Taming the beast: My life on antidepressants

Living in Alabama, I encounter a lot of intuitive spelling. I am no spelling snob. In fact, a roadside sign for “Bowled Peanuts” can brighten my whole day, as can a hand-painted billboard exhorting me to “Give Your Loved One A Missage For Christmas.” Never, though, have I taken so much pleasure from a spelling exception as the sign at a local health food store. “WE NOW HAVE ST. JOHN’S WART” proclaimed the movable-type sign out front. I imagined dusty all-terrain vehicles screeching up to the curb, relic collectors jostling to be the first through the door.

The storeowners had intended to advertise St. John’s Wort, the herbal supplement that many people take to ease depression. It’s not clear whether St. John’s Wort (hypericum perforatum) actually works. A 2002 study showed that it had no more effect on depressed patients than a sugar pill (Journal of the American Medical Association). On the day I drove past that little store, though, hypericum perforatum had just the right effect on me. Yes, I was depressed, but I felt a momentary lift, an escape from the gloom that followed me everywhere: I laughed. If only I could have prolonged that laugh for a few more miles, a few more days.

People experience sadness in many ways. I know it as a smothering pointlessness. A good laugh felt like taking a big gulp of air—only after that gulp I wanted another, and so I was always finding new things to laugh about. Gilbert and Sullivan worked for me. So did Flannery O’ Connor, old Doris Day movies, Garrison Keillor, and the front page of the tabloid Weekly World News. But I laughed at myself more than anything else. I had learned from Woody Allen movies that neuroses can be funny. Weren’t my phobias comical? Weren’t my compulsive behaviors, my screwy obsessive relationships hilarious?

When I finally went to a pastoral counselor, she asked me if I’d sought help before. I told her the funniest thing I could think of—how when my husband and I had once made an appointment for marriage therapy, the counselor suddenly left his wife and ran off with a patient. Telling her about this, I nearly fell off my chair laughing at the irony of it, gulping for air.

She stared at me in the annoying way that was going to become very familiar over the next year. “Why,” she asked me, “do you always laugh so hard at sad things?”

That question drew me up short. If somebody asked me the same question now, I’d have a ready reply. I’d say that nobody wants to feel sad, thank you, and that laughter eases sadness in two ways. First, it diminishes a wound by diminishing the situation or person that inflicts the wound—making the victimizer less potent, more easily overcome. Second, research shows that laughter releases serotonin in the brain. So comedy is a natural anti- depressant!

At the time, though, I saw myself clearly through the eyes of my therapist—giggling inhumanely at somebody else’s tragedy, either because I was too self-absorbed to feel affected or because I was afraid of being sad. The choice before me looked fundamental: did I want to be a cold person laughing or a warm person weeping? Other people have different choices to make, but the question of when to suffer and when to seek relief is there for everybody at some point. It takes many forms, some mundane, others momentous. Should I go for a walk or have another beer? Live without the things I want or sink into debt? Stay in this bad marriage or get a divorce? Even looking to Jesus’ example for guidance—choosing love over self-interest—there’s much left for us to interpret. Is it more loving, for instance, to bail a rebel son out of jail or leave him there overnight to learn about consequences?

I’ve noticed that when the choice looks moral or spiritual, we often choose the benefits of suffering—especially for others (Sometimes love must be tough, son! See you in the morning!). When a problem is physical, though, most people opt to relieve the pain. Liberals and conservatives reach for the Loritab with about equal alacrity. Maybe this dual approach to pain makes sense, since there’s no obvious benefit from simply enduring bodily illness, no hope of overcoming a bad headache by living through it. Enduring a bad marriage may strengthen the will and teach the heart to overcome, but living with a chronic migraine can wear a body down.

In the case of mental illness, however, the wide range of problems that appear moral/spiritual may actually arise from the physical chemistry of the body. “She really needs a kick in the butt,” someone tells you about a mutual friend. “She doesn’t do anything all day, just lies around and stares at the wall.” While it’s possible that the accused is lazy, it’s more probable that she’s physically sick (depressed), and that relief is only a slight alteration of her brain chemistry away. Many would argue that it’s possible for her to feel better without taking drugs: she could try the “talking cure” (regular sessions with a counselor), or an alternative treatment such as herbal or light therapy. If she goes to an M.D., though, she’ll likely carry away a prescription for an antidepressant such as Prozac or Zoloft—one of those brave new medicines that promise such good results with so few side effects.

