It’s a Monday morning. I’ve just locked the door to leave for work. Then I think, is the coffeemaker turned off? I unlock the door, go back and check. And as I head out the door again, I stop. I remember seeing that the little red light on the coffeemaker was dark. That means it’s off. But I don’t trust the evidence of my own senses. Or perhaps I don’t trust my own memory. And I go back and look at the coffeemaker again. It’s futile, really, because if I didn’t trust my sight and memory 30 seconds ago, why should I trust them now?
I’ve missed some doses. Not many, but enough to matter. I fell asleep reading one night, simply forgot another night because I had an unexpected phone call. Those lapses add up.
I know because OCD symptoms are the first problems to surface when I’m not taking enough medication. (Depression and OCD frequently occur together in adults and the same medication is often used to treat both.)
I will resume taking my prescribed dose tonight, but it will take some time for the meds to take effect. So there will be other alarm bells over the next few days: I will be more easily irritated; loud noises will bother me much more intensely than usual.
But worrying about the coffeepot. Unsure if the front door is locked even though I saw my hand turn the key. Those are the canaries in my pharmacological mineshaft.
So is having what doctors call “psychomotor restlessness.” Last week I was lying on my couch falling asleep. At the same time, my right foot was twitching.
There’s a note on the bathroom mirror now: “Pop your pills?”
*
I was 10 when I first started taking them. My mother handed me a small prescription bottle full of yellow, triangular tablets.
“Your father wants you to take these,” she said matter-of-factly. “One just before bed. Every night.”
I didn’t think anything of it. I was always taking something: for allergies, stomach bugs, migraines. I could effortlessly recite the names of a dozen medications. I still remember the name of this one: Triavil. Other men remember their first home run, first touchdown, first date. I remember my first psychiatric medication. My father, a physician, had informally prescribed me antidepressants. And I’ve been taking them ever since.
At this point, I can’t imagine being functional without them.
To think too much about life on brain-altering drugs is to imagine oneself with the chemical equivalent of a prosthesis that merges seamlessly with your body in unknown places, to view the accumulation of moods, thoughts and physical states that make up daily life, and wonder: What’s me? What’s the medication?
But to the few people who know my pharmaceutical history the more pressing question is why I began taking such medications when I was so young. My father told me later—in my teens—that at the time I was exhibiting obvious symptoms of depression. I don’t doubt it: I was not a happy child. And I think I know the answer—or answers.
My father was a member of the World War II generation. When he was a medical student, there was little emphasis on psychology. An M.D. in those days came away with an understanding of the human body as an interacting set of chemical equations. If something’s wrong with a person, whether it’s cancer, the flu or depression, you need to change one or more of the variables.
But why didn’t my father talk to me? Why didn’t he send me to a child psychologist?
I can’t imagine talking to my father would have solved anything. My most vivid memories of paternal conversation involve him approaching me on a significant subject and saying exactly the wrong thing. When I was a National Merit Scholarship Finalist in high school, his only words to me on the subject were, “Competitions like that are based on financial need, so you won’t win anything.” I think his intention was to shield me from disappointment.
As for the option of a psychologist: I lived in an isolated rural area, two hours’ drive from the nearest newsstand that sold a copy of the New York Times, which made easy access to a capable therapist unlikely.
And finally, my father was of a generation that still viewed therapy, if they thought of it at all, as a desperate resort. To send his own child to therapy would have been to him an admission of utter failure as a parent, an admission that something was very wrong in our family—and we weren’t that sort of family.
But the idea that whatever troubled me could be resolved by taking pills shifted my depression (if that’s what it was) from the nebulous world of mental illness, of personal dysfunction, to the comparatively clear and defined world of physical illness. I could take a pill for depression just like I would for a stuffy nose. Triavil: right on the shelf next to children’s Tylenol and pediatric decongestants.
I don’t doubt, as my father believed, that there’s a strong genetic component to depression; he himself suffered from it. I remember the sadness that took over his face; the days when even as a child I knew not to approach him or speak to him; the evenings when he went to the bedroom he shared with my mother right after dinner and shut the door. I can imagine him looking at me, the one who of all their children looked the most like him, and wondering if he had passed on to me his own sadness.
I also don’t doubt that changes in my environment would have made a substantial difference. Looking back on the child I was and where I was growing up, it makes complete sense that I was depressed. I was living in a small Bible Belt town that even then I hated. I had no real friends and I was bored in school. But the changes that might have alleviated my depression—new town, new school—simply weren’t going to happen.
In reality, my father simply wasn’t suited for dealing with many of the messy complexities of humans. He couldn’t understand why some of his patients kept smoking after he told them they should stop. He thought the foothills of the Appalachians would be an idyllic place to live and raise a family, but was horrified that my older brother grew up to be a total redneck—just like his high school classmates.
Before my father decided to go to medical school, he studied chemistry and mathematics. He loved the elegance he found in both, particularly chemistry: the poetry in the patterns and groupings of the periodic table—those elements that variously combine in ways to produce everything in the universe—the invisible communion of electrons that could form the wetness of water or the symmetry of salt.
