Depression: Notes of A Reluctant Pill Head
I remember thinking that quitting my job would solve everything. I had come home in the evening feeling wrung out, exhausted, pissed off, awash in a mind-numbing mix of bitterness, anger and despair. Nothing seemed to boost my spirits. I was caught in a tailspin of self-loathing and what-does-it-really-matter? thinking.I'd shuffle listlessly around my apartment, idly picking up a book to read, only to set it down 15 seconds later. I couldn't concentrate or focus. I couldn't affix any relevance to anything. I looked forward to sleep, soothing sleep, as much as anything, but never felt fully rested. Somehow, in my muddled state, I reasoned that everything would be OK if I were free from the burdens of regular employment. Yeah, brilliant! Then I'd have more time to mope and fully master the art of disaffection. Not exactly the logic of a clear mind.As far as I know, most of my colleagues never would have guessed. I'm openly and obviously neurotic, prone to cracking bad jokes and cheap puns just to get a reaction, but I speculate that few would peg me as clinically depressed. Some say I always seem so easy-going. One co-worker says I'm like a Muppet. Muppets can't be depressed, can they? Would Fozzie Bear take Prozac? How was your weekend? Great!But at home, I sank irrevocably into the funk. When I had energy, it was fueled by an anger so blinding that it gave me headaches. My stomach churned fitfully, taut with tension.I snapped at my wife, provoked by the smallest trifle, and then imploded into wordless hate for the world. I stalked gloomily around the apartment, barely speaking. My wife recalls a feeling that she had to dance delicately around me, uncertain what actions or words would deepen the funk. She in turn became frustrated and depressed by the fact that nothing she said or did seemed to make any difference in my mood. I resented the arrogance of anyone who thought they could help. I receded into an expressionless, wordless mask, quietly giving the world the finger.That's depression."Oh, you're depressed? About what? Buck up, it'll all work out!" Wrong. After a few months, by late January of this year, I decided that maybe I needed to try anti-depressant medication again."Like Nancy Reagan on acid. Like Bruce Springsteen on speed. Like Quentin Tarantino on Prozac." Everybody understands the pill-popping cultural shorthand. "On acid" means detached from reality, but euphoric. "On speed" means driven by manic energy. But "on Prozac"? What do most people think that means? Maybe something like this:There we were, drinking beers and popping Prozac by the handful, listening to Jimi Hendrix's Rainbow Bridge album, just blissing and grooving and thinking, I can't believe this is legal! I turned to my buddy, and his eyes are like asterisks and all he can say is, "Oh man." Colored lights dance before our eyes, and everyone is united in the same beautiful feeling. Somebody switches the music to orgiastic acid jazz and, oh my god! Ride the magic bus! Blissing Kesey and Kerouac and even though the music didn't have any words, all I could think of was Sly Stone singing, "I want to, I want to take you HIIIIIIGH-UHHHHHHHH!!!!"It ain't like that, Brothers and Sisters. Nor does it render you some sort of grinning zombie who knows the world is evil and corrupt but no longer cares. It doesn't inhibit you from being sad or angry, but it does seem to smooth the high and low ends. Incidents that might have provoked unwarranted, exaggerated anger or despair before, seem to float by. I had an easier time sorting out what was important and relevant from what wasn't. I can't exactly pinpoint the onset of my depression. I've always been shy and somewhat withdrawn, but I don't believe I always was depressed. Was it my parent's divorce? The death of my brother when I was a senior in high school? The revelation that an alcoholic in my family had never really quit drinking? A combination of all of the above incidents? Or none of the above? Or is it simply, as many believe, a genetic precondition, a flaw in the evolutionary stew? Maybe I have been depressed since birth, but am only now able to admit it to myself.I had been in therapy and taken anti-depressants before. I quit the drugs when I didn't feel that they were working. I stopped going to therapy when I felt better. But last fall, I found myself back in therapy, babbling about my family, and found it making no difference. As things went from black to worse, I resolved that, despite my aggressive distaste (and past