by Mark Gorkin, "The Stress Doc" ™

 Lately, I've been contemplating intimate relationships, especially the transition that occurs over time, whether by volition and/or attrition. And invariably questions arise concerning autonomy and dependency, reality or illusion along with the security of constancy and the risk of change. Hmm, or is I the risk of constancy and the security of change? And with the gnawing of a self-imposed quandary, an inspiring Muse for courage I ventured forth into the lyrical lion's den. (Where’s Russel Crowe when you need him?)

So here’s an overdue tribute to a longtime partner that also grapples with complementary personal conflicts at the commitment crossroads:

a) the fear of entropy or "death fear" – pioneering Psychoanalyst, Otto Rank’s fear of being consumed, controlled or overtaken by another and

b) the fear of exploration or "life fear" – the fear of being overwhelmed or disoriented by emptiness, isolation and alienation.

Consider the uncertain and dangers and transformational opportunities in…

It was chemistry at first sight
More precisely, first bite
Between you and me.

How you muted the pain
Redesigning my brain
It's a mystery.

Such a shape sleek and slender
Can one befriend her
Without surrender
Emotionally?

If I trust you my Muse
To seduce those old blues
Will I still refuse
The valley and shadows of intimacy?

My eyes close and we're close
But where is your heart pulse?
Poof...Are you that real ghost
Of dependency?

Yet, dearest Miss P
When tears couldn't stop
With fear over the top
When I felt like a flop

About ready to drop...
You then rescued me
From that lonely black hole

You unearthed my true soul
Now is there self-control
Or more fantasy?
No, you mirror my eye

Look, sweet tears when I do cry
As you ground my sky high
At least let us fly high
Through poetry.

When rage couldn't stop
With fear over the top
When I felt like a flop
About ready to drop.

Oh my dearest Miss P
Despite all of the flack
From my manic attack
On your white or black track...Still

If I should wander
Angst-ridden and ponder
Just don't let us crack...up
Oh please take me back...up.

With your magical sauce
Is it you and me, boss?
My crown and my cross
Is there no going back?

Once making a pact
With that alchemical genie
A lily so dreamy
Will you ever wean me
Miss Lady Prozac?

Okay, now let me come clean. For six years on Prozac, I’ve periodically raised and lowered the dosage as needed, to a current level of 10mgs once/day. 20mgs is considered the baseline clinical dosage. And while the benefits have far outweighed the side effects, gradually, dissatisfaction increased with the periods of drowsiness during the day. Then a fairly recent article on the use of antidepressant medication in the

"Health" section of The Washington Post disturbed my consciousness and complacency. The essay emphasized that for a number of patients effective intervention (in addition to psychotherapy) involves a medication regimen that targets some combination of the three main neurotransmitters that affect the depressive mood state. The article likened the optimal functioning of Serotonin, Dopamine and Norepinephrine as creating psychic harmony among "The Three Tenors" – Lucianno Pavarotti, Placido Domingo and José Carreras. (I recall a friend, years back, insisting that my "Shrink Rap" singing – talk about an oxymoron – had dramatically improved on Prozac. ;-)

The functions of these psychopharmacological tenors: 1) Serotonin targets anger and worry, 2) Dopamine stimulates initiative and pleasure and 3) Norepinephrine primes energy and alertness.

As I mentioned, Prozac has been my Serotonin supplement for years. So I definitely had some anxiety about rocking the biochemical boat. Still I began wondering about a medication that could both continue the Serotonin neurotransmitter presence while enhancing Norepinephrine’s brain wiring and massaging functions. As a booster of integrating hi-tech and hi-touch (I especially like the massaging part), as well as a cautious ally of the upgrade philosophy, I was tilting yet ambivalent. And then a client of mine, in consultation with a psychiatrist, started a trial with an antidepressant med that targets both of the above neurotransmitters. The new post-Prozac generation drug is Effexor.

After conferring with my doctor, we set up a trial – stopping the Prozac and starting the Effexor combo. A month later, I’ve had no Prozac withdrawal effects and the drowsy drugged state appears to be receding in intensity and duration.

So now you have a better understanding of the context for "The Alchemy of Miss P." And, of course, I’ll keep you posted on subsequent adventure trials, tribulations and triumphs. For now, a final moral: Sometimes it’s important to change "it," if not "fix it" even "if it ain’t broke." This approach is a modus operandi for psychological growth, not simply biochemical survival. And surely, it’s also a strategy for helping us…Practice Safe Stress!