Vitamin P (Prozac) and the Big D (Depression)

My bio blurb says I will be writing about every object from "pill bottles to pillow cases, from death notices to DVDs." It's time to make good on part of that promise.

Like most Americans, I have all sorts of bottles full of all sorts of pills: Advil, Tylenol and Excedrin for the occasional muscle or headache; Zyrtec for allergies; and a daily dose of Doxycycline to keep my rosacea in check. But the most significant pill bottle contains my Vitamin P, my "happy pills," AKA Prozac, which my insurance covers only in the generic version, called fluoxetine.

Depression runs in my family. My mother had undiagosed depression for much of her life. My younger sister took her own life at 17. My grandfather was an alcoholic, which might have been his way of numbing the despair that comes with depression. To name just a few.

I have not been immune. When I was a child, I had wild mood swings and temper tantrums. As a teen and young adult, I had periods of the blahs (or, more formally, anhedonia). But I didn't suffer my first full-blown depression until I was around thirty.

It's a long story, so I'll try to tell the short-hand version. Not long before my ex-husband finished medical school, I found him on the bathroom floor in a drooling stupor. He had smoked an experimental drug he was researching in his lab. He spent 10 touch-and-go days in the hospital, during which I didn't know if he would survive or regain his mind.

Matt did recover and I learned that he had been secretly using drugs for years. (Full disclosure: We both experimented with drugs in high school, but I outgrew it in college. He didn't. Instead, he just went underground.) After Matt's overdose, we thought his career was over. Amazingly, he was offered an internship in his first-choice program, which was in Los Angeles. We were living in the Mid-West, and I was loath to move. I had a good job, I was in grad school, and we had already moved 8 times in pursuit of Matt's ever-changing career goals. What's more, we would have to go to yet another city for Matt's residency. So, we agreed that I would stay in the Mid-West and visit LA when I could.

After Matt left, I learned I was pregnant. With Matt both geographically and emotionally distant, I went through the pregnancy alone. I queried friends, found an OB, shared the news by phone with my sister and mom. Then one afternoon around the third month, I noticed some spotting. Matt and my doctor both said not to worry, that spotting was common. But that evening, the bleeding began in earnest. On the phone, Matt sounded concerned and worried, but he didn’t have much time to talk. That long, lonely night, I lay in bed, cramping and sobbing, as my baby bled out of me. The next morning, when it was over, I asked Matt to come home. He refused, saying that asking for time off would jeopardize his standing in the internship program.

A day or so later, a friend drove me to the hospital, where I had a post-miscarriage surgery. I never felt so alone, sitting in a blue recliner in the tiny private waiting room, wearing my hospital gown and nubby-bottomed slipper socks, or in the recovery room, where the nurses made soothing noises and wrapped me in heated blankets. Shortly after I lost the baby, I put our furniture in storage and went to California while Matt finished his internship.

He was living in a tiny converted garage. It was in this dark, wood-paneled room that I spent most of my time, sleeping, watching TV, and perseverating. I remember little about those months except that most days I counted it a victory if, after hours of thinking about it, I managed to get up and walk to the mailbox by the front door. Matt worked 36-hour shifts, but when he was due home, I would rouse myself, take a shower, and fix something to eat. This was in the spring of 1992, and toward the end of our California sojourn, the cops who had been taped beating Rodney King were acquitted. I watched the riots on television, venturing out in the smoke-filled city for groceries, shocked at the eerie sight of military tanks and armed soldiers on the streets. It seemed a fitting backdrop to my own mental siege.

After Matt's internship, we moved again. But the geographical change didn't lessen the grip of my depression. Finally, I went to a psychiatrist, who recommended an anti-depressant.