failure with) anti-depressant medication, I had to give it another try.For me, depression is like a late-night walk through your own neighborhood. The scenery is familiar, but somehow darkly foreboding. An unexplainable fear and paranoia sets in. Even though you're in the middle of the city, surrounded by people, none of them are visible. You feel alone, vulnerable. During my latest encounter with Prozac, I started to keep a diary of that walk, waiting for the sun to come up.TUESDAY, FEBRUARY 13: WHY I STARTED ANTI-DEPRESSANT MEDICATION AGAIN (OR BACK ON DOPE)I've sensed for some time that my base-level mood imbues me with a sense of bleakness about the world that transcends such labels as "cynic" or "realist," titles I'm usually only too happy to claim. I've been in psychotherapy again since last fall, and it helps. But on evenings and weekends, I find myself prone to despair, blinding table-smacking anger and a listless ennui about everything. Dysthymia, the professionals call it. A base-level depression that does not lift.I love my wife, but I don't tell her enough, give her enough time, talk to her enough. I remain trapped in obsessive thought patterns about work, about fucking up a fact that ruins the career I'm not even sure I want, about an alcoholic family member who can't seem to get straight. My eating habits are abysmal. I have never deliberately exercised in my life.I know friends who have been helped, even SAVED, with the New Dope. Some have taken The Cure; others have bounced from med to med, in search of balance. Two years ago, I did a three-month stint on Zoloft, with the daily dosage increasing incrementally from 50 to 100 then 150 milligrams. Throughout my tenure on the drug, I found myself repeatedly questioning whether it was effective. Do I feel better? Yeah, a little bit. It must be working. Yeah, yeah, I think I feel better. But not that much better. Maybe it's not working. Shit, I can't tell. Memories of waiting for the mushrooms to hit: Are we there yet? Plus, there was an ugly side effect: It badly hampered my ability to have an orgasm. Uh, "sexual dysfunction" the professionals say. I followed doctor's orders: I tried to take it with food, and for the entire three-month period, I consumed a grand total of one glass of wine.I remember quitting Zoloft cold turkey and coming off it with a feeling of expansive, giddy freedom. I dismissed the drugs as the proverbial magic beans of experimental psychiatry in the late 20th century, and proclaimed myself cured through my own willpower. Some told me that I hadn't given the drug enough time or that I should have tried another one right away. I waved them all off, and for a time, I think the sheer adrenaline of freedom carried me.But the question continued to gnaw at me: Should I be on medication? It was a question I rarely dared to speak aloud. Still, I hate the idea of having to take a pill every day for the rest of my life to pass for sane among society. Does taking The Cure help me or make me one of the Pod People?Two days ago, my moods were swinging wildly. In the morning, I dreaded getting together with my favorite alcoholic. Throughout our lunch, I was impossibly tense. Afterwards, I felt drained, exhausted. I collapsed in my wife's lap for a nap. Listless, depressed. Then I snapped out of it thanks to seeing the tail end of Singin' in the Rain on TV. But by evening, I sunk back into the pit of despondency and anger. I lashed out at my wife over something about the soup. Went to bed angry, woke up angry, went to work angry, came home angry.Today I met with the doc to discuss the dope. Suicidal? Razor blades? No. Better to be unemployed than dead, I always say. I emerged with a prescription for a daily 20 milligrams of Prozac on a white and black slip of paper.Off to the pharmacy. An end of the day errand that seems so pedestrian, like stopping to pick up a quart of orange juice and a frozen pizza. Walk to the back of the drug store, trying to play it cool, like a guy buying condoms. Walk tall, Baby. You've got the paperwork. Ever had a prescription filled here before? Yeah, sure. Phone number? OK. That'll be five or 10 minutes. Three minutes later, I hear my last name over the intercom, beckoning me to the pharmacy.Has there been a slip-up? Do they think the scrip is forged? Is my health card no good? If I was already medicated, I wouldn't be having these obsessive, tortured thoughts. I would scream out loud, "Yeah! Gilyard! That's me, Baby! Let's boot up those drugs!"No problem with the young, long-haired pharmacy