#ocd is in my mental health chemical soup up there

[d1zzypaw]

sits on the floor, contemplating

[jinxedncharmed]

My psychiatrist has had me transition from citalopram (generic for Celexa) to Cymbalta, and I have to admit it’s gone really well.

I had been taking 60 mg of citalopram for a long time, maybe six or seven years. My abusive boss at the insurance company had broken me, and I was ready to end my life. My obgyn, with whom I just happened to have an appointment at the time, convinced me to see a psychiatrist, who I credit with saving my life. It took a year to get my meds right, and I took an additional supplement for a while, but it worked.

That psychiatrist has retired for health reasons. I regret I never really told her she saved me.

Now that she retired and I had moved up to DC, I had to find a new psychiatrist. The one I found I didn’t like, but I kept her for a variety of reasons: location, insurance, and easiness of garnering a prescription. But she always told me I was taking an unsafe dosage of citalopram, that it was bad for my heart.

“Listen, I don’t care if my heart jumps out of my chest like a Xenomorph,” I told her. “I don’t care if it liquefies and leaks out my ass hole. I want 60 milligrams.” So that’s what she has been prescribing, and I see her a few times a year for check-ups.

About two weeks ago I had an appointment. She knew I was having a lousy year, that I was deep in a depressive episode. I told her I had had back surgery, but I still had significant chronic pain in my leg, and was frightened it would be permanently crippling.

“Cymbalta,” she said, “Cymbalta is excellent for chronic pain. It’s often used for that. I’ll switch you.”

“You’ve just been waiting for an excuse,” I admonished. “I don’t want to quit citalopram. It’s working.”

She just gave me a doleful look. Because it wasn’t working anymore, and we both knew that.

It’s scary, being at medicine’s mercy. Antidepressants are poorly understood, and no one really knows how they work, although there are many hypotheses. Some asshats, like my dad, claim they don’t work at all. Some mental health care providers (usually counselors) and members of the general public think they’re crutches, for lazy people who want a quick fix.

This is not true. Medicine isn’t a quick, easy fix. It took my doctor and I a long, frightening year, a year I wasn’t sure I would survive, to get the medication right. My sister, who is bipolar, has struggled for years and still isn’t right with her meds. I had half-heartedly tried Zoloft as a teen but it hadn’t helped. I have been extremely lucky, that it took only a year to find a drug and a dosage that helped.

And the medicine isn’t a permanent fix. One day, it stops working. One day, the final grain of sand tumbles out of the hourglass, and your time is up. You body has acclimatized. The chemistry is no longer effective. Your brain structure has physically altered. Game over.

I have had depression all my life. My mom tried to get me to see a therapist for help and medication when I was a teen, but I refused. Partly because I was a teen and fought her on everything. Partly because I thought there was something noble about immense, desperate suffering. Partly because I didn’t think I deserved to feel good; I was bad, I should feel bad. And partly because I worried that any peace or happiness I felt while on medication would be false, a euphoric lie, no authenticity. There was a “real” me, and that “real” me hated herself and was always sad.

John Green, a man I greatly admire who is candid about his struggle with OCD and anxiety, stunned me with this passage in “Turtles All the Way Down”:

“The conversation devolved into her telling me that medication only works if you take it, and that I had to treat my health problem with consistency and care, and me trying to explain that there is something intensely weird and upsetting about the notion that you can only become yourself by ingesting a medication that changes yourself.”

I had to put the book down and cry, because I had had that exact same argument with Hilda so many times. And I had been thinking it again, recently.

Any pleasure you feel is false. You are not having real experiences. Your brain is deeply, irrevocably broken. All joy comes from a pharmaceutical. Your life hinges on a pink tablet. What are you, a soup of altered chemicals? Are you so ugly inside you need pills to get up in the morning?

Why are you still here?

So in that office a few weeks ago, I chose to be brave, and said, “Ok. If you think I would benefit from a change, let’s try.”

So we talked it over, and I transitioned over to the Cymbalta, tapering off the citalopram.

I was fearful, because I had once abruptly quit a 20 mg dose of citalopram after a year, when my script lapsed. The withdrawal effects were heinous. First came dizziness, vertigo, nausea. Then paranoid thoughts; I knew, of course, there was no camera filming me in my bedroom, but I didn’t know that. And then, one day at work, the worst of all:

Kill yourself. Now. Do it now.

It was a harrowing time, and I told no one. I had no confidant, no support system. No one knew that I sat at my desk envisioning slashing my wrists in the downstairs toilet. That I was up all night watching static channels, convinced there was a message for me.

My doctor at the time was horrified. “Never do that again, no matter what. You cannot quit cold turkey.”

But this time, there was no withdrawal. I was ok. I had some side effects, but I wasn’t paranoid or physically ill or suicidal. Now I was back for a follow-up, to see how things had gone.

“It’s going…really well,” I admitted to my psychiatrist, feeling unaccountably shy. “The pain is almost nil. I feel ok. Some side effects but ok.”

The pills leave a very nasty taste in my mouth, I can’t get rid of it no matter how much I brush, but that will fade over time. The vivid dreaming can be disturbing, or a lot of fun, depending on the subject matter. I take the pills in the morning now instead, so the dreaming will fade too. But I’d been spacy and aphasic, which is unlike me; I’m usually quite eloquent. It turned out I had misunderstood her directions and was taking too much citalopram while transitioning. I’m off it entirely now, so the spaciness will fade.

“I’m pleased,” she said, typing notes. “Try 90 milligrams for a while and we’ll check in before Christmas. 90 or 120 would be best for you, I think. We’ll adjust if necessary.”

Maybe I do need this change. The leg pain is almost entirely gone, just a few twinges in the morning. I feel less weepy; my adorable coworker says I “giggle.” Perhaps the citalopram had run its course, and the Cymbalta will be a good fit. It could be that the depressive episode, which started around this time last year, is wrapping up. That the steep decline has levelled off and maybe–maybe–started to rise. This could be a positive change after all.

But in the back of my mind, a little timer starts. The hourglass is inverted. Gravity takes effect. One grain, then two, a third, a fourth, then more. The game begins, duration unknown.