Furthermore, during his teens and twenties he witnessed an explosion of medical triumphs. Polio, whooping cough, staph infections—potential death sentences of his childhood all rendered toothless by the time he began medical school. And the proliferation of treatments for “incurable” diseases continued throughout his life. He was not a religious man in any orthodox sense, but he felt himself surrounded by miracles.
He loved chemistry, and he loved me. Surely, he must have thought, the endless possibilities of one could fix the other.
But I don’t know what, if anything, the Triavil fixed. It’s difficult for me to chart my pharmaceutical history, because I was so young. The switch to Elavil was probably around seventh grade. By junior year of high school I am fairly sure I was on Desyrel (one of the earliest of the family of antidepressants known as serotonin reuptake inhibitors, the most famous of which is Prozac).
The changes from drug to drug suggest that none of them were working very well. It’s quite probable that the medication did nothing to me except induce side effects. Dry mouth is the only side effect I remember experiencing frequently. I do remember days when I couldn’t go to school because I was too hung over from the previous night’s dose, but I can’t remember if that was Triavil, or if we had moved on to Elavil at that point.
At any rate, by the time I was 20, definitely by the time I turned 21, I had spent more of my life on medication than off.
A close friend whom I’ve always considered a natural candidate for antidepressants (cancer, fraught relationship with family, multiple career disappointments) has serious ontological issues with antidepressants: “If I were in a good mood or more functional because of pills, what would that mean? Where would the pills stop and I begin? Would it really be me living this better life?”
For me these philosophical questions have an extra dimension because I was so young when this all began. If my friend started taking antidepressants now, she would be doing so as an adult, making a somewhat informed decision. She would at least know who that person was deciding to take the medication. I, on the other hand, began taking medication intended to alter my personality before I became a person.
Four years ago I did go completely off my medication. Just to see. My rationale was: I’m better off now than I’ve been at any earlier time in my life. I have a meaningful, satisfying job. I have more self-confidence. I’m emotionally healthier. So let’s find out. What’s it like being me, without chemical additives? And if you’re wondering: yes, I did this without medical supervision.
I slept a lot more. OCD symptoms (predictably) surfaced. My memory suffered: I forgot to pay bills. At one point I actually forgot how much my rent was. I felt like I was working with half a mind. A freelance writing assignment fell due during that time. I had to pry each sentence out of myself. I re-read my work, sensing ideas and phrases just beyond my grasp.
At some point—as always when I’m really depressed--the mental home movies started. An endlessly playing documentary of every mistake I had ever made or cruel thing I had ever said. Widescreen edition of course. With critics’ comments. What were you thinking? (well, you weren’t, obviously) You actually said that? Jesus. Do you think she still remembers? And when she and her women friends are trading stories about asshole guys, does she trot out that night at Columbia Street? Even the longest home movie has to end. But my mind always managed to find the Bonus Features DVD at the back of the box.
For the record, I usually made it to work on time.
After six weeks of this I went to see a nurse practitioner and came home with a bottle of Celexa, which is now my primary antidepressant. My nurse later added a morning dose of Wellbutrin to the mix, to blunt the side effects of the Celexa.
All I learned from my ill-judged experiment was that I need the medication now. I don’t know if I needed it then. And I don’t know why I need it now. Do other people’s brains just process certain signals, secrete certain chemicals naturally that keep them okay? Could my brain do that at one time, but it’s just forgotten how because pills have being doing all the work for the past 30 years?
I recently read a 2004 article from The Journal of Ethical Human Psychology and Psychiatry, “The Ethics and Science of Medicating Children,” that suggests this might be the case: “There is evidence that the use of… psychotropics makes long-term… changes in brain structure.”
I know, both from my experiment in drug-free living and also from trying different dosages recommended by doctors and nurses, some of the effects my current medication has on me. In addition to making me less gloomy, I am calmer, less tense. I am much less irritable. I monitor actions, events and my relative lack of reaction to them. It’s as if I’m under the emotional equivalent of a local anesthetic. I still have feelings, but there are certain emotions I feel less intensely. Or it’s as if I know the feelings are there, but they’re on the other of a pane of glass so they can’t touch me. If my blood level weren’t just right, that confrontation at work with R. would really have gotten to me. That driver who just cut me off--how angry would I be about that without Celexa coursing through my bloodstream?
At times I am more or less untroubled by the fact that I chemically alter my personality. People do it all the time, albeit in more mundane ways. If I eat a lunch high in carbohydrates or fat, I’m going to feel relaxed in the afternoon because my blood levels of tryptophan will increase. I’m feeling better than usual right now because I went to the gym and my hypothalamus is producing polypeptides that induce a feeling of well-being.
And at other times I ask myself, who’s really at home?
I often get complimented on the way I conduct myself: stoicism in difficult circumstances, composure with difficult people. And I wonder, who are they complimenting—me or my Celexa-Wellbutrin cocktail?
Would I be able to have my regular, dutiful, labored phone conversations with my family without chemical assistance?
These are the sorts of questions that I confront daily.
Every morning when I shave I see a face that’s a lot like my father’s: the sharp nose and chin, the eyes that other people have called piercing. And there’s another way he looks back at me from the mirror: he’s still affecting what’s happening in my brain more than two decades after his death.
If that evening when my mother showed me a handful of yellow pills had never happened, I have no idea who would be looking back.
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