Go ask me: so, about the pills

I received an email a couple of weeks ago that posed the following question: knowing everything I know now, would I still have started down the medication road?

Well.

I have been thinking and thinking about this. Was I too hasty, starting on Prozac? Should I have explored other therapies? Tried to get my nutrition in order? Worked on becoming more active, getting more sunshine, found a spiritual community, taken herbs, gotten a good old-fashioned exorcism? Before I launched into this weird and side-effects-filled journey?

I first took Prozac when I was 27. I had been in therapy for years. No amount of talking seemed to shrug off the consistently low mood I had fought for as long as I could remember. I had anxiety and panic attacks, as well; these began when I was a teenager.

The worst part of my feeling awful was that there was no reason for it, as far as I could see. I had a boyfriend who was funny and loving and supportive (I later married him). I had a fun job working with people I loved. I had plenty of friends. I had therapied myself until there were no more issues to unearth and discuss. There was nothing that I could use to blame for my constant misery. At some point, when my therapist suggested for the 93rd time that I think about medication, I listened.

My first psychiatrist was weird. Off-the-charts weird. He giggled when he talked about the sexual side effects of certain medications. I remain mystified as to why people like that go into psychiatry. Nonetheless, he was thorough. He ordered a complete blood workup to see if there were any underlying physical issues. When it was confirmed that I was in full working order, except for my malfunctioning thought processes, he prescribed Prozac.

A few days after I began the Prozac, I woke up one morning, and I felt fine.

Here's the thing: up until that day, I had never felt fine. Not ever. I didn't know what "fine" was. I thought I did; I thought there were periods when I thought I was doing quite well. I thought the Prozac was treating a relatively recent development in my emotional state. And then I woke up that day, and I realized that this was normal, and this was how I was supposed to feel all the time. And it was utterly, utterly new to me.

It was as if I had spent my entire life hearing a constant thrumming sound in the background, a percussive rhythm that became part of the fabric of my life. And then I woke up to silence, and I had no idea what silence was. And I could think, without all that noise.

Well! I proceeded to call all of my friends. I couldn't get enough of this feeling. This being fine was a miracle! Who knew? Was everyone else like this? Did everyone else get to experience what I was experiencing? I practically skipped out of my house that morning. I'm sure I was unbearable for a while, there. I don't think I cared even the tiniest little bit.

That was 15 years ago, and if I had been smart, I would have never messed with the prescription I was on, but the records show that I am not always smart. About a year later, although things were going swimmingly, I decided to stop taking Prozac, and then I relapsed. And I began it again, and stopped again, the then another relapse. This happened four times. Meanwhile I switched psychiatrists (I just couldn't take the giggling) and my new doc for some reason just desperately wanted me to be bipolar. She put me on all kinds of bipolar meds that made me ill, and then I found a smarter doctor, and the bipolar diagnosis was quickly scrapped.

Here I am now, back on Prozac. I've read a lot about depression in the ensuing years, and one thing I learned is that if you have more than 3 or 4 relapses, you probably shouldn't ever go off the medication. If you've read my last few posts about my depression and the medication adjustments, you know that I had another relapse while on Prozac, which was (for me) unprecedented, and worrisome, to say the least. Thus the new drug, Remeron, which didn't take. So now I'm only on Prozac, again, and right now I'm back to feeling fine. Which is a feeling I love with all my heart.

As for my relapse-on-Prozac, I think I leaned on the medication a little too hard, and as a result let my diet and self-care slip because, after all, I had the drugs to keep me well. This is like a person being on cholesterol medication and eating bacon and ice cream sundaes every night. In the past six months I've been completely overhauling my diet, in addition to making sleep a high priority, both in quality and quantity. (Mmm, quantity.) I'll get into the food stuff in a later post, as I see this post is getting too long for its own good.

So: with everything I've been through, would I still have gone on medication? In a heartbeat. Medication was, for me, a tremendous gift. I got to see what relief felt like. And when I lost that relief, I knew what I could have again. I knew exactly what I was aiming for.

