The Medicated Me
It’s just after dawn, and I’m sitting on someone’s sofa in someone’s apartment somewhere in New York City. An attractive young woman I used to know is sleeping 15 feet away. Books I read, photos I took, CDs I reviewed as a music critic — all sit like props from a play I half remember. The sunlight looks toxic, radioactive. The murmur of distant traffic sounds alien, hostile, a predator’s low growl. Everything is exactly as it was yesterday yet feels totally different — in a bad way and down to a subatomic level. I feel like a character in some lame sci-fi novel who wakes up in a parallel universe or as a head in a jar. I’d skimmed over this sensation in nightmares and during extreme jet lag but never felt it descend as a full-blown totality, never felt it suck me down into it. I’d compare it with a bad trip if not for one terrifying irony now sinking in. This is my brain off drugs.
Six months ago, after 10 emotionally uneventful years on antidepressants — years that somehow included getting married, losing my job, and watching two skyscrapers implode from 20 blocks away — I began tinkering with my prescription, casting about for just the right med while the sturdy old Effexor trickled out of my system, a few milligrams less each week, a long goodbye to my silent partner of a decade.
Now, having decided to go off everything, putting my years-long chemistry experiment on pause, I am drug-free at last. For the first time in a decade, I am experiencing life in all its rich tones and vivid hues, and I’m about to throw myself in front of the 6 train.
I wasn’t actually depressed when I started taking antidepressants. Sometime in the late ’90s, fatigue, sleep loss, and various cognitive problems brought me in to see a doctor, who, after some negative blood tests, prescribed the era’s magic bullets: psych meds — first Zoloft, then Paxil, eventually settling on the antidepressant Effexor. After a while, my symptoms lessened and I’d stayed on them ever since. Every now and then, side effects like flop sweats or impeded orgasms made me question my lengthening drug addiction, but each time I mentioned quitting, experts and family members advised against it. Why rock the boat when you’ve got a big project looming, a breakup to get through, a war on terror starting? It was always something.
In the decade I’d been chugging along on Effexor, psychotropics had improved, been refined and rebranded. They weren’t even for depressed people anymore. They were lifestyle agents, tools for unlocking potential and finetuning the self. Like baseball players on steroids, more and more people in the information industries were mentally juicing, often with meds I’d never even heard of. Meanwhile, I’d been plodding along on the same one since ’97. Why stick with a Walkman when everyone else had upgraded to an iPhone?
So when my new primary-care physician referred me to an actual psychopharmacologist for a reevaluation, I couldn’t wait. On an otherwise unremarkable Spring day I sat opposite a man with a Pfizer mug on his desk, an Eli Lilly pen in his pocket, and the entire arsenal of modern mood management at his disposal, and fielded the following question: “How do you want to feel?”
What do you say? Confident? Bulletproof ? Godlike?
My emotional wish list was actually pretty short. I wanted: delusions of grandeur, irrational exuberance, and, my favorite warninglabel side-effect, “a false sense of well-being.” I’d had years of therapy, and by now I knew what I was: a career hipster, fallen IrishCatholic, devout existentialist whose core values were wit, style, and humor — the last at the expense of other values, like, say, kindness. A resting state of self-contempt seemed perfectly appropriate for a guy like me; I just wanted to feel otherwise. Instead, I muttered something about improved concentration, and we began.
The psychopharmacologist led me through a long and surprisingly grueling Q&A, pursuing my mental, drug, and family history with a series of questions I felt oddly unqualified to answer. Was I depressed? (No, yes, not sure.) Had I contemplated suicide? (Like in the last five minutes?) Had I experienced highs followed by lows? (Yes, followed by highs.) I tried to keep my responses honest but not crazysounding, aiming for some sweet spot between Ativan and Thorazine. “Do you feel contaminated, worthless, sick inside, like you’re bad, like there’s something wrong with you, like you’re unworthy of love and about to be found out?” (Bingo!) What I said: “Sometimes.”
He nodded, took some notes and gave me what I realized I’d been looking for: a diagnosis. I was not simply thwarted, distractible, moody, and confused. I was — eureka! — Bipolar II. That is, I had Manic Depression Extra-Lite, a low-impact mood variability without the suicidal lows or the symphonycomposing highs. I was mentally ill and, thus, stoked. Because with a mental-illness diagnosis comes drugs — new drugs, better drugs, more effective drugs. And I, like most Americans, love drugs.
