Consider alternatives first. Look at the bigger picture. Look at what else is going on. I don’t think depression myself, despite all the evidence that there is in literature is caused by chemical imbalance in the mind. It’s caused by what’s going on in someone’s life. It’s caused by not having enough money to live on, not having a decent place to live, not having enough friends. So if you can address those problems, begin to address them, I think that’s what’s going to solve things in the longer term.

Because one of the things they often say is, well we’ll put you on these and they’ll kind of stabilise you and then you can deal with that other stuff.

And that’s what they said to me.

Yes.

But I think, I think they’re not quite upfront about that. I think they need to be; well it might improve your mood. It might help you. But rarely do GP’s actually say that in my experience, they’ll just say look here it is, take it. Have antidepressants, they will help with your mood. And they don’t, again they don’t look at the bigger picture.

Above all, I’d say be informed. I would say seek out as much information as you can and use the medication only, only as a kind of second resort, not as a last resort but as a second line of defence. I would say your first line of defence, I think should be knowledge. You should know what the, what you’re suffering from and try and improve the situation socially. Friends, exercise that kind of thing. Try and find practical solutions to your problems that you can involve in your life. I would say do that first and then you go to take, consider taking medication if that’s not worked. I would say be very, very informed about the side effects of these drugs and have strategies in place if possible for dealing with some of the more common side effects associated with what you’re taking and also be very aware of the dose that you’re taking because you’re almost never told whether you’re taking a high dose or low dose, you’re simply given a dose and you’re none the wiser as to what that dose might be or where even that dose might be taken. They don’t tell you necessarily. If at all I don’t think. Are they going to change your dose over time, they just do it. And you’ve got to be willing to take a very proactive approach to your own health care, to be able to ask these questions and be informed about that and know how long you’re going to be on them, that’s another thing with these medications is that doctors tend to just put you on them and never take you off them. You’re just on them, and they will, a repeat prescription or whatever and they just never take you off them.

At the time I was very strongly of the opinion that you can’t necessarily trust information that you’re given and oftentimes you’ll get no information. They will just say, Here’s a drug, amitriptyline. They wouldn’t say it’s a tricyclic antidepressant at all. I’d have to go away and find it all myself. So it was more kind of the fact that I would have to find information out for myself because it wouldn’t be offered to me. And also that I wouldn’t trust any of the information that they gave me anyway.

So I felt it was quite empowering. I quite enjoyed it. I resented in a way having to look it up. I resented more their reaction to me bringing in this information.

What kind of response would you get from here, from the doctor, actually coming in with that kind of level of information?

It was pretty negative to be honest. It would be Well you know, you have to be really careful. There’s a whole list of side effects as long as your leg. You know, You don’t have the training to kind of interpret these things. You know, what they put down on that sheet is every side effect anyone has ever reported so they have to cover themselves legally and so on. It was pretty dismissive, pretty negative.

I think I would have liked to have been better informed, more generally about how long these medications might take to, to be effective. One thing I’ve learned with antidepressant medication is they always say, Look it takes a while for the levels to build up in your system to the point where they are efficacious. They, they work. But they gave me no particular information about how long that might be. They said, Well it could be another few months, it could take up to a year, and perhaps even longer for someone. And also some idea of what the dose, the dosage range was. Now I found that out myself by looking at the BNF and having some idea of what kind of dose it was that they were giving to me. If you’re prescribed 20mg of Cipramil you’re none the wiser, you know whether it’s a high dose, you don’t know whether it’s a low dose or medium dose or what. So I would like to have some kind of indication between what would be considered a low dose or a high dose of what I have. And that’s never given.

So there was a kind of attitude conflict between the different people I was seeing. There was my psychologist, who has never focused on medication until recently. He suggested I take mirtazapine. There was no kind of. He would see as the psychiatrist job or the GP’s job. The GP and psychologist would see medicine as their job but not the talking therapies. So it was a complete non communication between the people that I was seeing.

And going back when I was seeing the lady at the university counselling service – group therapist again there was this non, no communication. They were just – no you don’t take medication; you talk things through, that’s how you solve problems. And they didn’t talk to the GP or the psychiatrist whose main business to be honest was kind of crisis management and giving out medication. There was no communication between the two.