dude. (Where was Chet, the kindly old white-haired guy?) Have you ever taken this before? No, uh ... Did the doctor give you instructions for how to take them? Yeah, sure ... I've taken similar ... OK, once a day. It might be a few weeks before, before you feel any effects. Your card's in the bag. You can pay at the front register.I had the tablets -- a clean score. I walked around clutching the waxy white bag, quietly amazed at how routine the transaction seemed. Was he ONE OF US? Was he ON THE SHIT? Was he a brother of the 20-milligram capsule? I read the pharmacy's "patient awareness label" stapled to the bag: "Up to 3 weeks may be required before you feel better. Do not 'double up' if a dose is missed. May cause drowsiness; avoid alcohol and antihistamines. Rise slowly from sitting or lying position to prevent dizziness. Use ice, saliva substitute or sugarless candy or gum for dry mouth. Contact dentist if dry mouth persists." I think my Zoloft prescription had come with exactly the same general warning. Salvation can be mine for a $10 co-pay.At home, I twisted off the push-down-with-palm-while-turning white cap of the brown bottle to find the unassuming capsules. On the hospital-green side, it said "DISTA 3105"; on the white side, "PROZAC 20 mg." Take one capsule every morning.It's not clear now. I've thrown back a couple of glasses of red wine (Rosemount Shiraz, Australia, 1994) and am feeling a little fuzzy. I can't state it any more plainly: I am scared of being on medication. I don't want my cantankerous personality to evaporate into the ether of a medicated stupor. I don't know what tomorrow will bring. Valentine's Day. Maybe I'm not doing it entirely for myself. Is this the mental storm before the calm?SUNDAY, FEBRUARY 25: ALL WE ARE SAYING IS GIVE DOPE A CHANCEBeen on the magic beans for a week and a half now. Still don't know how to feel about it. I began taking the medication on Valentine's Day, and scribbled some crude notes that morning. I popped the pill at about 6:25 a.m. after eating a bowl of flakes with almonds and milk. I felt the uplifting placebo effect, probably brought on by the simple knowledge that I was doing something different with my life. My head felt strange, like it was gently flexing itself against the inside of my skull -- brain calisthenics. Waiting for the drugs to take hold, I think of B.B. King. Rock me, Baby. All night long. I think of a headline I saw the day before in The New York Times Science pages: "New Muscle Found, Deep Inside Skull." A group of researchers in Maryland claim to have found "a previously undescribed muscle in the human head, that extends from behind the eye socket to the lower jaw." Maybe these were the new brain muscles, psychosomatically flexing at the mere suggestion of their existence.I remember feeling deeply fatigued my first evening on Prozac. We went to the Saigon Uptown. I ordered sesame chicken, but lost my appetite. I fought back yawns. I remember an early bed.I remember a feeling of terror in the earliest days of The New Dope. Pangs of nausea, fatigue, a general "spaced out" feeling, the insuppressible yawn. I remember on the first weekend needing to take naps in the afternoon, and another incomplete dinner, this time at a Thai restaurant. Talking to a medicated confidant that weekend, I could barely stay awake as he insisted that Prozac had no soporific side effect.Takes longer to urinate now. I walk around with a prostate the size of an unabridged dictionary, stand in front of the toilet for five minutes and nothing comes out.Idle thought: Does Prozac show up in the urine as crack?I can't really say that I've felt any great motivational boost under the influence. Less anxiety, yes, but maybe because I've felt tired. You could be tired for lots of reasons, suggests the pro-dope crowd. Maybe I should call my doctor and switch from morning to evening doses.What have I accomplished in the last 10 days? Cleaned the apartment? Visited the new children of my friends? Written a bold, innovative new piece of short fiction? Nope. Went to see a bad movie yesterday. Give dope a chance, they tell me there's no soporific effect. Increase the dosage.MONDAY, MARCH 4: TOO BUMMED TO WRITE A PROPER HEADLINEThe Bad Inertia will not lift. Everybody's in some kind of crisis. What makes me think I'm so special? Breakups, long-term disability, feet in a cast. What's my precious problem? A little short-term credit debt. Slowly mounting.I felt useless much of the weekend. Slept 24 out of 48 hours. Straggled out to some movies. Had pangs of blissful