We made up for lost time, Dr. Mood and I. He chartered a months-long cruise from Lamictal to Geodon to Seroquel, and other psychotropic ports of call. We tried Klonopin, Cymbalta, and several others, all while I slowly dialed down the Effexor in my system. I thrilled to this experiment with my future, submitting each scrip like it was a lottery ticket, even dining out on certain med classes. (“What’s that pill you’re taking?” “Oh, nothing, just a...very mild ANTIPSYCHOTIC!”) Some pills made me itchy, others cranky. One made me soak the mattress through with sweat, and one made me talk like I was drunk — a strange sensation to have while sober, if I was technically sober. Another antipsychotic gave me a maddening urge to remove my pants and bang my head against a wall, which isn’t the least psychotic thing I can think of. But since none of these meds was quite hitting that elusive mark, I kept searching. And as my Effexor dwindled to negligible doses, I soon realized that the side effects of the drugs I’d rejected were nothing compared with the effect of no drug at all.
One day that September, weeks after my last tiny doses of Effexor, my mind turned on me. Journalism, writing, words on a page — what a fucking waste of time. Music, marriage, New York City — what an idiot I was for thinking I liked them. Only then did I realize the gravity of this chemical shift. That purely pharmaceutical optimism had just left my system and, with it, the delusion that had skewed 10 years of hopeful acts and lighthearted decisions. “One can live only so long as one is intoxicated, drunk with life,” Tolstoy wrote in My Confession. “But when one grows sober one cannot fail to see that it is all a stupid cheat.” That’s the kind of sober I got.
I pulled myself off the couch and dressed. I faked my way through a day or two, then collapsed — spending the rest of the week cowering in the bedroom. Eventually, I dragged myself to a standing appointment I had with my longtime therapist, who’d been putting up with me for years. He noted some pronounced changes in affect and attitude — a raspy voice, a difficulty forming words, a reluctance to leave his couch — and recognized this as a Major Depressive Episode. The therapist was not surprised. In fact, he seemed to think that this crash was overdue.
The crisis, he thought, was brought about by lifelong assumptions — that I’m the proverbial “piece of shit at the center of the universe”, among others — which had trapped me in destructive patterns of thought, mental icebergs I’d been building for years that the drugs had merely obscured. He said I had a choice: I could re-mask those icebergs with the chemicals I’d just gotten off or I could learn to navigate around them or shrink them to manageable size. I would discover new strengths, while I slowly found my way out of this years-coming crisis. The work would be painful, scary, and challenging but could eventually yield the kind of true personal growth that sustains a lifetime.
Fuck that. I called Dr. Mood.
He listened and gave me an explanation I practically begged for: “Don’t worry, it’s not you. It’s your disease.” I clutched the phone like a lifeline as he prescribed an emergency battering ram of Effexor — three times my original dosage — to pull me out of despair. I hung up hopeful and chastened. Maybe I wasn’t facing facts. Maybe I was surrendering, recommitting to a life of chemical dependence, but surrender has an upside: You don’t die.
I filled the scrips, took the pills, and waited. But as the weeks wore on, things did not go back to the way they were. Even after the Effexor reached all-time highs in my bloodstream, that rosier, slightly detached worldview I had taken for granted — the sunnier, sturdier chemical assemblage I had been — did not return. Instead, I had perspiration-drenching, jaw-clenching side effects, 24-hour despair, and a collapsing faith in the whole psychopharmacological enterprise.
If you swim far enough into the ocean, you forget which direction leads to shore. By the end of the year, I was at an impasse — afraid to go up or down in doses, left or right in meds. And I wasn’t so sure I could keep treading water. I thought about it, talked it over with my therapist, and came to the grim realization that there was no way forward but down. I had to get off everything and get a baseline reading to see who I actually was without meds. And so I embarked on a year of dodging friends and snubbing relatives, crying in public, spewing my guts to some strangers while picking fights with others, and developing one conviction about the experience that I carry to this day: I can’t recommend it enough.
The withdrawal process was not attractive. Showers became infrequent. Returned phone calls rare, departures from my apartment rarer. At one session, my therapist asked me if I “wanted to go somewhere safe for a while” — meaning a hospital, so I wouldn’t kill myself. I found that if you want to remain part of society, you have to do certain things — like perform a job, eat dinner, celebrate birthdays — and some of these are hard to do when you’re sobbing.
