Part two – mental health
How long have you suffered from depression?
Looking back I have probably suffered from depression for most of my life. I have had periods where I withdraw from family and friends and lose interest in activities I normally enjoy (sailing and singing) and the spark in my eyes went out. These episodes generally coincided with a period of intense pressure at work. On some days I didn’t have enough energy to get up in the morning to go to work. When I was younger after a few weeks of doing very little apart from going to work and sleeping I’d gradually start coming back to life and the sparkle in my eyes came back. As I got older the periods of mental and physical exhaustion became more frequent and my mood also started to be affected. I think my 1st episode of severe depression occurred in New Zealand in 2004, I had a prolonged period of exhaustion, lost interest in singing (I was singing in St Paul’s Cathedral Choir in Dunedin at that time), avoided seeing my colleagues and spent my evenings crying alone. I saw my GP repeatedly during this time and we investigated medical causes for this exhaustion, but it didn’t cross my mind that I was depressed. I made the decision to move back to the UK in November 2004 but committed to teaching clinical pharmacy until July 2005, during this time I gradually came back to life and thoroughly enjoyed my last few months in New Zealand.
I moved to Cardiff in 2005 and threw myself into life in Wales, singing in 3 choirs, sailing, rowing and playing double bass in an orchestra. I think I was keeping myself busy to avoid being home alone in the evenings and weekends so I couldn’t think about work. At that time I was the only clinical trials pharmacist working at University Hospital of Wales and had a sustained period of stress at work while preparing for an MHRA inspection in 2007. I also wasn?t sleeping at that time due to severe gastro-oesophageal reflux. The combination of stress at work and lack of sleep resulted in mental and physical exhaustion. I lost interest in singing, withdrew from my colleagues and lost confidence in my ability as a pharmacist. I gradually ground to a halt in April 2008 and after spending 3 days crying in bed I went to my GP for help. I left with a diagnosis of depression and a prescription for citalopram but no additional support. I was fortunate that one of the priests at Llandaff Cathedral, where I sang in a few choirs, was an experienced counsellor and recognised my symptoms and offered me help.
How do your symptoms manifest themselves and how bad does it get?
Since 2008 I have suffered 2 episodes of severe depression that have both been triggered by periods of intense pressure at work. I become anxious, exhausted but unable to sleep because my brain won’t stop, lose interest in my hobbies, withdraw from family (including my husband), friends and colleagues, argue with my colleagues, cry easily and I’m convinced that something dreadful is going to happen to me. Gradually it becomes harder and harder to keep going and I stop. At my worst I barely function, getting out of bed in the morning requires more energy than I have and I spend days lying in bed trying to block thoughts out by listening to Radio 4. I haven’t been suicidal but I’ve considered falling off my bike so I didn’t have to go into work, but I’ve had enough insight to realise that this wouldn?t solve any problems.
I’m fortunate that I have a very good relationship with my GP who has now supported me through 2 episodes of depression. I started taking citalopram after an episode in 2015 and added mirtazapine in 2016. When I start taking antidepressants my anxiety worsens and mood takes about a month to start to improve. While waiting for the antidepressants to start working I barely function and spend my days lying in bed or on the sofa with the radio or TV on to stop me thinking. As I gradually improve I’m able to concentrate enough to read or follow a TV program (I binge watched The Crown during my most recent episode). The initial recovery process is frustratingly slow and sometimes after having a series of good days I’d have a bad day and would get upset about this, but have recovered in the past I have faith that I will get better eventually. I equate recovery from depression to walking up a sand dune – you walk up a few steps and then slide down to below where you were, but with determination, you get up to the top eventually.
What mechanisms do you use to cope?
While I was unable to work in 2015 my brother recommended a book written by Mark Williams and Dr Danny Penman from the Oxford Mindfulness Centre Mindfulness: A practical guide to finding peace in a frantic world?. This gave me an introduction to mindfulness through an 8-week course of guided mindfulness exercises. Discovering mindfulness and learning how to break the cycle of negative thoughts helped my recovery. I now try to incorporate mindfulness into everyday life by being more aware of how I’m feeling and what I’m thinking and paying more attention to my surroundings. I now occasionally do a guided mindfulness medication using the Headspace app (www.headspace.com). I use gardening, knitting and baking as forms of relaxation.