euphoria at one point, walking with my wife along Chicago Avenue under the streetlights, where it looked like the main street of a small town. At dinner a waitress spilled a pitcher of water down my leg, but I didn't care. My pants were soaked. She apologized profusely, but I shrugged: "It's all right. I'm on medication." So am I, she replied quickly. Hmm.Today, battered in the bad confusion, I come home to the dust, the piles, the dishes, the reading I want to do, and I collapse into hopelessness. A walk for a cup of coffee, some idle chat with some vague acquaintances. Couldn't accomplish much today, nothing tonight. A blur of failed ideas, a lingering headache. See the doctor on Wednesday. Figure out the riffs. Still have the anxiety. Is this better than before? Am I on the road to "better"? By whose standard?MONDAY, APRIL 1: APRIL FOOL'S DAYFinally ran out of capsules this morning. Have to force myself to take the prescription to the pharmacy. New guy tonight, but they know me here. I'm in the computer.Walk the aisles and pretend to shop while waiting for the Dope. Glaze past the magazines. "Drifting Toward Disaster!" proclaims The Atlantic Monthly. I lift the magazine and see that although it does discuss the apocalypse, it's only in terms of the dismantling of U.S. energy policy.Right. Let it go.Idly look at the paperbacks. Any Walker Percy here amid the John Grisham, Robert James Waller, Stephen King and Robert Fulgham? No. Bodice-busters outnumber pulp. Scan the Easter candy. Look for some Cadbury Mini Eggs. What? Can't be. Again, I walk the aisles of jelly beans, malted-milk goose eggs, chocolate eggs, marshmallow bunnies. No Cadbury Mini Eggs! All right. Go grab a personal pizza: pepperoni. Look at the magazines again. Bump into others pretending to shop while they await their own personal dope.Prescription for Gilyard yet? Eyes scan the bags. Yeah. Different person still again. Trust, and then suspicion. Uh, first name? Ivan-fucking-hoe. Oops. No. Didn't say it, just thought it. Burl. OK, sign here. Pay up front. Old hat. I'm a pro with the dope now.I've been taking 40 milligrams a day, two tablets, for about a week and a half now. Have felt a definite decrease in my anxiety about my job. Leave the office at a reasonable time. Don't give work much thought in the evening, on the weekends. This is good. Conversely, have felt that I no longer give a shit, have no sense of urgency. Less concerned about the quality of my work. Good. More concerned that I'm settling for mediocre.Bad.Sleeping nine to 10 hours during the week, 10 to 12 hours on the weekend. Haven't had pangs of motivation for other activities. Where's the freelance work? The novel? But generally, I don't panic about this. I shrug. Go along, get along. Is this the way everybody else does it? Manic worry is a waste, yes. But shouldn't I give more of a damn?Fighting off yawns in the early evening after a deep sleep. What gives? No soporific effect. The tired feeling for me is more druggy-fatigued than simply tired. Sometimes, I feel a full-body lethargy without necessarily desiring sleep. Has my anxiety dropped simply because I'm tired all the time?Positive effect: fewer of the absolute, inconsolable moods; have been more affectionate with my wife. Yet, at the same time, I feel like I've lost my high end as well as my low end. Crazy, amped-up manic energy -- happily unhinged? This feels more like managed care.My doctors are encouraging me to be patient with the medication, to give dope a chance. People who know I'm on the medication tell me that they think it's helping me. Privately I wonder if they're just saying what they think I want to hear. Actually, I don't want to hear it. The voice inside my head keeps saying, GET OFF THE MEDICATION. My greatest fear doesn't seem to be that the drug won't work, but that it will and I'll have to take it ad infinitum.Despite these feelings, I simultaneously fear what life would be like without it swinging madly again. Have I already forgotten? I know one user who periodically tries to taper himself off Prozac by "forgetting" to take the medication for a few days, only to start when the clouds descend again. Or is the fact that I want to go off the medication a sign that it is actually helping me and that the last thing I should do is go off of it? Hard to know. Psychology, biology. Eenie, meenie.Let's review. Until the pizza at about 8:30 p.m., my entire consumption for the day consisted of four Cadbury Mini Eggs (last of the bag); one tall mocha, no whipped cream (Caribou); two