The Advantages of Anxiety
My mom once tried to sell me on the advantages of anxiety. She did this by telling a story.
“You know,” she said, “back, thousands of years ago, the anxious ones were the ones who lived. They were always on the look out for tigers or snakes or lions or whatever deadly shit was on hand. They were always alert. They were always on edge. They were always worried.”
“The complacent people? The chill people? They got swallowed up, right off the bat. They would fall asleep in some tall grass and wake up and it was chow time for the Sabertooth. Not us. People like you, people like me, people who deal with anxiety all the time, we’re not so bad off. We’re engineered for survival.”
That was her story, and if I was roaming the Great Plains with my clan of hunters and gatherers, I would probably feel pretty good about being on the leading edge of the survivability curve. Alas, I remain dubious. I think the utility of anxiety has waned over the last few centuries.
For better or worse, anxiety has been my constant companion in life. It sits in the gut (always the gut) waiting for even the most innocuous of social situations to boldly assert itself. It can cause my body to sweat gallons, my stomach to roil, my chest to tighten, my brain to fog and seize. Anxiety compels me to flee. Anxiety compels me to avoid. Anxiety compels me to take the well-trodden road, and keep my eyes down.
In early 2005, I had landed my first job out of college and I had good, solid medical insurance and I had options, and I decided that dealing with my anxiety could mean more than just dealing with my anxiety. I don’t remember the catalyst – or if there even was a catalyst. Maybe the cumulative weight of social acceptance for mental health treatment finally penetrated my numb skull. Shrink stopped being a dirty word. My mom had a therapist. My sister had a therapist. I had friends who took pills to manage anxiety and depression and more.
Because I didn’t know any better, I made an appointment at a place I would later describe as being a mental health puppy mill. It was a large, nondescript building nestled a good distance off campus, with some sort of affiliation with University of Michigan Health System. I tried to look it up on Google as I was writing this only to find that it apparently no longer exists. It had a vaguely unsettling name, like “University Psychiatric Services.”
My recollection is that I filled out some forms, talked to a nurse, talked to a psychiatrist, and left about an hour later with a prescription for a powerful psychiatric drug and a cache of refills.
That drug was a selective serotonin reuptake inhibitor – an antidepresseant – called Celexa, and the next day I started taking it in a 20 milligram dose.
That was 7 years ago, give or take, and through all that time, I’ve continued to take medication to manage my anxiety. Of course, I wizened up a little bit. I kicked the Psychiatric Services Center to the curb and got a proper psychiatrist. I started to see a psychologist twice a week. I talked about my feelings. Working with both of them, I changed my medication, monitored it, and changed it again. And again. And again. I tried Prozac. I tried Wellbutrin. There were others – Lexapro, I think, and a few more. In the end, in 2007, we settled on Cymbalta and I’ve been taking it ever since.
I got to a point recently, though, where I started to ask myself certain questions with increasing and irritating frequency. The first question was, “Do I still need to take these pills every morning?” The second question was, “Why did I start taking these in the first place?” I guess it’s really par for the course. After all, we do a pretty good job of remembering things that have happened, but we do a less good job of remembering emotion. I mean, you might remember that something made you mad or that something hurt, but it’s a sort of abstract, blunted thing. We have a harder time connecting directly with the emotion itself. When I ask myself, “What did I feel like 7 or 8 years ago? What was was that anxiety I was running away from? What did it feel like?” That’s a hard question to answer. I still feel anxiety today. I feel anxious all the time. I run a whole cottage industry on anxious. It’s not like a series of long talks and a tumbler of pills have stripped that away. How is that anxiety different from how I felt way back then? How is it the same? How have I changed?
I was paying $45 a month in insurance co-pays and I was waking up every morning and going to the sink and taking some pills, but I could not – could not – answer the questions I kept asking, and although I carried on for awhile on the sheer momentum of routine, that started to drag on me in a major way.
So I came up with a plan.
I had a good job. I had a good marriage. I had good health insurance. I was in good health. I had solid fundamentals, in other words, and so I decided to stop taking my medicine. I decided to stop taking it in a controlled, reasonable way – in careful union with my psychiatrist and my psychologist and my doctor. I would stop taking this medicine, slowly and surely, and I would establish a new baseline, and I would see. To my mind, there were two possible outcomes to this venture. On the one hand, the experience might clearly remind me why I started taking medication for anxiety in the first place. On the other hand, maybe I would find that with the help of therapy and time and personal growth that I was OK – that I was in a place where I could have the same quality of life without pills.