I was skeptical and reluctant. Prozac felt like a failure. Why couldn't I just buck up and cope? And too, as a writer, I was worried that it would turn me into an emotionless automaton, that it would sap my imagination. (Name five of your favorite authors, and I'll bet three of them were depressed, alcoholics, or depressed alcoholics.) I was as surprised when the drug actually worked. Within a few weeks, the shadows lifted and I felt that life had a purpose, that I had a future. It didn't solve all of my problems--it didn't bring back my baby or improve my marriage -- but it also didn't flatten my moods and stifle my creativity as I had feared. It simply lifted me out of that trough of depression and set me back on level ground. I stayed on Prozac for about two years, then tapered off. And for a long time, I was fine without it.

My second full-blown depression came several years later, again sparked by trauma. For brevity's sake, I will simply say that while I was again pregnant, Matt had an affair and got the woman pregnant. I lost my baby (my fifth and final miscarriage); she had hers.

One thing about depression is that you don't feel like you deserve to be treated well. But even I had reached my limit. I asked Matt to leave and began divorce proceedings. But I also sank back into a debilitating depression.

By this time, I had been attending Al-Anon for seven years. People in AA and Al-Anon share one thing in common with Scientologists: their disdain for anti-depressants. There is an outspoken contingent of amateur psychiatrists in AA/Al-Anon who insist that people who take these drugs are failing to truly "work the program." My Al-Anon sponsor and her husband, who was in AA, shared this view. To them, Prozac is a crutch. It masks underlying problems that can only be dealt with by rigorous honesty and by "letting go and letting God." So, I resisted going back on Vitamin P. I convinced myself that my depression was only situational and would recede as I got more used to my new reality and kept trusting in a higher power. But after a year went by, I knew I had no choice.

It was the semi-hallucinations that did it. Usually these involved various sharp objects slitting my throat. I call them "semi-hallucinations" for want of a better word. I knew these flashing images of butcher knives, scissors, saws, or guillotines slashing my throat were not real. I didn't "see" them like one sees an actual object or a photograph. And they weren't like the few hallucinations I had in my wayward, drug-using youth. Nor were they ideations: I had no conscious intention of actually hurting myself. (I have lived under the protective knowledge that I could never do that to my parents, who already lost a child to suicide, or to my sister. And besides, if I ever did kill myself, I would never choose such a messy, painful method.) These semi-hallucinations were just fleeting images that flitted across my mind in a nano-second and then were gone. But they were happening more and more often -- dozens of times a day -- and they were scary. I needed help.

I went to a psychiatrist, who put me back on Prozac. Once again I got better. Day after day I had struggled through low moods and energy levels, a sense of worthlessness, racing thoughts that looped all night like hamsters in a wheel, preventing me from sleeping, and all those slashing, hacking knives. The Prozac took most of it away. I still had to do the hard work of the 12 steps, still had to practice rigorous honesty, still had to learn how to let go of resentment and bitterness and my need for control. I am certain that the insight and skills I learned in Al-Anon are essential to my happiness and perhaps to my very survival. But so too is the decision to treat my depression.

Although my depression was kick-started by trauma, I know it is a physical disease, an imbalance in brain chemistry. I have read the scientific literature on depression, but that's not how I know it's true. I know this from the inside out. I have experienced it.

I've also learned that people who have suffered more than one serious episode of clinical depression often have to stay on anti-depressants for the rest of their lives. Always a bit of a rebel, I've tested this theory. From time-to-time, I've gone off of Prozac for a few months, but eventually, my depression always creeps back...not the full-blown, knock me off my feet variety where I can't even get out of bed, but the low-level, droning depression, where life is sucked of all energy, where my mind is filled with negative self-talk and racing thoughts . Frink can always tell when I have gone off my medication. I have learned that I am simply healthier and happier when I take it.

So, while I may be a member of the derided and criticized "Prozac Nation" and considered a backslider by the Al-Anon crowd, at least I am alive and, for the most part, happily so.

And that's the story of my pill bottles. Now, about those pillowcases.....

Update 5.12.09 -- Here's an article I just found about the efficacy of anti-depressants. I guess I am in the subset for whom they work; I don't have a substance abuse or personality disorder (that I know of).