To Medicate or Not To Medicate?
I’ve always fantasized about walking into my therapist’s office, lowering my sunglasses, and announcing: “well, I’m cured!”
Sometimes I feel that way, when I’m on an upswing. I’ll talk to my therapist like I’m the most neurotypical person on the planet. “Anxiety? I don’t know her!”
But as preeminent anxiety writer Melissa Broder said: “Just when I think I’m never going to have panic attacks again, that’s when I start to get them again.”
Things will be great, and I’ll feel like I’m approaching happiness or some degree or normalcy. I’ll think to myself, “I just hope my anxiety doesn’t come back.” And then my throat begins to tighten. And I feel vaguely dizzy. Am I going to pass out? I’m going to pass out.
It’s fine, I tell myself. This too shall pass. But then I wake up, and it’s still there—the phantom hand on my throat, trying to strangle me. My breath is shallow. There’s a pit in my stomach. I try to go about my day, pretend it’s not there, but the pit just gets more intense, and the discomfort spreads over my body. I try to meditate, pay attention to the sensations, but focusing on them just makes them worse. The sensations are hell. My cells are going loco.
I am convinced my meds have stopped working. Before I know it, I’ve spent four hours in a Reddit hole about Cymbalta, which I’ve been on since 2014, reading that it can randomly stop working and that going off it is the most painful thing anyone has ever experienced. Then I read about other meds, switching meds, what worked for people and what didn’t, and it’s more of the latter—horror stories. I’m in heads of the most mentally ill people on the internet, and the pit in my stomach is getting deeper.
I’m there now, in the Reddit thread stage. “Not okay.” Of course, there is a global pandemic peaking, an easy explanation. But I don’t need a deadly virus outbreak to justify my anxiety.
The clinical literature calls anxiety “fear without an object.” People ask “what are you anxious about?” and I think, ah so you’ve never been anxious? I’m not anxious about anything; that’s precisely why it’s so scary. Things are normal and then they are not, suddenly I can’t remember what normal feels like. Every thought is unpleasant and is accompanied by a corresponding unpleasant feeling in the body, a tightness or unease. It’s not pain, exactly, but pain-adjacent.
And unlike depression, anxiety isn’t glamorous. Anxiety is embarrassing. Anxiety is a sweaty man in a too-tight tie.
And the cure is elusive.
I try to tell myself that medication helps, but I don’t know because I’ve been medicated since I was 19—first on Celexa and then Cymbalta—and there are always a billion factors swirling in life and it’s hard to tell what’s contributing to what.
Besides, no one really understands psychotropic meds. Psychiatrists prescribe them on a trial-and-error basis. Most meds take 4–6 weeks to work, so if you think one is “working,” it could just be the passage of time. (A body can only stay in an anxious state for so long.) Studies show that antidepressants may not be any more effective than placebos. Also, getting on them is said to cause the very symptoms they’re meant to cure: anxiety and depression. Same with getting off. So when you try a new med, you have to expect to be more anxious or depressed than you were before for up to to six weeks.
When I first got on Celexa, an SSRI, at 19, I remember experiencing a bout of the worst anxiety I’d ever felt. But it might not have been the Celexa. Other things were happening. I was visiting a friend in Boston who was having some kind of breakdown. I wasn’t sure what was happening at the time, just that she was sleeping all day and unable to hang out with me, then getting very drunk at night and getting mad at me. I later learned she was in the throws of a very serious Adderall addiction, one that required rehab, and maybe I wasn’t anxious from the Celexa, maybe I was just responding to that. Those of us who end up on pills tend to be what Californians call “energetically sensitive,” so it’s hard to know exactly what’s affecting us.
I got off Celexa seven years later when a new psychiatrist said she could tell by looking at me that the pills weren’t doing shit. She put me on Cymbalta, which she described as “very mild”—“they give it to pregnant women!” So I took her orders and went on the pill, which at that time was very expensive and required me to drive to a special pharmacy to get it on my insurance. Other than this inconvenience, I didn’t notice any difference. I wasn’t less depressed or anxious. I was blacking out more. But I was also drinking more. Because I was more depressed.
Later I read that when an SSRI becomes ineffective, the standard practice is to prescribe an SNRI, like Cymbalta—which is what my shrink did to me. When the SNRI stops working, the next option is to add something onto the SNRI, mostly because SNRI withdrawal is hellish (something I wish I’d known) and you eventually become dependant on it, so your psych might add back on another SSRI like Prozac or Lexapro or Zoloft, or they might add an NDRI like Wellbutrin (one of the few antidepressants without sexual side effects). Or they might add an antipsychotic like Lamictal, which is prescribed off label for anxiety and depression, and has to be tapered slowly because it can cause a deadly rash. Going on these drugs might cause anxiety or insomnia, so the psych could add an anti-convulsant like Gabapentin or an antihistamine like Hydroxyzine or a benzo like Xanax or or a beta blocker like Sectral to alleviate those side effects.
Before you know it, you’re on a serious cocktail. If you feel better, you can’t really pinpoint what’s doing it. Same if you feel worse. And if you talk to people who are on these cocktails, it’s more often the later—they feel worse. Or they feel too numb to care about anything, which sort of kills your will to live, a sensation approaching suicidality.
On top of it, you’re taking all these chemicals with unknown long term effects, and they might not be helping at all.
Roughly a year into my Cymbalta usage, I noticed when taking my morning pill that I was taking 30mg instead of the 60mg that had been originally prescribed to me. The inconvenient pharmacist had made a mistake. I was on my last pill of the bottle, so it had been a month, and I’d noticed nothing in the dosage decrease. So I decided to stay on 30mg.
I’ve since had random bouts of depression and anxiety, as well as good periods, “anxiety? I don’t know her!” periods. But I’ve stayed on the 30mg of Cymbalta mostly because I don’t want to suffer the potential hell of Cymbalta withdrawal or potential anxiety accompanying a new pill.
I think meds work best when you believe they work.
Therapy also helps, more than meds for me. Sometimes just booking a therapy appointment calms my nerves. Recently I’ve been doing acupuncture, and I got a breath work app on my phone. Sometimes anxiety and depression just need to work their way through your system.
In the end, I think the best medicine is time.