• The Resolution Issue

    Serotonin Diaries

    The Resolution Issue

    Depression is incredibly common, yet our pain always feels singular: no one has ever felt this bad.

    Serotonin Diaries

    On meds I no longer worried that I was evil, but my suffocating thought loops still centered around the idea of having a dark secret; of, essentially, discovering I was alien to myself.

    A few months ago I became more depressed than I’d ever been. I had tapered off of Sertraline (the generic version of Zoloft, a popular antidepressant) in the summer after seven years of near-constant use, save for an extremely brief, unmedicated stint during my senior year of college. This experiment would prove to just outlast that one.

    Though initially prescribed a Selective Serotonin Reuptake Inhibitor (SSRI) to treat anxiety, it was depression that enveloped me when I was done with the last of my cut-in-half, then quartered, pills. Of course, depression and anxiety are cruel first cousins; they tend to bleed into one another like tea submerged in hot water before it’s stirred, distinct but not for long. I will say, though, if I’m afflicted that bad again, I would choose anxiety as the primary tormentor. It could be because I now feel further from one than the other, but still as miserable as I was, I never felt I wanted to die, earnestly, when I was paralyzed by anxiety, as I did when I was by depression.

    Defeated and in the throes of the worst of it, I went back on my medication in January. And that’s how I think of it, how I speak of it — not as a medication but mine. This is in spite of the fact that, according to The New York Times, twenty-five million adults in the United States take antidepressants, and 15.5 million of those adults have taken them for at least five years. More particular to my identity categories, the New Yorker tells us, “Today, antidepressants are taken by one in five white American women.” To consider these numbers claws at my sense of autonomy; I feel at the mercy of pharmaceutical companies that have successfully marketed little-understood, brain-altering chemicals to a staggering number of people, who now depend on these chemicals for psychological stasis without a complete picture of potential risks of long-term use. And yet, I hate reading articles that criticize medication use in anxious or depressed adults, that point to overuse in women or that imply SSRIs dull our inner lives, making us less distraught but more numb versions of ourselves. All of this may very well be valid and true (for some people more than others), but I feel about my medication the way I feel about my family: I can question, malign, or trash-talk it, but you cannot. This is, obviously, because of how fraught my relationship with medication is. In spite of its ubiquity, I need to feel some sense of ownership over it, some sense of possession and uniqueness in my own experience, because that is also how anxiety and depression feel. Though undeniably common and afflicting millions, one’s own mental anguish feels singular: no one has ever felt this bad. And under duress, I’ll do anything to stop it, including returning to a pill I disavowed just months earlier.


    I don’t know how to reconcile my return to medication with my desire to be unmedicated. Going back on Sertraline was a blow to my hope to not be on it forever, though what forever means, I’m not even sure. I don’t know if I want to be medication-free because of some abstract idea of what a real self is; I can make the intellectual argument to myself that this makes little sense in a world where we constantly consume mind- and body-altering products, many with effects we’re not even aware of. Still, there remains something unsettling about knowingly altering my brain chemistry every day. Happiness, too, isn’t enough of a marker to strive toward, as I often don’t feel happy even on medication. Andrew Solomon writes, “The opposite of depression is not happiness but vitality,” and that is where I land. I want to want to live. I want my desire to build my life, to be with the people I love, and to create things to outweigh the strictures in my brain — so tight and self-flagellating they make thinking, the only thing that moves me forward, impossible. I want freedom from a mind in flames.

    I found the Solomon quote in December, during my periodic research on depressed writers; feeling so low, I found it comforting to read about others’ losses of self. Comforting but alienating, as I was reminded of their successes in working and publishing even in the face of failing mental health. I was hyperlinked to the essay it came from, a famed New Yorker piece, but had to stop reading before I reached the point where he actually said it. I closed my computer close to the end, when he remarks, “I wonder constantly whether these experiences have served any purpose.” I had already sat through his frightening case studies of medication-resistant depressives, and his own experience altering his medications only to find that what once worked for him no longer did. It stoked my new fear that even if I were to go back on my meds, they wouldn’t work. I couldn’t bear to consider that on top of going through this, my experience would prove to actually be as meaningless as it felt. Ironically, after the point where I initially stopped reading comes the only part of the essay where Solomon allows that the ubiquity of medication may be a problematic response to the pathologization of what were previously considered normal emotions. He asks, “Is the grand-scale social experiment of eliminating a state from the human mood spectrum dangerous?”