Here is a little lesson if you are uninitiated to the world of psychiatry. You do not fuck around with brain chemistry. You don’t wake up one morning and flush your stash down the toilet. You don’t dose your brain daily the same way you throw back some ibuprofen. Small movies, Ellie. You work your way on and off a medication in small, incremental steps. You come at it with a plan.
I learned this the hard way the first time I missed a dosage of Cymbalta. I was careless. I meant to go to the pharmacy. I meant to call my psychiatrist and settle up. I meant to do these things, but I didn’t, and then next thing I knew I woke up one morning, walked to the sink, and found the orange, plastic prescription bottle empty. While I called and left voice-mails and made appointments and tried to get an emergency resupply, I missed a day.
That was a bad day.
I was fine, really, perfectly fine, until 2 or 3 in the afternoon. Then I started to get moody. I started to get irritable and wound up. I started to feel manic and slightly off-kilter. We all have off days. We all have bad days. And it could have just been one of those, except soon after that I started to get the Brain Zaps. I didn’t know what to call them at the time. I just knew the sensation. Every time I would turn my head or try to focus my eyes on something, I felt little sparks of lightning jumping across my skull. Not painful, these little sparks – but uncomfortable, and definitely unsettling.It was only much later, when I started to do some research on my own, that I found out that this phenomenon is well-known to people who take Cymbalta. On some forums they’re called Brain Zaps. Or Brain Shivers. Or Brain Shocks. The instant I read those words, I knew implicitly what was being discussed.
I went to bed early that night, and the next morning I didn’t leave the house until I got my psychiatrist on the phone. She called in a refill. I explained what had happened when I missed my dosage the day before.
“That’s because Cymbalta has a really short half-life,” she said, by way of explanation. “Don’t let that happen.”
That’s why you need a plan.
In early May, at the outset of this experiment, I was taking 90mg of Cymbalta (3 blue and green 30 mg pills), every morning with a long draw of water.
My psychiatrist suggested that I drop down to 60mg, sit at that plateau for 2 weeks, then drop down to 30mg for another 2 weeks, and then be done. 30 days to a drug-free baseline.
“We’ll see how it goes,” she said. “We’ll readjust as necessary.”
That’s why you need a plan.
The next day, I took 2 pills instead of 3, and life more or less went on. I felt a little jittery, like I had had a couple extra cups of coffee, but I was otherwise functional. For two weeks, this went on, and I felt like I was on my way.
Two weeks later, in early June, I dropped to a single 30mg pill.
The first day went OK.
The second day, I lost my mind. It’s uncomfortable to write about, because, well, it’s my mind, and I lost it. I was, for a few days in early summer, vulnerable and lost, and that’s hard – to experience, to share, you name it. I’m sitting here, looking down at the keyboard, thinking I am OK. I am aNORMAL. I don’t have MENTAL BREAKS.
But I did. I really, really did.
I didn’t even make it as far as going to work the second day.
The Brain Zaps returned, furiously returned, before I even made it clean into the shower in the morning. As a prelude to bad times, it served as a good prognosticator. Shortly after, I fell into the thrall of manic mood swings. I started crying. I got angry. I got depressed. I felt confused. I was harried by the sensation I was strapped to a malfunctioning gimbal, a wonky suspension – every time I moved, the world seemed to lurch awkwardly after me.
I had no idea what to do. I called my psychiatrist, but she was unavailable. I left a voice mail. I started to think that if I kept myself busy, I could stay ahead of the thunderclouds forming in my head. I thrust myself outside, into the garden in the backyard. I grabbed up my broad-brimmed hat and my spade and a pad for my knees and I tried to immerse myself in what was in front of me. I didn’t know what else to do. The zenith of all this was a surreal attempt to go to Home Depot to buy mulch – a misadventure that turned into three hours of driving aimlessly down long country roads, feeling lost and despondent and broken and absolutely terrified.
I called my wife from a Taco Bell outside of Dundee.
“I don’t know what to do,” I said. “I don’t know what’s happening to me.”
“Come home,” she said. “Come home to me.”
And I did. I limped home, came into the house, and collapsed into a pile of sobbing that would not abate.
The next day started no better. My psychiatrist called me back, and through gritting teeth I reiterated my narrative.
“Yeah,” she said. “Sometimes that happens.”
“How long can this last?” I asked. “I mean, I have to get through it eventually, right?”
“It can last a couple of weeks,” she said.
She presented two options. One was to immediately give ground, and retreat back to 60mg. That made me uncomfortable, because I had already spent two days in a no-man’s land of batshit. I didn’t want to let go of those two days. If I gave up, if I went back, then two days of suffering were for nothing, and that was a difficult idea to grapple with.