For about eight years I’ve taken fluoxetine (Prozac). Twice I’ve tried to live without it, only to slide back into gloomy, horizontal wall-staring. Lately I’ve begun to thank God for it, this chemical that—if scientists are right, and they aren’t even sure—inhibits my overly efficient reuptake of another chemical (serotonin) that somehow facilitates communication between nerve cells in my brain. I don’t understand why I feel so bad when those nerve cells are on the outs: I only know that when they’re getting along better, so am I. And so are my husband and children, who don’t like to see me sad. For their sake I swallow my pride, and swallow the pill.

Have I sold out to a materialistic view of the universe? Does accepting the importance of the chemicals in my brain preclude a more spiritual view of emotion and thought? It seems to me that the value of consciousness lies in who created it rather than in how it happens. I imagine the neurotransmitters in my brain as, collectively, an instrument of perception, a kind of ear meant to pick up on the purpose of my existence. Fluoxetine is a tiny hearing aid: it amplifies the teleological strain in the material world’s great cacophony. Without it, I’m pretty deaf to anything in life that sounds like a point.

Yet I do see the pitfalls of trying to overcome emotional pain apart from an accompanying emotional struggle. Whenever I tell my sister that I’m feeling worried, mad, sad or guilty, she says without blinking twice, “Up your dosage.” I laugh because it’s a running joke between us. I say, “Yeah, and you’d probably give Paxil to Hitler so he wouldn’t feel bad about himself.” It seems right that I should sometimes feel terrible about things in my life. After all, terrible things happen in my life, often as a result of my own wrong-headedness. I worry that I’ll medicate myself so thoroughly that I’ll lose my desire to work hard at being a better person.

But I think again of my counselor’s question: “Why do you always laugh at sad things?” I was already taking Prozac. She never recommended that I stop taking it or stop laughing. What good would that do? Depression had no particular value of its own. Depression was a thief. It stole my hope and energy and even my affection for my family. It was a beast, and when it had me in its jaws, I’d do about anything to get free. No, her suggestion wasn’t that I embrace depression, but that I look past both suffering and happiness and consciously, willfully love others, even at great cost to myself. Rather than trying to feel well, I was to try to love well.

This sounded impossible to me at first. I didn’t see how I could do it. But not long after that conversation came a moment in which I understood better that Jesus is our man of sorrows, a companion in grief. I had a sense—maybe a miraculous sense, maybe the finger of God on my neurotransmitter—that Jesus was with me and loved me. I wouldn’t be alone. I began, ironically, by giving up a friendship I’d pursued for years, because I knew it would be best for the other person if I stopped trying to make things work between us. This felt like starvation and self-deprivation; it felt like the end of the world. But I prayed and I envisioned Jesus on the cross, giving himself for his people. I tried to believe that I wasn’t performing an act of self-denial or self-discipline, neither of which I’m very good at. My action was positive/outward rather than negative/inward: I was offering myself to someone else.

There’s a world of difference between self-denial and self-giving. Though self-giving does sometimes mean denying my own wants (most of the time, when my children are sick), it often means living like a hedonist, drinking deep of what others offer me rather than refusing out of fear (because I don’t want to feel controlled) or pride (because I always want to be the one who gives). It’s a demanding and adventurous way to live, with constant opportunities for interpretation and evaluation. There are traces to follow—Christ’s example—but no hard-worn path. Every day brings new ways of loving and new people to love: every day I watch myself succeed in some ways of loving and fail in others.

The hardest times for me come when the feelings of pointlessness crowd in, as they still do. Then I don’t want to see people, much less serve them, laugh with them, weep over them. Verses from Ecclesiastes pop into my brain. All is vanity, say the unconnected nerve endings. I start to see love itself as a lie, just empty cheerfulness spinning its wheels. Love doesn’t contain anything, doesn’t go anywhere that matters.

But I choose to believe that pointlessness is the lie. I choose to believe that the sane woman—the sane me—is the one with the happy brain neurons, shaking hands and smiling—thanks to the seratonin molecules that float around in there like tiny diplomats, while fluoxetine stands guard at the door.

Yes, that “sane” woman is often sad, often worried or angry—the world is still a pretty tragic place, and no amount of seratonin can change that. But she’s also happy a good part of the time. She finds joy in giving herself to people, even though love brings pain. She remembers that there’s a reward ahead. And when really dark times come, she prays for help, opens The Habit of Being, and does her very best impression of Doris Day.