    Like Solomon, I too have many times, “reached a strange point at which I could not see the line between my own tendency to theatricality and the reality of my illness.” Am I just being dramatic? There is much discourse around the need to take mental illness seriously, to treat it with as much urgency as one treats physical illness. There is less discourse, at least in my circles of those who already do take anxiety and depression seriously, around the currency that goes along with proclaiming oneself ill. It can become a pissing contest, of sorts; while all of our sicknesses are real, who has it worse? Who is less functional? I remind myself and others of how long I’ve struggled with this, on and off, in order to make it feel real, to prove I’m not just seeking attention, or am garden-variety unhappy. But then doing that, recounting it all, writing about it here, in and of itself feels pathetically attention-seeking. The truth is, being profoundly unhappy is garden variety, and maybe that’s the point. There isn’t anything unique about being depressed, any more than having a nose is unique, or having sex. Nonetheless, here are my experiences.


    In a Religious Studies seminar I took in college, my favorite professor asked us to recall our first encounter with evil, experienced in practice or learned as a concept. Some shared personal stories of bullying or abuse; others described watching footage of the twin towers falling on 9/11, or learning about the Holocaust in school. I remembered my childhood anxiety. What remains clearest in the haze of memories from those bleak and alienating nights is thinking I was evil in some way. I was unable to distinguish between myself and those who committed evil acts in the world. I didn’t understand how people felt certain they wouldn’t kill other people or otherwise cause destruction. This fear of the self and my lack of control over it manifested in many ways. I obsessionally wondered if I might hurt myself or others, and as anyone with obsessive thinking patterns knows, obsessing over something is a surefire way to convince yourself you want to do that thing. Otherwise, why wouldn’t you be able to stop thinking about it?

    I heard a story in the news about a person who committed murder in his sleep, and wondered if I might do that, too. For a time, I slept with my overhead light in my room on, fluorescently bright, because the dark simply made my thoughts close in too much. I still can’t sleep in total darkness unless another person is beside me. My nights in elementary school followed a pattern, in which I would try to withstand the onslaught of frightening questions in my brain, and either succeed, or sneak into my sister’s room to sleep, or wake my parents, desperately ashamed. I remember one night, in particular, having laid awake for what felt like hours but was perhaps much less, I got out of bed in search of my father who I knew was still awake somewhere in the house. I found him in his office, climbed on his lap, and confessed that I couldn’t stop wondering if I wanted to slit my wrists. I remember his alarm, asking, did I want to? I didn’t know how to explain that I truly didn’t know; I could not distinguish my intrusive thoughts from reality. If I thought about something enough, would it become real?

    My parents found me a therapist who was also a psychiatrist, and she suggested medication. I wish I remembered more about my sessions with her, but I only recall crying that first day and being struck by her use of the word “weeping” to describe my tears. At ten years old, I took Zoloft (there was no generic back then) and continued in therapy for about a year, before I felt recovered, weaned off the medication, and went on to middle school. My therapist suggested the SSRI would reset my brain — that I had gotten so deep into certain thought patterns, I needed them to be externally disrupted, re-circuited in some way. This would allow me relief enough to be able to step back from my thoughts and examine them in therapy, wading through their irrationality. She was right; our work together worked, though I don’t recall exactly how.


    My anxiety, reasonably at bay for many years, resurged in full force at nineteen, and I went back on Sertraline, the generic version of Zoloft. I no longer worried that I was evil, but my suffocating thought loops still centered around the idea of having a dark secret; of, essentially, discovering I was alien to myself. For the first month of my re-medication, I took Clonazepam (the generic of Klonopin, a benzodiazepine that quickly alleviates anxiety symptoms) every day, too, as SSRIs can take a month or two to kick in. This and therapy pushed me forward again, and I stabilized for years. For all of those years, I lightly resented being on medication and toyed with the idea of going off of it. I never felt flattened by medication the way some people describe; I merely felt normal. I still felt able to access the full breadth of my emotional experience. Anxiety never felt emotional to me--it was the opposite. It clouded me from feeling. It was all-encompassing but empty, like turning out the lights in a room before your eyes adjust. No meaningful shapes can be made out, and suddenly there is only a wild, intangible panic.

    On medication, I felt fine. I wondered, though, if I would feel fine off of it too. I wondered this often, privately and aloud, as I’m sure almost anyone on psychiatric medication does. I expressed ambivalence to the people around me, to varying responses. I went through phases of feeling defensive of SSRIs, of calling what I had a chemical imbalance, insisting it was all entirely scientific and therefore justified. I went through phases of feeling my anxiety was a result exclusively of external factors, of being (I arrogantly claimed) simply unable to adjust to life under capitalism. I felt both; I felt neither. It’s the galaxy brain: anxiety isn’t chemical and medication is bad; anxiety is chemical and medication is good; anxiety is whatever it is but medication is a product of evil companies and is bad; anxiety is whatever it is and it’s okay to do whatever you need to do to survive. But then, how did I want to survive, became the question. Just out of college, I told my then-boyfriend I wanted to try stopping and he encouraged me; he said he’d help me not to be anxious. It was a beautiful idea. But I didn’t do it. It hadn’t been long enough since my last effort to stop, and I was suspect of my own stability. Sweetness can only go so far.


