to medicate or not to medicate

Interesting. Twenty years after its premiere, I have learned about the existence of an opera version of Oliver Sacks’s wonderful neurology book The Man Who Mistook His Wife for a Hat. Apparently it was transformed into a one-act chamber opera by Michael Nyman (who did the sumptuous soundtrack to The Piano). It was first performed at the Institute of Contemporary Arts in London (coincidentally, that’s one of the places I want to hit next time I’m in London). This has me wanting to re-read the book!

Moving on...

I’ve been on antidepressants for nearly 11 years now, and periodically I idly mull over the idea of maybe stopping my meds. Because the thing is, I was never officially diagnosed as being clinically depressed. I just kind of assumed I was, since clinical depression runs on my dad’s side of the family, and after eight years of unrelenting, exhausting depression, I figured that it had to be more than just teen (and early twenties) angst. I said to myself, “If I’m clinically depressed, I should be on medication. There’s no shame in that. It’s no different from a diabetic taking insulin.” What really drove me to this wasn’t so much the years of depression I endured, but the situational depression I was facing at that particular time (it was situational depression on top of my regular depression, basically). It was this situational depression which finally made me say “Fucking hell, I’ve had enough!”

So I went to my GP and asked for meds and when he refused, I got a new GP who didn’t refuse. This was during fall break of my senior year of college, when I was 21 years old. First came Zoloft, which eventually helped, but because I didn’t like the side effects (short-term memory loss and reduced powers of concentration), I later switched to Serzone, which was worse. The spaciness was out of control. Then I tried Paxil, which was better, but still caused a bit too many memory and concentration problems for my taste. Nowadays I’m on Effexor. My short-term memory and ability to concentrate aren’t pitch-perfect (were they ever?), but they are vastly improved over what I experienced with the previous pills.

I can honestly say that I was never crippled with depression, and because of that, I’m sure there were people didn’t take it seriously. I was a functioning depressive. I was able to keep my head above the water, go to school, work at summer jobs, etc, but barely. And treading water like that took a lot of effort—it didn’t come easily. This is really the main thing that keeps me from stopping my meds now.

Like I already said, I do chew on this idea occasionally. Nobody really knows the long-term effects of antidepressant usage—or at least the effects of my particular antidepressant (it’s an SSNRI, not an SSRI, tricyclic, or MAOI)—and I worry that it could be doing lasting damage. And what if I don’t need it? What if life from ages 13 to 21 really was just an exercise in teen angst and nothing more? Why am I pumping chemicals into my body if I no longer need to do so?

I guess the sensible thing to do would be to stop the meds and see what happens. If I subsequently get smashed across the head with a 2x4 plank of depression, then I can always resume the meds, right? Well, yes, but what worries me is that I don’t really have the luxury of doing this. Because, after all, if the depression is indeed clinical and it returns (since it is no longer fettered by chemical chains), there are two likely scenarios I could face:

1) The depression is stronger than ever and effectively paralyzes me.
2) The depression exists as it existed before and I resume life as a functioning depressive.

And again, I don’t know if I have the luxury of facing either scenario. I face a lot more responsibility as a 32-year-old than I faced as a 16-year-old or a 20-year-old. Back then, being a functioning depressive wasn’t unreasonably difficult, because I didn’t have to function at a very high level. Minus 10th grade, when I juggled both school and minimum wage slavery in the hellish fast food industry, I kept my schooling and working segregated. During the school year I only focused on school, and during the summer I only focused on working at a crappy summer job. So my stress levels were a lot lower than those found in kids who had to work and go to school at the same time. I had very minimal responsibilities around the house, and aside from being involved in some school activities, I really didn’t do much. All I really had to do was put one foot in front of the other and, day by day, survive the smoggy torpor of life. I don’t want to minimize my academic experiences in college, because I worked hard, always carried a full course load, and prided myself on getting good grades and a high GPA—it wasn’t like I was a slacker. But there’s really no comparison between being a student, when I wasn’t responsible for much more than academics and doing my own laundry, and being an adult living on my own.

I have fewer responsibilities than many people. I’m not a CEO or even a manager, I don’t own my own house (through no fault of my own; I want to own a house, but can’t afford one in the current housing market), and I don’t have a spouse and/or kids. But that’s not to say that I don’t have any responsibilities. I have my main job and six freelancing jobs to do, bills to pay, a car to upkeep, cats to care for, and an apartment to run. I live alone, so I’m the one who is responsible for all the little things: making sure the garbage and recyclables get taken to the curb every Wednesday; doing the dishes and laundry; keeping the fridge stocked; ensuring that I’ve got backups of shampoo, light bulbs, toilet paper, etc; and so on. These responsibilities will only increase when I finally manage to snag a house. At that point there will be a new host of drudgeries to consider.

As I said, all of those responsibilities are little things, but you have to understand that when I’m depressed, it doesn’t take much to overwhelm me. I may be functioning okay, and successfully going through the motions of surviving, but in that state of mind, molehills easily become mountains. And trying to remember everything when depressed—remember to run this errand, remember to return that library book on time, remember to buy extra cat litter because the litter box is running low, remember to pay those bills before they’re due, remember to stop for gas before my car dies—is damn near impossible. It’s like asking me to remember the entire numeric sequence of pi.

So if I do stop the meds and I do resume life as a functioning depressive, I don’t see how I could swing it as an adult—especially where work is concerned. Juggle seven jobs when barely holding my head above the water? Umm, no. And that, I guess, answers the question. Stopping the medicine isn’t wise because I just can’t take the chance that I’ll slip under the waves. There’s just too much at stake, especially right now, when I’ve got a towering stack of freelancing facing me. So why do I sometimes still ponder the issue? Why do I sometimes still think Should I...?



song heard most recently before posting: Bachelorette—Björk