Starting an anti-depressant medication is easy. See a doctor, get a script. Stopping one is not so easy.
Especially after two decades.
For nearly 20 years a little green and white capsule was my insurance policy. Swallow 20 mg daily and I could handle unexpected situations, or just life, with far more equanimity. The mental judge always on alert to remind me of failures, insecurities, an inability to ever be enough, was dulled. Creeping suicidal thoughts were silenced.
Fail to ingest it for more than a couple of months at a time, and the fibers of my brain would begin to slowly unravel, or that’s how it felt. The ability to feel pleasure was reduced to the point of near impossibility, the ability to create, equally missing. I might want to go off that drug, for whatever reason, but every time I tried, there was an inevitable slip backwards.
Until my family would practically beg me to go back on it.
I’d kill anyone who tried to take it from me, said my mother on more than one occasion.
Because I did go off it, you see, about once a year…always with the hope that my faulty brain chemistry would by now have repaired itself. My original prescribing physician had told me that about 90% of his patients were able to stop medication after a year. The remaining ones, for reasons not immediately clear, had to stay on it indefinitely. Some deep inner part of me wanted to be a member of the 90% club.
Without even fully admitting it to myself, I think I viewed my need for medication as a personal flaw, even though I was in good company – half the country, it seemed, was listening to Prozac.
Tell myself as I would, as others would, that a prescription for Prozac was really no different than one for high blood pressure or diabetes, it never quite worked. And in the secret fear that others would also view it as a personal flaw, or worse, suspect that beneath the surface I was essentially unstable, I largely kept my prescription a secret.
But it was astonishingly easy to forget that daily capsule. You’d think that popping it for so long would make it an automatic part of my routine.
It never became automatic. Not in 20 years.
As of today, I’ve been off anti-depressant medication for three years.
And that’s automatic.
Happy Anniversary to me.
* * * * *
The most insidious thing about depression is that one typically cannot see beyond it, an inability that causes some to take their own lives. Typically, those left behind waste time trying to understand their motive.
I realize that sounds harsh. I stand by my words even as the farthest wish from my mind is to give additional pain to anyone who has lost a loved one in this way. I understand the endless “what ifs” that attend a suicide, but I’ve also lived on the flip side of that coin. It has rightfully been called called the ultimate irrational act, but the mind of the depressive is a place where the light of rationality simply cannot shine. Prozac silenced not just that dark temptation, but the excessive anger and irritability, the heart-crushing spells of sadness painful almost to the point of paralysis, for about seventeen years.
Which was longer than it should have, according to some. When at last it began losing its effectiveness, I informed my latest doctor, who switched me to Lexapro, but that never had quite the same result. After about two and a half years I finally approached my doctor a second time about this (the first time, it was recommended that I increase my dosage). His advice was to switch back to Prozac again: there had been good results for some who did this.
I took his advice, for about another six months. It was effective for about a third of that time.
When I resumed Prozac I had no way of knowing if I would have to switch yet again, to Paxil or Wellbutrin or some other drug I hadn’t even heard of. And what if none of those worked? If they did, how long would they last? I was also becoming exposed to information that indicated there could be long-term effects from long-term usage. Why had no one mentioned this to me before?
The biggest shock was hearing of studies which seemed to show that anti-depressants frequently had no more effect than placebos.
How can that be? I wanted to shout. They worked for me for nearly two decades!
I started thinking – really thinking – about those little miracle pills for perhaps the first time since I’d started taking them. Asking myself if I wanted to bounce from prescription to prescription for the rest of my life, if there was not a better way. (I knew there were other methods of addressing the issue, including nutrition and exercise, but taking a pill was so easy!) Was the true root of my problems a chemical imbalance? I’d been told years before that proof of this was the fact that the drug worked.
I’d swallowed that explanation as easily as I did each capsule because it came from people with medical degrees, or other reasons to know. Now I was hearing a different story.
I was almost 50 years old, and ready to stop listening to Prozac.
* * * * *
The topic of anti-depressant medication does not, in my experience, tend to elicit mild reactions. The subject of articles, books, lectures, even a movie, so ubiquitous that as of 2008 it was the third-most commonly prescribed drug in America, it has been linked with numerous side effects, including suicide, to balance the positive results of many others. Friends told me they didn’t think I had a chemical imbalance, that they wouldn’t want to “take a drug that controlled their personality,” that I seemed “more alert” and “with it” when I was off medication for a while. Another experienced side effects and gave it up. As I began researching how to quit, I not only had a great deal of difficulty in finding agenda-free information, but read alarming stories from those who quit too abruptly. A slow tapering would be required…again, something I had never been told by a physician.
But then, I had pretty much been conditioned to believe that I would be on such medication for life.