Chasing rabbits

Let's talk about the meds. The MEDS. Goddammit.

Here's a brief overview of what's been going on, medication-wise.

In December, the Prozac I had been taking, successfully, for years, decided to stop working. Just like that! I took to my bed.

A few days later my doctor put me on Remeron, because it's fast-acting. I had never heard of Remeron. Scott said it sounded like Scooby-Doo saying "Enron," which sounded about right.

The Remeron worked great--SO GREAT IN FACT that in April, my doc suggested I go off the Prozac. Since it wasn't working, right?

Then, a few weeks later: ruh roh. The depression returned, but even worse, like it was all mad at me. My doctor put me back on Prozac--but since the Prozac takes a while to kick in, he upped the dose of Remeron. He did this twice, until I was no longer feeling completely and utterly sick and like my life was draining from me. So that was good.

But then I started having these…episodes. In general I'm a little lightheaded and spacey, nothing too dramatic, but enough that I need to hold onto handrails and should not operate heavy machinery. As if I ever should. But the episodes are far more dramatic. When these hit, I get so lightheaded I am about 99% sure my life is ending, imminently. My vision gets fuzzy, my limbs feel like they're not mine, I'm nauseated and shaky, and in general I feel as awful as I've ever felt in my life. Like I'm just bathed in awful.

Unfortunately the first time this hit, I was taking a nice long walk to visit my psychiatrist's office, which is about 4 miles from my home. How cheerfully I set out on my mission! There I was, happily marching across the Gowanus Canal, when my vision started winking in and out and I felt like I was floating and my arms weren't mine. Unfortunately every time I stopped to sit and regain full consciousness, it became harder and harder to stand up and get my limbs (the ones that clearly belonged to someone else) moving again. So the breaks became more frequent as I neared my destination, until I had to sit at pretty much every block. Sometimes just right there on the street. (Well, against a building. I didn't just plop down in the middle of the sidewalk.) An intelligent person would have tried to get a cab at this point, or sought out the nearest subway stop, but, you know.

I told my psychiatrist about this when I saw him, but by then I had had some water and some quality sitting time in his waiting room and actually felt fine. So maybe the extent of the awfulness I felt didn't come through in my retelling of it. He responded with something noncommittal, about keeping an eye on it, etc. Then it happened a few days later, and then again, and then another time, and each time it seemed even more likely that I might face-plant on the sidewalk. (Why always outside, Brain? Can't you do this when I'm near a fainting couch?) I thought maybe it was low blood pressure, but it feels also an awful lot like how I felt when I became anemic during pregnancy. Or maybe it's some thrilling combo of the two.

At any rate I Googled, as one does, and the Googling brought up a lot about Remeron and passing out, and I called my doctor, who recommended I stop the Remeron for a couple of days and then restart at the original dose. Of course there's a withdrawal syndrome for Remeron, of COURSE, but the danger that I might black out is more pressing, to my doctor's way of thinking, than my temporary discomfort. Which means that I might feel awful for the next few days, and I wouldn't even mind this so much except that I'm going to my college reunion this weekend. I apologize in advance, my Wellesley sisters, if I throw up into a flower arrangement. I probably won't. Probably.

The other problem with the Remeron is that I can no longer sleep. This is sad, as I enjoy sleeping. Remeron is supposed to help you sleep--in fact, it's often used to treat insomnia. In my case, I have to take it when I am on my way to slumberland, or I get a case of the Restless Legs that's so bad there's no way in hell I'll sleep that night. It seems, somewhat not surprisingly, that taking a pill, washing it down with some water and then squeezing one's eyes shut while thinking "OH MY GOD I NEED TO FALL ASLEEP RIGHT NOW OR ELSE" is not the most relaxing way to drift off. So I worry, and if I'm lucky I fall asleep anyway, but even if I do I tend to wake up every hour or so with some INCREDIBLY URGENT THOUGHT in my head. A few nights ago I lurched out of bed because I Had To Print An Email! And Read It To Scott! For instance. If I don't fall asleep, which usually I do not, I lie in bed twitching and dying and considering calling the Church to see if they'll give my legs a nice long exorcism.