    This past summer, I felt ready. I was reaching my late twenties and facing the reality that I’d been medicated for most of my adult life. I was curious to know how being medication-free would be and confident enough that, though I might falter, I would feel largely alright. I was wrong. Mental pain is akin to physical pain in the sense that the sufferer can think of little else but it. To describe what happened feels trite — crying mindlessly on the train; waking up filled with dread; losing my appetite entirely; feeling as the sun went down that I went down with it, and might not ever rise again — but I had rarely experienced the fog of true melancholy this way. A fog that descended and lifted at unpredictable times, but that, when enveloping me, left me to see no way out of my despair. I could think of nothing but my hopelessness, feel nothing but a dull, anguished certainty that things were not, and would not be, okay.

    In this fog, I was unsure why I ever went off medication in the first place. I felt stupid. Unfortunately, a primary thing one feels when depressed is, acutely, stupid. Stupid in the sense that your brain doesn’t work the way you want it to; memory, words, and the ability to pay attention jumble, weakening your cognitive faculties. Stupid, also, in the self-loathing and self-blaming sense, as in, every decision you made that led you to this point was painfully, deeply, wrong. I was lucky enough to never suffer the common side effects others tend to experience on SSRIs, and cite as reasons to cease their use; my sex drive remained unaffected, my sleeping as strange as ever but no worse. Now, without them, I felt at best, barely managing, and at worst, completely unraveled. I somehow wrote and published an essay during this time, but still felt terribly sad that evening. I took this as cold comfort I wasn’t making it all up, as proof that something inside me had broken, and wouldn’t be fixed by external affirmation. I found a sick satisfaction in proving the realness of my depression to myself, in plumbing its depths. I was impressed with nothing about myself but my capacity for what seemed to be self-inflicted pain. In the throes of a fraught conversation with my current boyfriend about my condition, I said, “I remember that I’m not always like this, but I’m worried you won’t.” As the weeks went by, even this knowledge became lost to me.

    I knew my situation was untenable when I began to have intrusive thoughts about suicide. They reminded me of my uncontrollable childhood fantasies, but feeling so bleak, it was harder to discern their character as random unwanted images versus expressions of a different kind of motivation. Intrusive thoughts are characterized by the thinker’s distress at having them. They are violent, graphic, or otherwise disturbing, and seem to come from nowhere; people with intrusive thoughts fear that having such thoughts means they will act on them when the thoughts are actually meaningless. This was my experience in childhood, but as a depressed adult, I wasn’t so sure. It became hard to distinguish the feeling that things would not get better from the fleeting, almost flippant feeling of wanting to die and to distinguish the fleeting feeling of wanting to die from a more active desire to render oneself gone. Were visions of myself dead at my own hands the same as previous fears that floated into my head unbidden, indicating nothing but an overactive imagination, or were they a rational extension of wanting these painful feelings to end at all costs, including the ultimate end — to not feel at all?

    These thoughts scared me, and I didn’t want to find out what would happen if I kept trying to fend off my darkness without pharmaceutical help. I began again on Clonazepam and Sertraline, flooded with disappointment and relief. It’s been almost four months and I feel remarkably better; my psychiatrist called my response to the medication “robust.” I feel strange that I feel better. I wonder if my moods would have leveled off if I’d stuck it out. More continues to be written about the difficulty of weaning off antidepressants; how little research exists on the best ways to taper off; how many people have taken their so-called de-prescribing efforts into their own hands, making their own liquid doses so as to decrease by a milligram at a time, so much so that it’s become an informal, virtual industry unto itself. Perhaps what I was experiencing was not necessarily depression but withdrawal. I’m thankful I was treated at a young age but sometimes I feel cheated; I wonder if I would still be so dependent on these drugs if I hadn’t trained my brain to rely on them so young. But then, I think of how what I experienced as a child was sheer relief. After I went on Zoloft, for the first time in my living memory, I wasn’t afraid of myself. It felt like magic.

    I feel flashes of the well I fell into still; there are days when I feel a prolonged pain but also a blankness, which is, to me, the worst combination. I’m back from the void but I know how big it is, or rather, through descending into a small part of it I can imagine how much further it might stretch, how much farther I might fall. I don’t know what to feel, other than grateful for this knowledge--I generally think that having a visceral understanding of why someone might not want to live makes a person more compassionate--and consistently alarmed that a tiny, chalky corporate entity has once again taken up residence in my bloodstream, for an indeterminate period of time. And considering it all just feels like an answerless loop, like depression itself.

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