My GP would use it as a mechanism to get me to go back and see her, and see me in the surgery and that’s what they were doing recently with me, when I was coming off the sleeping pills. They would only prescribe me mirtazapine, the antidepressant that I was on and the sleeping pills one week at a time. They would force me to come back at one week intervals.

And what effect did that have on you? Did you kind of resent that?

I really resented it, because of work problems I was having. I was taking so much time off with these medical appointments and everyone else in the office was like, well they could see me coming in at 11 o’clock in the morning. It was like, it was because I’d been queuing since 8.30 to see my GP but it still looks bad. And trying to kind of explain to people, although I didn’t explain it at all. It was a medical thing.

So that made it quite difficult kind of not being able to provide any kind of cogent explanation as to what?

No and I would always have to give kind of, get into quite convoluted stories really, to try and explain why I was coming into the office late.

It was treated fairly unsympathetically, they never had any, they never seemed to have any answers and so that’s one of the reasons why I kept looking in books and I kept trying, looking up papers, and what’s I thought there’s got to be an answer. Someone’s got to have a treatment for this, for sexual dysfunction. Or the burning thirst, the metallic thirst, like it seemed that only sugar would ever quench. Someone’s got to have had an answer for this and I couldn’t find it in any of the books that I, that I read at the time. No one had a side effects solution. That’s what I was looking for – side effect. How to treat it. Sexual dysfunction. Burning taste in your mouth. Nauseous. Feeling as if you’re going to be sick.

Those are quite powerful things to have to cope with, especially if the actual drug isn’t doing what you’re hoping it’s going to do. Which sounds like it wasn’t really.

Well the people that I was seeing at the time, my GP and my consultant were saying give it time, give it time, you know, it’ll kick in. And I, I was saying to them, Look, it’s not doing any good.

It sort of eroded my confidence really, that they really knew what they were doing, or did these medications work, and all these side effects that I got from these medications also made me lose confidence, because they couldn’t tell me it seems how to manage them. They’rewell the only suggestion I got the first was I think it was have a Polo mint, you know, and I was, I was very dismissive about this, I thought come on you, you must have something better, there must be a spray or something, or you know, give me something. And the sexual dysfunction as well which I got absolutely no answer for. You know, what’s going on? And that made me just lose confidence in them, everything.

I would sometimes miss doses. Prescribing was always a huge problem because the repeat prescriptions, they would always get mucked up by Boots. They would always get the timing wrong. They’d have to ring up the surgery. So it would be a few days when you wouldn’t get medication because the prescribing thing didn’t work out and also there was just access to doctors. I would, there were long, there was a long kind of waiting list for appointments at my GP’s surgery at the university so I’d have to go to a walk- in clinic. It would just be a huge palaver really to get a prescription. And even when they put you on a repeat prescription that didn’t work either. Boots would muck it up. They wouldn’t pick it up or say oh you have to tell us when to pick it up, and ring and so on, and then it wouldn’t come through and so on.

My GP would use it as a mechanism to get me to go back and see her, and see me in the surgery and that’s what they were doing recently with me, when I was coming off the sleeping pills. They would only prescribe me mirtazapine, the antidepressant that I was on and the sleeping pills one week at a time. They would force me to come back at one week intervals.

And what effect did that have on you? Did you kind of resent that or.?

I really resented it, because of work problems I was having. I was taking so much time off with these medical appointments and everyone else in the office was like, well they could see me coming in at 11 o’clock in the morning. It was like, it was because I’d been queuing since 8.30 to see my GP but it still looks bad. And trying to kind of explain to people, although I didn’t explain it at all at – It was a medical thing.

So that made it quite difficult kind of not being able to provide any kind of cogent explanation as to what?

No and I would always have to give kind of, get into quite convoluted stories really, to try and explain why I was coming into the office late.

Then basically I stopped taking it. I kept being prescribed it, but it wouldn’t, I wouldn’t actually take it. Because I thought well if on paper I’m being prescribed medication and sort of I say I’m taking it, then it makes me less likely to be sectioned. You know, I thought well if I can be seen to be compliant to treatment and this is fairly common for people who are actually prescribed psychiatric medication. Almost half would say they don’t actually take them.

