I’ve been on antidepressants for months now. At the time, shortly after I was prescribed Lexapro, I wrote about the experience, and especially about the odd and slightly disconcerting feeling of not being able to tell if my general good feeling was a genuine good feeling or whether it was the result of the pills. And while that problem hasn’t gone away, I can say it hasn’t really bothered me in the intervening months. (Of course, that, too, falls into the “is it for real or is it the pills” trap, but that’s sort of the point of all this, so…)
I’m going today for an appointment with my doctor because my prescription’s out, and since we’re dealing with mental illness here, it ain’t the kind of thing they want to give you just for calling on the phone. No, they want to see you face-to-face, ask you questions, make sure you’re not contemplating purchasing guns or rope or Herbalife or converting to Scientology or some such crazy crap. Not that I’m afraid or nervous about speaking to them about what’s going on with me. I haven’t had any of the terrible feelings that sent me to the doctor in the first place at all in the time since then. Which is awesome. Life is good.
And because life is good, I’m bullish on thinking that things in general are good. So when I told my wife that my pills were almost out and I had to schedule an appointment and that I was keen to start tapering off the meds toward a goal of getting off them entirely, she gave me the skeptical eyes. And the skeptical eyes from my wife are usually a sign that I need to pump the brakes and think a little harder about what I’m charging into.
“You’re talking about mental illness,” she told me, “and that’s not a thing you just stop taking medication for.”
Which is absolutely right, of course. Intellectually, I know this. Because mental illness is about chemicals, and more importantly, chemical imbalances, and as a result, medication for mental illness is about rectifying chemical imbalance by creating new balance. Taking meds out of the equation, then, is like taking your thumb off the scales — it throws things out of whack again.
But I was doing the classic “crazy person” thing (and I know that crazy is a term that shouldn’t be bandied about when talking about the mentally ill, I use it here only as shorthand) of thinking, “well, I’m fine, so I don’t need those pills anymore.” Like a true red-blooded ‘Murican, my thinking was:
- I have this malady.
- I took these pills.
- Malady appears to have passed.
- No need to keep taking the pills.
Because that’s how medication tends to work in any other arena. Got a headache? Take a few Tylenol and lay down for a bit. You don’t take Tylenol for the rest of your life. Just came through surgery? Here, take these pills for the pain until the pills run out.
You get sick or injured or otherwise out of whack, you go to the doctor, they straighten you out, end of story. Close the book on that chapter.
Which is very much how my brain wants to view this issue.
Because that’s the insidious nature of pills that mess with brain chemistry: you can’t really feel them working. You feel “better”, but you don’t know why. Put another way: you have a headache, you take Tylenol, the pain tends to evaporate within a few hours. You have a cut on your arm, you put some ointment and a bandage on it, and a few days later, the cut is gone. Empirical signs of the efficacy of your treatment. With anti-depressants you don’t have that, because the symptoms fade out gradually, like an 80s rock ballad that just repeats the chorus again and again until you change the station. There’s no healed cut to behold, no relief of throbbing pain to point to, just general dread and unease that don’t seem to be hanging over every little thing so much anymore. But could that really be the result of the meds you’re taking? Seems hard to believe. And were things really that bad before? Probably not. Do I really need these pills, then? I should be fine without them.
The medication doesn’t make you feel differently, it makes you perceive differently, and when you alter your perception, you alter everything, including your ability to perceive that your perception has been altered.
In short, as is so often the case, I think my wife may be right, and I may be a bit overzealous about getting off the pills.
Here’s the heart of the struggle, though: I don’t want to need the pills. I sort of have this image of myself that’s, while certainly far from perfect, generally pretty solid. Reliable. Not broken, not malfunctioning, outside perhaps of a relatively benign proclivity for swearing and a running addiction. I shouldn’t, in other words, be the sort of person who has to gulp down a cocktail of pills, tablets, and capsules just to get through the day. I very specifically do not want to be that kind of person. Maybe it’s the tree-hugger I try to pretend doesn’t exist, or the anti-healthcare-monolith conspiracy theorist thinking I can’t quite put out of my head. But I don’t want to need these pills. I want to be normal without them. I should be normal without them.
But then I think about what normal was for the months before I admitted something was amiss and went to the doctor, and here I go into a spin cycle again. Because I don’t want to be that either — going to tears while heading to work in the morning, fighting just to get out of bed in the morning, drifting away from the activities that I once enjoyed (and have been enjoying again since!).
And the choice between becoming that again or popping a tiny little pill every night? That’s not a choice at all. “Wants” and “shoulds” are generally useless — we have to deal with the world we’re presented with, not the world we wish we lived in.
So I’m heading to the doctor in a few hours. I’m going to ask about scaling back on my dosage, because I want to see if I can be okay with less pills before I try to jump back to having no pills at all. But if they think I need to stay where I am, I guess I need to be okay with that, too.
To do otherwise would be, well, crazy.