Prior to then, I’d cried maybe three times in my adult life. Now I was the motherfucking Lifetime Channel. On subways, in movie theaters, at major tourist destinations — eyes brimming, throat closing off to the most ludicrous triggers imaginable. In the laundry room: a cartoon on a poster warning against overfilling the machines, the washer fixed in a silent, tear-sprouting wail. On 57th Street: A golden retriever who meets my gaze with a penetrating smile that seems to say, “It’s OK. I see you. All is forgiven.” Or, God help me, WALL-E: trundling along on a debris-heaped planet, his programmers centuries dead, carrying out tasks with no earthly meaning. My entire consciousness fell sway to literature’s pathetic fallacy, projecting human emotions onto animals and inanimate objects — the angry wind, the bitter sun, the sad, sad Con Edison truck — any of which could set me off like an Italian widow at a funeral.
My wife, 13 years younger than me, was press-ganged into motherhood: comforting me, coaxing me out of bed, convincing me that all my cowering and simpering weren’t the least bit unsexy. At first, I was so grateful. Then I started wondering how long she was going to put up with this shit. She married a chemical facade, a serotonin mirage: a sharp, funny, dependable guy who no longer existed. One night she confirmed this impression. “You’re just...it’s like...you’re not here,” she wailed, leaving the apartment in tears.
On my few attempts to hang out with friends, I was either a stone-faced mute or a wild-eyed, overcompensating (usually drunk) nightmare. One longtime friend who had fought through a heroin addiction and his own depression became indispensable, the only guy I could talk to. And so I did, every day, desperate for his counsel. “You know,” he told me one afternoon, “at times like this I can’t say enough for the fetal position.”
I managed to stay marginally employed, since articles could be written at home and alone, with brief Klonopin-fortified reporting sorties. But the subjects often contrasted so shrilly with my inner state that I could barely get through the interview. Heidi Montag, power-bitch from MTV’s reality show “The Hills”: “I plan to win an Oscar,” she told me, teeth gleaming in the California sun. “I’m very ambitious.”
I’m dead, I thought. A walking, talking corpse. “Got any pets?”
But work and writing were soon all I did, since fear of the abyss allows desperate focus on anything but the abyss itself, and since the idea of “fun” began sounding perverse. Even so, the work itself was agonizing, and not only because I sucked and everything was pointless but also because without meds, I wasn’t just sad and afraid, I was also retarded. Even the simplest decisions paralyzed me. Music was either insufferably inane or unbearably poignant (which rather complicated my work as a music critic). Reading was difficult, since sentence beginnings often evaporated before I got to the period, and dangerous, since new information often presented itself as an omen of doom.
For at least a year, I woke up with the binary default settings — Grief and Terror — all the while telling myself “things aren’t that bad,” “feelings aren’t facts,” “your perceptions are distorted.” On paper at least, I had no reason to complain — safe home, loving wife, all four limbs — yet every bit of stimuli suggested some imminent horror. Then, in 2008, almost exactly a year after my first meds crash, a strange thing happened. Headlines started to match my inner monologues. Indicators suggested things just might be that bad — I was a 41-year-old, precariously employed man in a nation edging into its own depression.
Among other things, being depressed in depressing times prompts one existential question: Am I overreacting? Ten years ago, I was not depressed — at least not with a nonsleeping, noneating, suicide-contemplating capital D. I took meds for 10 years, stopped, and got Depressed. Many doctors, including my physician sister, believe I need medication. They tell me I have a chemical imbalance. They remind me of the suicides, electroshock, and institutionalizations in my family tree.
But what if there’s another way to look at it? What if this chemical imbalance was of my own making? Some might call this a rebounding effect, the brain’s reaction to long-term suppression of its natural responses. As the psychiatrist Peter Breggin wrote in his polemical Your Drug May Be Your Problem, “the brain reacts against this drug-induced overactivity by destroying its capacity to react to stimulation by serotonin.” That is, it burns out its own mood-regulating capacity. This compensation is called “down regulation,” a condition in which receptors for serotonin die off. If use goes on long enough, Breggin writes, “down regulation continues indefinitely and may become permanent.”