But you would say you were taking it? Is that right? You would tell the people that were prescribing it?

I would be prescribed it. I would pick it up at the chemist and that would be that. So I did take quetiapine for a while but again I noticed no real difference, benefit.

So your concern about that again was that kind of stigma but also the, the fact that you felt it could send you further down that road of psychiatric treatment?

Well no. My motivation behind saying I was taking it was I thought that it would make me appear to be compliant with treatment. And therefore I would less likely to be sectioned, you know.

And was that a fear that you had at that time, that you might be sectioned?

Very much so. My, my psychiatrist had on one occasion sort of said, Are you asking me for a hospital appointment? That was the time that she sent the crisis team after me and again I said, Could I leave? And she was sort of went, sort of like that, and that kind of, that was the first kind of moment that I felt the system kind of really, kind of coming in on me. And I didn’t want that.

And what was it about that that made it feel that didn’t feel like it would work for you?

It felt like I’d have to give up my PhD. If you’re sectioned you will be in hospital for months. Again it was my worry about my studentship, my housing, everything.

I came off citalopram quite quickly really within a year of taking it in about 2002. And I was just treated thereon medicinally for what they would say is paranoia.

So I was treated them with some atypical antipsychotics. I was, I was treated first with risperidone, but I started to have huge weight gain problems with that, and then in 2003 I was prescribed another atypical antipsychotic called quetiapine which is known as Seroquel, the drug’s brand name, which I’ve been on ever since – 400 mgs and that’s been okay for me, but again I’m not sure if it really does anything for me whatsoever.

After the CBT and then you stopped taking Cipramil was there a gap where you didn’t have any medication at all?

It was not antidepressant medication. So it was antipsychotic medication I was taking.

So this is the Quetiapine?

Quetiapine.

Quetiapine. And how long ago did you start taking that one?

Well I was prescribed rispiradone for of all

Right.

In 2002 I believe. Just a small dose. And then it got gradually increased by I started to have weight gain problems with it.

And did you take that in addition to the antidepressant that you were on at the time?

Yes. I did.

Right, so all it did for you was weight gain and you didn’t feel any

Well no.

It was quite interesting. I had this huge problem, as I sort of said before, I was going in at night to the university, I was scared about people following me around that kind of stuff, but the moment I started taking risperidone, for some reason it gave me the confidence really to walk through the front gates of the university. I have no idea why, but it did, and I walked through the front gates of the university and I walked out. The university that I went to, it had several entrances, it was a huge warren complex and I would go in through various routes and things. I would change my route every night. I went; I walked through the front gates of the university during the day in the full view of everyone. And so for me in my mind it was – this is good being able to do that and I linked it to my medication I was taking and so, and I, I didn’t really, although I had lots of weight gain I didn’t directly at the time, again I was quite na√Øve, I didn’t link it to the medication. I didn’t realise that the reason why I was gaining so much weight was because had this, again this thirst, this sugar thirst I would call it that only could be quenched by lots of sugary drinks, and lots of sugary drinks means lots of calories and lots of calories mean you put on weight. I didn’t make the link. It only came later. And I’ve got no explanation for why I didn’t make that link.

And I stopped taking risperidone because I was putting on so much weight and my psychiatrist agreed to replace it with quetiapine which has a lower weight gain profile. So okay same type of drug, less, it has less of a weight gain profile.

She prescribed me Cipramil which was dispensed by my GP, but it was prescribed under the direction of my, of my consultant psychiatrist at the time. And I started that on 20mg which is the starting dose for Cipramil. I found it again a very troublesome medication. So I would find that I would sweat profusely. So I’d go in a shirt and trousers, as I’m always dressed into meetings, and I would find that my shirt would be drenched within minutes. I would just sweat, sweat, sweat, sweat, sweat, that was very embarrassing. I’d have to carry around spare clothes with me to change because my shirt would be sodden with sweat.

I also – what really, really did it for me, was the sexual dysfunction. I got quite a lot of sexual dysfunction with citalopram. I found that very difficult to deal with, and I also got a feeling that I was just about to be sick. It was like eating, I don’t know, something like a double cheeseburger and it fills your stomach, and it should be so good, and then you feel permanently as if you’re about to be sick, but you never quite are. I suppose nauseous feelings. And I got a horrible metallic taste in my mouth. And nothing could quench that taste, apart from sugary drinks. So I would drink lots and of lots of coke. Anything with lots and lots of sugar in it. That would be the only thing that would cover the kind of metallic taste. It would always, always make me feel thirsty.