Interestingly, what I did not find a mention of was the issue of psychological dependence. (I’m sure various people have addressed this, but everything I read dealt with physical withdrawl.) It’s not easy to mentally taper off a drug you have taken for 20 years – in fact, I would say without question that psychological dependence far outweighed the physical in my case. But I was further spurred on by a visit to my then-chiropractor’s office from Gwen Olsen, author of “Confessions of an Rx Drug Pusher.” A former pharmaceutical sales rep, Olsen, who came from a family plagued with addictions and mental illness, chronicled the tragic suicide of her niece, her own unfortunate experiences with anti-depressants following her divorce, and an insider’s knowledge of the pharmaceutical industry. I waited for nearly a half hour to talk to her after she spoke and left with a copy of her book, which I started right away.
It’s also not easy to stop medication without a strong measure of support. I informed my doctor and the family member who would be most directly affected by my decision. My doctor was sympathetic and agreed that I was making the right decision, indicating his availability to help with the process. I knew, of course, that this was essentially lip service: he was a very busy man and it wasn’t his job anyway. I also agreed with said family member that I’d consider going back on medication if it became clear I was failing at withdrawl, giving her permission to watch for signs. I understood why my wish for unconditional support could not then be given. She had lived through too much of the darkness with me.
At first I considered trying liquid Prozac, which seemed an easier way of reducing dosage, but ultimately failed to use it. Then I discovered a program developed by a gentleman (not a physician) who had seriously researched the subject and prescribed the careful use of certain nutrients alongside a detailed reduction process…at a pace I considered agonizingly slow. I tried it, for a while…but didn’t get the desired results, in spite of having taken a questionnaire to help determine if I was the sort that would be helped. It is entirely probable that I did not follow the plan long enough or carefully enough to achieve the desired result.
At any rate, that one fell by the wayside too.
For reasons that are not clear even to me, I had decided I wanted to work the quitting process in conjunction with my 50th birthday. I began again, this time on my own schedule…first switching to a pill every other day, then leaving two days in between…then taking, perhaps, one pill a week…because it was still so easy to forget…
Until I took no pills at all. The wait for the accompanying side effects, of which I had been so stringently warned, continued.
They never came.
It was at least three months before I let myself draw the first breath of relief.
* * * * *
“Do you consider yourself cured?” a friend asked me when I’d been off medication for a little over two years. It was a fair, and expected, question.
The answer was and is “No.”
“I consider myself in remission,” I told her, adding honestly that I didn’t know how and why said remission had occurred.
I still don’t. Why were there no side effects this time? I tapered off a little more quickly than many recommended. Was it because the drug no longer really worked? Had my “faulty brain chemistry” corrected itself at last? If so, why did it take so long? Did I ever really have an imbalance?
I may never know the answers, and frankly, I seldom ask these questions anymore. Three years on, I don’t know if I will ever be “cured.” Generally I accept that as my reality…and it’s why I haven’t completely closed my mind to the possibility that I may someday feel the need for medication again.
For now, I know my triggers (and how easily I still fall susceptible to them, in spite of that knowledge!). Depressive spells last, on average, about three weeks. Sometimes longer. Within them, I still manage to function, to get up each morning, to shower and dress and go to work and “act normal.”
But the taste of ashes is in my mouth.
And it’s during those spells, if only briefly, that I consider calling my doctor. Yet I don’t, partly out of stubbornness (you’ve made it this far, Lucie; just get to the three-year mark!), partly out of the knowledge that this latest spell will indeed pass. Even if I can’t see or feel it at the time.
Because it always does.
I just have to take it on faith.
* * * * *
Depression is a complex, sensitive and frequently misunderstood subject. It is somewhat uncomfortable to admit what i’ve admitted here, and in no way do I set myself up as any kind of expert. How, when and why those suffering with this illness (and yes, I do regard it as such) choose to handle it is between them, their family and their doctor. Speaking only for myself, I’m glad to be off anti-depressants, glad I’ve made it for three years thus far – but I do not regard them as the enemy some do, because it is no exaggeration to say that they probably saved my life. There are many different routes to healing, and healing is an ongoing, sometimes mysterious process.
I share here in the hope that it may help reduce, if only in a miniscule way, the stigma that still clouds the subject. Depression thrives in darkness, and the natural tendency of those who suffer from it is to isolate themselves in much the manner of a sick or injured animal. It is one of the worst things they can do and one of the things that make treatment so challenging. If this part of my own story, unfinished and lacking in solid answers as it may be, helps others to start talking, thinking, listening a little more deeply, I don’t mind sharing it.
Perhaps this is merely the start of doing so.
* * * * *
Years ago I addressed my own struggles with depression in this poem. I also highly recommend the following resources: “Ten Practical Tools to Battle Depression” by Christa Sterken (http://www.christasterken.com/10-practical-tools-to-battle-depression/) and “What I Learned About Suicide” by Eva P. Scott (http://evapscott.com/what-i-learned-about-suicide/). While these sites address depression from a Christian perspective, they contain links to sources of help appropriate for those of any belief system.
I hope you’ll check them out.