During my most recent episode in 2016 I was too anxious to leave the house and with the combination of citalopram, mirtazapine and no exercise I started to put on weight. My GP suggested seeing if learning to run would help my mental health recovery as well as help me to lose weight. I downloaded the NHS Couch to 5k program (https://www.nhs.uk/Tools/Pages/couch-to-5k.aspx) in February 2017 and with Sarah Millican as my coach and listening to the NHS Choir Something Inside So Strong CD I started running. The combination of having a target to work towards (being able to run 5K) and getting outside helped my recovery. I ran my 1st Parkrun on 8th July 2017 (the day before my 47th birthday), 1st 10K race on 3rd September 2017 and completed the Cardiff Half Marathon on 1st October 2017. Exercise has played an enormous part in my continued recovery from depression and I have a new set of running friends.
I try to incorporate some form of self-care into my day, whether it’s taking time out of the pharmacy to have a coffee outside, baking, knitting, gardening or talking to friends.
I saw a psychiatrist privately in 2017 (I wasn’t ill enough to be seen on the NHS because I wasn’t suicidal) and have recently completed a course of talking therapy with a clinical psychologist. This treatment helped me enormously because I was able to recognise my triggers, develop coping strategies and learn acceptance of what I can and can?t change in my life.
How do you think pharmacists who are open about their mental health challenges are perceived?
I made the decision to be open about my experience of being a pharmacist who suffers from depression because talking about my experience helps me. In the past when I’ve started to struggle I’ve not told anyone and taken a long time to admit to myself and other people that I’m suffering from a relapse. By the time I admitted to myself and my colleagues that I’m struggling it?s been too late and I’ve plunged into to the depths of despair.
Hopefully by being open with my colleagues about how I’m feeling they can put in support mechanisms to help me. I actively share my experience on social media and have so far not had any negative comments and I’m developing an online support network of people with similar experiences around the world. I’ve recently shared my journey as a Pharmacist with depression as keynote speaker at the College of Mental Health Pharmacist conference and presented to C&V UHB board as part of the health boards Time to Change Campaign. I am also a National Centre for Mental Health Research Champion.
Deciding to be open about your mental health is a very personal choice, but my feeling is that if you don’t speak to anyone about how you are feeling, you won’t get the help that you require. As a healthcare professional there are fitness to practice implications if your mental illness impacts your performance.
If you can?t turn to your colleagues, friends or family for help and you’re a pharmacy student, pre-registration pharmacist or practicing or retired pharmacist you can get help from Pharmacist Support. They offer a whole range of services including a Listening Friends confidential helpline, that is manned by volunteer pharmacists who will understand the pressure that pharmacists are under, Wellbeing workshops, a specialist confidential advice in the areas of debt, benefits and employment law, their website www.pharmacistsupport.org is full of very useful information. I first came across Pharmacist Support at the 2015 RPS conference when they were recruiting a team of fundraisers to celebrate their 175th birthday. I signed up as a #175hero and raised money for them by baking #cakesbypost and skydived on their 176th birthday. In 2016 I became a Pharmacist Support Ambassador and go to meetings on their behalf promoting the services they offer.
What is your favourite piece of music to sing? While I lived in London I was fortunate to join the London Philharmonic Choir and regularly performed in the Royal Festival Hall, Albert Hall and The Barbican with professional orchestras, amazing conductors (including Zubin Metha, Roger Norrington and Danielle Gatti) and sung with incredible soloists (including Willard White, Bryan Terfel and Montserrat Caballe). But I think I am happier singing English Choral music (including Purcell) in a Cathedral Choir. I’ve been lucky enough to sing in a number of cathedral choirs including St Paul?s Cathedral Choir in Dunedin, New Zealand and Llandaff Cathedral Girls? Choir and I’ve sung solos in Westminster Abbey and St Paul?s Cathedral in London.
A staff choir has just been formed at UHW and I’m enjoying singing again.