of the most significant experiences in my life which enriched me, gave me dignity and fullness of life and understanding of life.
 
 
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Ivan was guided by a trusted GP through a number of antidepressants until he found the right one...

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 I certainly tried with medication, I mean my GP, he tried with two…huh, I couldn’t, I felt like I was not myself, like I was out of my body, horrible…I can’t remember what it was, I would be glad to give you the names of the medication but we can find it in my documents. We tried with two, but finally we found the third one which was Lovan (fluoxetine), 20mg and…my therapy was 4 capsules a day, two in the morning and two in the evening. That was a rather hard dose. I asked him, we discussed it as friends and he said' ‘Look, you will need about two weeks for it to become effective, to start building-up in your body’. And I said' ‘But how long will it take?’ He said' ‘The question is how long you have been ill?’ And then he explained to me a formula in defining depression as an illness. He told me something which made sense and sounded logical. He said' ‘Your recovery will take as much time as you were ill before it was discovered. For example, we diagnosed it in 2004 when you resigned from your job, which is not necessarily significant, so, it will take another four years to reach some kind of normality’…if…I was horrified. Then, in 2004 it sounded…what?! 2008 and I will still be on antidepressants!? Antidepressants, that was something which Hollywood stars used to take to poison themselves, take antidepressants to move to Xansa (alprazolam), they can’t live without Xanax, they live on Xanax…this was my feeling… of stereotypes, because you hear that from popular media, antidepressants have negative connotations, ‘Don’t give me antidepressants’, they are almost like anti-psychotics…aren’t they? 

 
Anyway, I can say, here we are, it is April, 29th 2010 and I am proudly still on one capsule of Lovan (fluoxetine). It gives me confidence, it is like a security blanket and I think it is fine, I am not ready to terminate my therapy, not yet. I tried to stop it twice but after a couple of days I had a feeling that I felt better if I took it and so I returned to it. Well, how long will it take I don’t know. In any case from 2004 to 2006 I was on 4 capsules, from 2006 to 2007 on 3, from 2007 to 2008 on 2 and from 2008 on one. So, from 2008 I am taking one, one capsule of Lovan (fluoxetine), 20mg for the last two years.
 
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