Snickers Bars; and two cans of Mountain Dew. The pepperoni (washed down by ginger ale) has had some rejuvenative powers. Main accomplishments for the evening: getting more pills, taping a movie for my wife, hunting and gathering. Worked through the day, spent the morning staring at the screen, wasted calls, then blew four hours in the federal building.Last week, I made no real progress at work. Stared at the screen, lived in fear. If my strongest resolve is to get through life without medication, maybe I need to start living without it. Don't have to decide until morning. Not even scheduled to see my doctor again. Can't afford the treatment, can't afford not to take the treatment. Probably doesn't help that I've been reading Walker Percy's Love in the Ruins.MONDAY, APRIL 22, 1996: OFF THE WAGON (OR WHY READING WALKER PERCY WHILE TAKING ANTI-DEPRESSANTS MIGHT NOT BE A GOOD IDEA)Last week, I went in for a therapeutic double-header: psychotherapy followed by an assessment of the pills from a psychiatrist. The Ph.D. and I talked at length about my persistent malaise, disaffection, lingering anxiety. Some benefits from Prozac, yes: less worry about work, more affectionate. But replaced with what? Lingering dread about being on medication. A crazy restless feeling that is still there beneath the surface, dulled and muted by medication but not truly treated?Have been on the meds for more than two months, close to a month on the 40-milligram dosage, a fairly standard dose. He tells me I'm still "stuck. Not where I'd like you to be." I concur. He suggests going off the Prozac and trying another medication that grapples with more obsessive types of depression. Later, my psychiatrist tells me she'd like me to try bumping up to 60 milligrams a day before abandoning the Prozac Experiment altogether. If it fails, she suggests trying a different med -- I forget the name, an old tricyclic. An oldie, but a reliable goodie. We also discuss the possibility of switching to nighttime doses.I leave nodding agreeably, with no plans to disobey. I switch to evening doses on Thursday and Friday. I toy with not taking the tabs on Friday, but then I feel (fear?) myself slipping and gulp down the mint-and vanilla-colored caps. But on Saturday, I unilaterally quit drugs.How long can I hold out? How long before the dope leaves my system? Seventy-two hours without Prozac. I feel OK, better than OK. Footloose, fancy-free, liberal with cliches. Cured?Hell no."I seldom give anxious people drugs. If you do, they may feel better for a while, but they'll never find out what the terror is trying to tell them." Dr. Tom More in The Thanatos Syndrome, Walker Percy (1987)I read that line while I was still taking Prozac. I quit taking it not long after. Do I put more stock in a dead Southern novelist than in my own doctor? Not necessarily. Percy didn't convert me; he merely spoke to my already-present aversion to anti-depressants.To see if anyone would notice, I didn't immediately tell anyone I'd quit. I waited for them to say, "The medication seems to be helping," so that I could respond, "I quit last week." Nor did I ever call my doctor. Probably an ill-advised therapeutic move. Childish, yes, but perfectly in sync with the "I need help, no I don't" mind-screw of depression. "I've kicked drugs!" I would joke and then privately wonder when the crash would come.While there's some evidence that depression is gaining wider acceptance and recognition (Mike Wallace of 60 Minutes unflinchingly tells Newsweek, "I will take Zoloft for the rest of my life."), there's plenty to suggest that misconceptions about it are as prevalent as ever.Brain Candy, the recent feature-film debut by TV sketch-comedy artists the Kids in the Hall, offers ham-handed satire of what happens when an anti-depressant reaches the market before being adequately tested. Users of "GleeMonex" become radically changed: A dark, brooding death-metal rocker turns into a folk-singing peace-love-and-flowers moonbeam. But there's just one problem: After taking the drug for a while, the user becomes effectively locked in a wax-museum-like coma. The lesson? We can't always be happy in life; sometimes we have to be sad. Hea-vee.The cover art accompanying Greg Critser's lead essay in the June issue of Harper's ("Oh, How Happy We Will Be: Pills, Paradise, and the Profits of the Drug Companies") is apparently an art director's vision of what the medicated nation looks like: Two smiling, sunny blonde women flash white teeth, the sun creating an almost halo effect around their heads. But