Prozac on TV vs. Prozac in me

How my expectations compare to the real thing

March 11, 2017

I sullenly sunk into the smooth gray couch in the psychiatrist’s office, savoring the seven seconds of silence that elapse between her door closing and the utterance of The Question. It had been weeks since a natural sociable smile came to my face when her eyes met mine, and as she walked the three steps to her chair and swiveled to face me, I felt the heavy stillness of the motionless muscles in my face, drooping with the weight of insomnia. With each blink, I could feel the soreness of the purple bags under my eyes.

So how have you been?” asked the psychiatrist using an upbeat tone of voice, but her eyes surveyed my face with a cautious severity, and they lingered there without shifting to follow her hands as she grasped for her keyboard to begin to take notes on my response. I’ve seen this psychiatrist five times at this point, and I know that this opening question is how the conversations will inevitably start, but I never know exactly what to say. I’ve felt so many things – guilty, fogged, ashamed, hopeless, anxious, worthless, overwhelmed, pitiful, malaise, exhausted. Where do I begin? I knew she could see that my fingers were scraping at each other’s nails and my palms were glistening slightly with perspiration, and that my eyes were wandering around the room as I searched for my reply. I knew her perceptive gaze was weighing this visible anxiety. I didn’t want to put on a show, nor did I want to avoid vulnerability, as I sat there fidgeting slightly with tears beginning to well up along my lower eyelids. Only two seconds have passed since she asked The Question, as these thoughts slip through my mind.

Things have been really bad”, I chose to say. My voice croaked dryly, I thought it sounded like I had a cold. Since our last meeting, I had hit my lowest low in my present episode of depression. That day was nearly a month ago, on February 16, 2017, the day after I wrote this journal entry on grappling with suicidal thoughts. I told her that things were out of my control, and I needed help. That’s when she decided my anti-depressant Lexapro wasn’t cutting it.

She switched me to Prozac, hopeful that it “might be a better fit.” It never ceases to amaze me how many euphemisms can be concocted to accommodate the mentally ill – I would have preferred her to have said “let’s hope that this has a chance of doing something, which would be more than could be said of the Lexapro.” Or even “let’s hope that you won’t come close to killing yourself on Prozac.” Anything more direct would have been better than describing the potentially life-saving drug change with phrases appropriate for a patient shoe salesman.

Before trying anti-depressants and anti-anxiety drugs, I had learned a bias against them. Perhaps my bias comes from an old-school Hollywood view of psychopharmacology that I learned from TV and the movies. They show crazy people being treated with drugs that level them, they show uncontrollable people being sedated and flattened with the blunt instrument of medication. They delivered those drugs in moments of crisis via sharp metallic syringes, or from small paper cups in moments of banal meaninglessness in a psych ward queue. I envisioned myself becoming the zombified patients in Shutter Island or the begrudgingly docile background characters of One Flew Over the Cuckoo’s Nest.

I imagined anti-psychotics to be polite molecular lobotomies, the mental equivalent of chemical castration.

The idea of treating my depression with drugs frightened me, which you can see in my first journal entry on Medium. My value at work resides in my ability to use my brain, as I explore in a recent journal entry, so the idea of putting any chemicals in there feels risky. I shivered at the thought handing control of my brain over to some drugs, even though the reins of my mind were gripped tightly by depression. At the time, I had no control to lose, because I was not in control. I couldn’t see that irony back then.

I’ve been on Prozac for a month now, and doubled my dosage to 40mg this week. It has been long enough that I think I can articulate one aspect of my experience with anti-depressants that has surprised me.

I am not flattened by these drugs, I am not leveled by them. Prozac at 20mg makes my baseline mood a tiny bit higher than it would be without help. It does not diminish the amplitude of the range of emotions that I experience – there are still moments of calm normalcy and others of turbulent lows, sometimes I visit both ends of the spectrum on the same day. I can still feel relatively normal in one minute, and be calculating how many of my pills it would take to kill me in the next. We’re increasing my dosage to 40mg this week because those lows are still too low for comfort, but I don’t expect the effects of the drug to be so different at higher doses.

It’s not readily obvious to me how the anti-depressants affect my brain. They don’t squander my creative abilities. They don’t change the way I interact with people. They don’t make me happy. They can make me a bit foggy, a bit dizzy, a bit sleepy – it seems their side effects are more noticeable than their primary uses. They don’t take away or suppress any of the things inside of me that make me me. They just slightly shift the sea level, my origin.

In my darker moments now, this underwhelming reaction is a source of great disappointment to me. Sometimes I wish to be sedated, to be mentally incarcerated, to be put in a chemical straightjacket to protect me from myself. The breakdown of trust I have for myself has always been one of the most disturbing aspects of my depression. Sometimes I don’t want to leave me alone in a room with myself, who knows what I could do to me, I think to myself. These anti-depressants don’t feel like the net that will catch me, or the sleeves of the straightjacket that will restrain me, or a warm blanket comforting me.

Maybe that will change in the coming weeks – here’s to hoping.

Read my previous or next journal entry, and get immediate help if you need it.