They tried various dosages to try to raise enough dosage up and I would keep chopping and changing the doses myself. Because I wondered if I could, if I changed the dose the side effects might be a bit different, but then they never seemed to be.

And the side effects were so immediately obvious, as I said, you know, sweating, sweating, sweating, sweating. My back was absolutely wet. I couldn’t actually hide it, so it was really quite a problematic medication for me. I have heard other people who were on it who did rather well, and did rather well on amitriptyline. I described it as kind of devil’s poison’ or something. I absolutely hated it. I completely couldn’t believe that anyone would get any benefit from these things.

But the Cipramil gave me immediate side effects which were quite obvious which caused me practical problems, and were never explained, these side effects were never explained to me by GP. When I actually said, look I’m having sexual dysfunction problems with taking Cipramil, my GP actually said, Oh I’ve never heard of those before.

Even though it was on the patient information leaflet, wrapper that comes with the medication.

My GP my GP prescribed me mirtazapine. I think it’s a small dose 50mgs of mirtazapine. For depression but also for the sleeping problems. He said, It’s quite sedating. It can act in the same way that zopiclone can, sleeping tablets. And, you know, I hope you get some sleep, and double benefit it may help your depression. I’ve not found really that it’s done anything for my mood whatsoever It’s quite a low dose. It’s a quite a low therapeutic dose anyway. And I found that while it did sedate me, it didn’t sedate me, just at night time. When I took it, it sedated me all the time. So I would simply have to soldier my way through it and essentially you know, I’ve discontinued taking mirtazapine as I have done with all my other antidepressant medications because it did absolutely nothing for me. It, one pleasing thing though was that it didn’t affect my sexual functioning which was good. All the other medications I have taken have. It didn’t cause any weight gain. It didn’t have any kind of bad taste in my mouth at all. The only thing with mirtazapine was the sedation which was permanent. It was always there, it wasn’t that it got better through the day, as the level of drug in your system decreases, it was constant and that’s a problem because I’m in a job where I have to meet lots of people. I have to use my head. I have to talk to people. I have to write things, and I found that I would spend hours just looking at half a page of paper, and I just couldn’t. I just couldn’t function. So I discontinued taking mirtazapine and at the moment I’m taking nothing.

Perhaps the reason why I’m still able to talk to you today and not dead is because I changed from amitriptyline to Cipramil. I later found that amitriptyline’s quite toxic, can put you in a coma. The tricyclics are cheaper.

So if you had overdosed on it?

If I had overdosed and there was a period of one week between overdosing. I took my overdose then changed from amitriptyline to Cipramil. If I’d had that pack of amitriptyline I would probably have been in a coma, possibly dead, I don’t know. I don’t know what would have happened. But these tricyclics, the cheaper ones which tend to be prescribed more often, because they are cheap and they’re older, are quite toxic. But you’re never told that. And it’s a major source of poisoning they reckon. And I don’t, I don’t think people know about that. I think if you’re going to prescribe an antidepressant you should prescribe an SSRI, fluoxetine, Prozac or one of these sooner, and not prescribe tricyclics.

I still remember picking it up at the pharmacy and, and taking it out of its box and looking at it and deciding whether or not I should take it. But I took it, and it felt like I was being hit by a tank somehow. I just felt completely flattened. I couldn’t really function. I remember going to the cinema and again it being quite dark and falling asleep during the film and then waking up hours later, and this was on quite a low dose of amitriptyline. It was only a starting dose and I remember spending hours and hours and hours just lying in bed. It just completely sedated me.

It seemed to do nothing for me. My GP at the time said, Well, you know, you have to give it some time, it’s a tricyclic antidepressant, they take a few weeks for it to kick in, or a few months maybe. You have to give it some time.

I didn’t know how I was going to cope with this because I couldn’t, I couldn’t function, I couldn’t get myself out of bed. I couldn’t get myself to the lab. It was so sedating. That was the main thing I remember about amitriptyline and it gave me a funny taste in my mouth. One I’d never had before.