you can't see their eyes, which are obscured behind mirrored sunglasses, lending the pair a disquieting, android-like look -- zonked out of their minds on prescription drugs.The essay itself is more about broader medical conspiracies in what Critser calls "the new age of pharmo-capitalism." Still, what I do recognize in Critser's essay is his own psychic wrestling with the notion of taking medication for depression. He's decided to stay on it, but he seems to resent it.Depression is a cyclic condition, and so are my responses to it. In February, I believed that I had nowhere else to turn but to try medication again. For a time, I felt like my mood was even darker than it had been before, simply because I expected and hoped for some kind of drastic, nirvanic change.But as the drug seemed to level out in my system, I grew fitful and restless. Should I be on the drug? Should I go off? What happens if I drink a beer? The irony is that if the drug is somewhat effective in making you feel better, you instantly think, "I feel great! Who needs pills?"I would never proclaim myself cured or healed. Perhaps the most unsettling thing for me now is that I actually feel all right: I'm OK, but I don't know about you.One month off the anti-depressant medication, hairline cracks are beginning to show: I'm a little more prone to irritation, moody patches, the unexplainable malaise and a manic-panic stress, but I feel I've been reasonably successful at fighting it off with the instincts I've learned in therapy. But by next winter, I could be slumped over the magic lamp, waiting for a different drug to take effect.The moodiness, edginess and crankiness are strangely addictive. It's what I'm used to. I'm comfortable with it. It's like a psychic roller-coaster ride -- as exhilarating as it is terrifying. Smoothing out the edges makes for a calmer journey, but I miss the ride. But I also fret that if I decide to go without medication, I could end up naked and baying at the moon, walking the streets muttering about the apocalypse or working in public relations. Then there's always those ubiquitous, ominous billboards: "#1 Cause of Suicide: UNTREATED DEPRESSION."Mental-health professionals call drinking and drug use among the depressed "self-medicating." They're right. Yet drinking to unwind isn't just socially accepted, but encouraged. You deserve a scotch today! Got promoted? Let's celebrate? Got fired? Let's commiserate! Made it to the magic hour of five o'clock without killing anybody or losing your job? Let's have a beer! Walker Percy loved to drink bourbon so much that he once penned an ode given solely to celebrating the wonders of the nectar.I've resigned myself to the fact that I will likely grapple with depression for the rest of my life. Hold it. Textural --or textual? -- analysis of the previous sentence says as much about the vagaries of depression as anything. First, I say I acknowledge my condition, but then I qualify it by saying I'll "likely" grapple with it my whole life. Privately, I hope and pray that circumstance or experience or something will conspire to banish the dark thoughts. I understand intellectually from observing friends on the medication that Prozac doesn't erode the personality or creativity, but I seem to prefer the unfiltered moods to worrying about the medication. These are the mind-games depressed people play to convince themselves they don't need help:*I'm not that depressed. I still go to work every day. I haven't filed for bankruptcy. At least I'm not a schizophrenic or a manic-depressive. Yeah, I'm bummed out a lot, but that's just the way I am. It's not like I'm suicidal.*I can't be "depressed" -- that's just a middle-class luxury for people who don't have any real problems. I'm not poor or starving. I have the delusion of living in a democratic country. Other people have real problems -- if I just buck up, I'll make it.I can't dismiss drugs out of hand, because I know too many people who've found them helpful. Still, treating depression seems to remain a fairly inexact science. One close friend bounced from drug to drug for years before finding the right pharmacological cocktail. Maybe I'm behind the curve, but I feel more comfortable with talk therapy.I'm thinking about Waylon Jennings singing "I've Always Been Crazy." The punch line? "It's kept me from going insane." I'm thinking about Walker Percy and what the terror is trying to tell me. I've decided to try to hear the terror out, unfiltered through medication. For now, I'd rather try to talk it out than stare it down.