While the Remeron gives me trouble when it comes to sleeping, my doctor has assured me that going off of it will cause (wait for it) sleeping problems. But then the Klonopin might help with that, being a benzo and all. It's getting very Go Ask Alice, around these parts. Maybe I'll wash these Bennies down with some LSD! What? Don't be such a square!

UGH. I can't believe I just wrote all this about these drugs. And now I'm going to publish. And you're going to read it. And I'm going to get an alarmed call from my mom. AGAIN. My poor mom.

A startlingly accurate account of what's going on in my head right now

Brain: Did you know? Depressed people have shorter life spans.
Me: Oh, for the love of--cite your studies!
Brain: Oh, but there have been so many. Depression increases the risk of heart disease, cancer, strokes… isn't this a tremendous bummer? Let's think about your tragically abbreviated life for a while. Aw. You need another tissue?
Me: You are being such a prick right now, it's not even funny.
Brain: You know what else isn't funny?  Congestive heart failure. Sad face. Guess you won't see your grandkids.
Me: You realize that you are me, right? You're just messing with yourself.
Brain: I just think you should think about how you're being a terrible parent NOW, while you're still alive.
Me: Wait, what? What does that have to do with--
Brain: Your terrible parenting which will be the only legacy you leave in your short, sad life. Oh, wait, I forgot--you co-wrote a fake parenting book. Yeah, I'm sure that'll be one for the ages.
Me: But…but Kirkus Reviews liked it.
Brain: Sure. Kirkus liked it, which means it'll never end up in the remainder bin. Nope. You're like Virgil or whomever.
Me: Oh, that's it. You know what? BOXER ON A TRAMPOLINE, THAT'S WHAT. Blammo!
Brain: OH MY GOD THAT DOG IS ADORABLE--I mean, ahem, that dog is probably dead now?
Me: Nope. Not working. That dog cheered me up, and there's nothing you can do about it.
Brain: The dangers of trampolines? The effects of trampolines on depression? Uh?
Me: Can't hear you over all the joyous barking.
Brain: I bet that dog's dead. I'm going to go find out.
Me: Meantime, I'm just going to go ahead and get a load of a disapproving rabbit.

Brain: DAMN YOU.
Me: Just enjoy the rabbit, why don't you?
Brain: Cinnamon does love his carrot top.
Me: There you go.
Brain: You've won this round, Bradley. You've won this round. But as soon as we're done with this, I'm going to find some studies about…something. See if I don't.
Me: Shhh, now.


Depression: the awful sequel

So, the thing is, I am not feeling all that well.

Sometimes you just need to say it. I feel bad! I am feeling poorly. In the head, that is.

I had a lovely time on tour and at the conference--I truly did! I wasn't the crying-on-the-inside clown I can sometimes be at these things--but shortly after I got back a whole cascade of awfulness knocked me right over. I could blame it on exhaustion, and I'm sure that contributed, but also I've been adjusting to some new meds mixed in with withdrawal from my old meds. My old meds, which, it became clear, I still needed, so now I'm back on 'em. Plus the new one. Plus another one, for anxiety. It's getting very Valley of the Dolls up in here. I've got a Lazy Susan of pill bottles.

The acute horror of depression-recurrence has abated, mostly--I'm ambulatory, able to laugh and shower, and so on. But I haven't yet experienced that relief that washes over me when I realize my brain is back to its regular, happy hum. I'm no longer horrible, but I'm frustrated. And irritated. And maybe a little despairing? Every time this recurs, I feel the teensiest bit hopeless. I like to believe I have my Depression beat, but here it's been lurking in the shadows all this time, waiting, ready to pounce.

That dick.