So I quickly after not very long, I discontinued amitriptyline. I said, I can’t cope with this, it’s not giving me any kind of benefit and it is just knocking me out. Its, not… it’s not helping me.

She prescribed me Cipramil which was dispensed by my GP, but it was prescribed under the direction of my, of my consultant psychiatrist at the time. And I started that on 20mg which is the starting dose for Cipramil. I found it again a very troublesome medication. So I would find that I would sweat profusely. So I’d go in a shirt and trousers, as I’m always dressed -into meetings, and I would find that my shirt would be drenched within minutes. I would just sweat, sweat, sweat, sweat, sweat, that was very embarrassing. I’d have to carry around spare clothes with me to change because my shirt would be sodden with sweat.

I also – what really, really did it for me, was the sexual dysfunction. I got quite a lot of sexual dysfunction with citalopram. I found that very difficult to deal with, and I also got a feeling that I was just about to be sick. It was like eating, I don’t know, something like a double cheeseburger and it fills your stomach, and it should be so good, and then you feel permanently as if you’re about to be sick, but you never quite are. I suppose nauseous feelings. And I got a horrible metallic taste in my mouth. And nothing could quench that taste, apart from sugary drinks. So I would drink lots and of lots of coke. Anything with lots and lots of sugar in it. That would be the only thing that would cover the kind of metallic taste. It would always, always make me feel thirsty.

I weighed things up in my mind. So I would write down on a sheet of paper what were the positives and what the negatives were and for the Cipramil it was almost all negatives but that was coupled, with they became to be more reticent about prescribing Cipramil at the time, because I’d taken an overdose and so on. But I clearly saw there were many more negatives and almost no positives. I mean I couldn’t think that it had improved my mood. It hadn’t done anything for me. It had made me more sedated which wasn’t a good thing, I wanted to be active and doing things. And, and so I just wrote it on a piece of paper and took it from there really. And as I say I didn’t have all that much confidence in them at the time in what they were saying because they were fairly dismissive of the side effects I was getting, so I lost confidence in them and I decided to take matters into my own hand, and, and not take the Cipramil.

What kind of information would it have been helpful for you to have had right from the start?

Okay. What I had was literally just this tiny metal tube, the kind of information sheet inside of the box the medication came from the from the Boots chemist. And it just simply had a side effects’ with a huge list, one huge long paragraph of short type. It wasn’t even very good for me because I’m partially sighted so I couldn’t, you know, read it properly. That’s all I had.

What I would want was a list with common, can happen, rarely, side effects, how to treat it, and with the treatment being prescribed along with the medication. That is what I would want.

So some idea that those side effects could be managed in some way?

Yes.

By whatever means.

But that’s not what I got. So you know, some way of treating the horrible taste I had in my mouth or some way of dealing with the feeling of always kind of wanting to be sick or just sweating, but they would never , they would, you know, it wasn’t like that. It was just a list of side effects. So that’s what I would have wanted.

So she continued to see me and then she was a group therapist by background and they ran groups, cost effective, a group in that so called And I started going to group therapy but it seemed to be making me worse and worse and worse, and then in the year 2000 my GP prescribed me for the first time an antidepressant called amitriptyline and I had a big, I was very hesitant about whether to take amitriptyline because I thought well you know, that’s it, I’m official. I’m depressed. I’ve been given medication for depression. You’re depressed.

One thing I’ve learned with antidepressant medication is they always say, Look it takes a while for the levels to build up in your system to the point where they are efficacious. They work. But they gave me no particular information about how long that might be. They said, Well it could be another few months, it could take up to a year, and perhaps even longer for someone.

I weighed things up in my mind. So I would write down on a sheet of paper what were the positives and what the negatives were and for the Cipramil it was almost all negatives but that was coupled, with they became to be more reticent about prescribing Cipramil at the time, because I’d taken an overdose and so on. But I clearly saw there were many more negatives and almost no positives. I mean I couldn’t think that it had improved my mood. It hadn’t done anything for me. It had made me more sedated which wasn’t a good thing, I wanted to be active and doing things. And, and so I just wrote it on a piece of paper and took it from there really.