Her other suggestion was that I could start taking a cocktail of Prozac and Cymbalta. Prozac could help off-set some of the side-effects of the Cymbalta, she said, and make coming down from the whole thing easier. This sounded fishy to me. It sounded, in fact, like some invasive species bullshit – like, you’ve got a problem with mice, so you buy a bucket full of snakes. And then you have a problem with snakes, so you buy a mongoose (or two). And then… well, on and on, until somewhere down the line you’re left with an infestation of Border Collies or something. Moredrugs somehow didn’t feel like a viable plan.
I did not want to go forward. I didn’t think I could go forward.
I did not want to go back.
And I was angry.
“Sometimes that happens?”
Sometimes that happens. Sometimes you lose your mind.
When I was lying on the floor in the living room, clutching my knees to my chest and losing my mind, I kept repeating the same phrase. “No one told me. No one told me. No one told me.” It was my mantra of blame. When I left her office in early May, she gave me my marching orders and wished me good luck. We’ll see how it goes, she said, with nary another word, except to say thank you when she took my check.
Doctors of all stripes are eager to talk about all the good things that psychiatric medication can do, and they’re not lying – I believe, truly, that for millions and millions of people, these little pills make all the difference when it comes to living a normal, functional existence. But, in myexperience, with my doctors, I felt like it was a story told with rose-colored glasses. No one talked about the consequences, the dependency, the withdrawal – the raw stakes of mucking about with mind. And by the time I realized the danger, truly realized, I was a muddled mess.
It’s easy to project all that anger on everyone else, but let’s not kid ourselves – when it came right down to it, I was also plenty angry at me. I felt how my body and mind reacted as I transitioned between medications; how Celexa wound me up, how Prozac wound me down, how Wellbutrin made me break out in hives, how Celexa made me endlessly grind my teeth. I saw what happened after I missed a single dose of Cymbalta. I was there for those things. They happened to me, and each and every incident along the road should have been a giant, red, flashing, neon warning sign that I was playing a dangerous game. Instead, I was content to be glib about both the pills and the process.
Why? That’s a good question. Because I had a prescription. Because my doctors didn’t seem concerned. Because, for a long time, the medication felt like it was doing something, even if that thing was vague and shapeless and hard to quantify. Why does anyone ignore potential consequences for present results? Because we’re selfish and short-sighted.
In the end, I opted for retreat. The next morning I went back to my 60mg dosage. On that day, I decided I needed a new psychiatrist, and I through a recommendation, I got one. Together, we concocted a new plan. Slowly, surely, I would reduce my medication by 10mg every two weeks until all was done. With a bottle of 30mg pills and a bottle of 20mg pills, I played a sort of adding game. A 30 and a 30, a 30 and a 20, a 20 and a 20 – things didn’t start to get interesting until I dropped down to 10mg. This involved corking open a 20mg pill and trying to spill exactly half of its insides down the sink – something that is about as difficult as it sounds.
As simple arithmetic will tell you, my metered journey from 60 to 0 took 12 weeks. There was no crying or wild mood swings; no Brain Zaps or floating – I was copacetic. I was A-OK.
And then, one day in early September, I woke up, took a shower, shaved, brushed my teeth, and walked out of the bathroom without taking a pill. A little thing, but a big thing.
That was six weeks ago. It still feels weird, having dropped that part from my morning routine. I still feel flashes of panic. Oh no! I forgot my pill! And then I remember. I remember that I’m done.
In some ways, I feel like maybe I’m writing this too soon. To provide closure, to provide a satisfying narrative arc, I should be able to answer the questions I set out to answer. Do I still need to take these pills every morning? Why did I start taking these in the first place? What did I find at the end of the rainbow? The answers to all this is, honestly and truthfully and Hand to God, I don’t know. I’m decompressing. I’m gaining perspective. I’m mulling – but it’s just too soon.
From the hip, here and now, I feel like Cymbalta rounded the corners, if that makes any sense. Cymbalta turned the volume down. It took the sin wave of emotion and chopped off the top and the bottom, for better or worse, and here, on the other side, everything seems louder and more amplified. I cry more. I laugh more. I feel the tightening grip of anxiety in my chest, the sheen of sweat on my brow, and I grimace – but I smile, too, because it feels familiar. Something I lost. Something rediscovered.
I don’t know if that’s good or bad. I don’t know if I’m better or worse. Right now, I simply am. The journey down this path was eye-opening and frightening, but the journey is finished.
We’ll see what the destination is like. I haven’t been here long.