In 2006 a sociologist named David Karp found a similar trend in antidepressant users he interviewed. People tried them, had mixed reactions, but slowly accepted them as essential parts of their lives, eventually realizing they’d “laid the cornerstone for a life circumscribed by pills,” that they were “married to medications.” That same year, TK million antidepressant prescriptions were dispensed in the U.S., many of them to people who weren’t any better informed than I was when I started taking them.
What’s behind a trend that has one in 10 Americans on mind-altering drugs? Do we all have a “chemical imbalance,” or is there a fundamental dissonance between the world as it is and as we think it should be?
The fact is, I’ll never know which is true. I’ll never know whether this is simply me or if I’m reeling from a strange, poorly understood 10-year bender. All I know is that it seems pretty important to grab this unrequested, unpleasant window of opportunity before I become a pharmacological lifer.
Antidepressants didn’t change me much at first. They brightened mornings, softened edges, padded landings, tilted my horizon by just one or two degrees. But I’ve come to believehat over time, those degrees came at a high cost, with hidden fees and a ballooning adjustable interest rate. Today I suspect there’s a price for spending a decade outsourcing grief and terror, living with SafeSearch on, and keeping a whole mushy, messy part of life at a cool distance, while some crucial, unseen parts of you — the kind they don’t talk about in doctor’s offices or drug ads — eventually atrophy. By simply accepting a scrip, I signed on to a belief system that may be even more cynical than I’ve so long pretended to be. I made a blithe commitment to a medication whose long-term side effects just may be spiritual: “May cause detachment from parts of yourself that truly matter.” “May place all faith and agency in a pill bottle.” “May reduce sense of self and soul into dopamine, serotonin, neurons, milligrams.”
No matter what caused it, I know that some unmistakable shift happened after the meds left my system, and it’s one I can’t explain in strictly psychopharmacological terms. This came on slower than my slide into the hole did and felt less psychological than tectonic, like some cosmic GPS system slowlyetting a fix on my small blue dot in the grid, surrounded by thousands of other dots just like it. For years, whenever I looked around me at a stoplight or an airline gate, humanity was a Hieronymus Bosch painting — beaks, bulges, greed, folly — and I their satirical observer. Sometimes it was funny, other times depressing, but that fundamental impression — of a loud, colorful, totally separate and likely lesser field of strangers — was always there. Sometime last year, that impression changed.
The strangers became familiar. I don’t know how else to explain it. It was a subtle thing, I don’t know when I caught it first — maybe in the tired eyes of a subway driver or in the nervous glance of a stroller-pushing mom — but humanity itself started morphing. Distinctions in ages, styles, and social classes started melting away. Differences receded; similarities sharpened — sharpened until they hurt sometimes, sharpened until they set off tears. Only this ache wasn’t triggered by sad cartoons or robots or sympathetic dogs but by actual people: the homeless, investment bankers, foreclosed dads, war widows, motherless children, childless mothers, everyone, all of us — and I can’t competently diagnose this feeling as “bad.” While I would not choose my general mood right now, I can’t imagine choosing an alternative.
Another September morning, this one nearly 10 years ago, the medicated me stood on Houston Street and watched a skyscraper full of people become a cloudburst. My then girlfriend burst into tears like an actual person. I snapped photos, surveyed the scene. As we started walking away, the second building went down, and a collective wail rose from the streets. I took a quick look around us. A twentysomething Latin girl in a pastel sweatsuit, hand clamped on her mouth, tears streaming. An Allen Ginsberg–ish guy in a Hawaiian shirt clutching a woman tightly to his chest. I looked back at the hole in the sky, looked at my girlfriend, and said, softly, “There’s something you don’t see every day.”
That’s all I had — a deadpan quip from a Bill Murray movie. All I felt -- fear and amazement. No grief, no sadness, no loss. It's an utterly insignificant deficit in the grand scheme but for me, I think, a symptom. Because I know there are plenty of less dramatic deficits from the last decade — when I was smarter, younger, cooler, braver, and on 150 mg of Effexor. I’ll never know which of those factors made me look at this world and its people as I did then. All I know is, I don’t today. How do you diagnose this? What do you call this late-onset, possibly illusory, deeply felt connection to all the people you suddenly realize you’re sharing this planet with, during this brief, perilous life that sometimes feels as if it’s running through your fingers like sand? Affective lability disorder? Pathetic fallacy? Or is it acquiring a soul? Is it joining the human race?
How do you want to feel?