The Stress Doc swings open the door of his depression closet documenting his initial experience taking antidepressant medication. There definitely were some vivid, manic moments and some startling, ongoing effects. Let's just say the Doc has a new appreciation for the "c"-word.
Trial By Prozac
Well folks, after several steps out of the depression closet, we're into the homesketch. As outlined previously, five years ago, an acutely depressing period of my life - intense pressure as a Postal Service stress consultant, loss of a major consulting contract, the sudden death of a beloved uncle - finally compelled me to face my chronic low (and, occasionally, not so low) grade depression. Recently, I noted contributing factors for my resistance to an antidepressant meds trial - from psychiatric family history and misguided, neurotic false pride to fear of a psychotic reaction along with the loss of my primal pain and passion.
The Prozac Plunge
In my mid-40s, I had hit bottom; I couldn't willpower my way out of the latest black hole. Maybe a lifetime of creating and combating stress really does take a toll. I stopped fighting my resident psychiatrist's recommendation. Of course, this was also a sign of therapeutic progress. I was less defensive about the issues of depression and medication. Anyway, with prescription in hand, I then nervously passed it to a pharmacist, carried home the mysterious green and beige capsules...and popped my first 20mgs of Prozac. (Prozac enables serotonin to linger longer between brain cells, improving the chemical's efficacy. Serotonin plays a role in sleep, apetite, self-control, aggression and anxiety, in addition to effecting mood states. Prozac and its clinical chemical cousins - Zoloft, Paxil - have been likened to anti- inflammatories for emotional pain.)
Twenty milligrams is the basic starting clinical dosage. Typically, one is told that it can take two or three weeks before the antidepressant effects kick in. Within a couple of hours I knew I had ingested something unprecedented. Sort of like Alice's "eat me" encounters while falling down the hole in her early, madcap adventures through Wonderland. Things were getting "curiouser and curiouser." First, there was kind of a buzz. Then, after a day or two, I realized I was not having such pronounced sleepiness after eating. I had always attributed this to low blood sugar. Hmm, maybe there was a serotonin-related chemical deficiency after all?
Manic Moments
Within a week, a couple of dramatic symptoms appeared. I was recalling very vivid, violent dreams. One involved stabbing a father-like figure. (My father, as many readers know, has his own history of clinical depression.) Yet, I didn't feel malevolent or enraged. More like a psychic part needed to be killed off for me to explore fully new possibilities and paths. As the artistic genius Pablo Picasso observed: "Every act of creation is first of all an act of destruction."
Then, a couple of weeks later, on my yearly retreat to see the Fall colors in the mountains of West Virginia, I had a momentary scare. My thoughts were flyng. I was probably a bit hypomanic. In fact, a friend had commented around this time that he thought I was more aggressive than usual. I knew I was feeling a bit more energetic. What was his problem? Why was he uncomfortable with my more animated, dynamic self?
Fortunately, my retreat was in a remote bed and breakfast known for its mountain view and clean, crisp air. Gum drop trees on sloping sides as far as the eye could see. Out my window, ducks paddling in a babbling stream. Sheep enclosed in a pasture. A quaint wooden bridge connecting the rooms to the smoke curling out of the chimney Beekeeper Inn. The enclave in Helvetia certainly lived up to its mountain moniker -- "Little Switzerland." Being embraced by this pastoral panorama, I realized racing thoughts were likely jump started by the Prozac. I reassured myself that this was a mind-body system adaptation to a biochemical changing of the guard. My little alpine- like eco-cradle gently rocked away the mania while nurturing my newfound energy.
Lasting Side Effects Trinity
However, there were some ongoing side effects. Let me itemize:
1. Sleep. Many people when depressed have difficulty getting up in the morning. Sometimes this is due to staying up late at night or an inability to sleep through the night. (Do you know all the best buys at 3am on the QVC home shopping channel?) But for someone like myself, with a long-standing "agitated depression," getting up in the morning wasn't the problem. I would get up at six or seven am and be at my desk writing two minutes later. I never understood why people needed coffee as a catalyst. Of course, anxiety- propelled fuel would burn off pretty fast and I might feel sleepy or exhausted before the morning was out. (Who would have imagined that this was an aspect of a depressive cycle? I just thought the shutdown was a brainstrain by- product of creative "sturm und drang" or aerobic brainstorming. Ah, once a narcissist...)
With the Prozac, however, my sleep cycle was turned upside down. No longer was I sleeping through the night. I was waking, though just one time, usually in a REM cycle. So that was a positive - greater access to my dreams. And getting back to sleep was pretty effortless. I could live with these developments.
However, the most disorienting and disturbing change in sleep pattern was actually related to my waking pattern. For the first time in years, I was having difficulty getting up in the morning. Of course, I could recall years where high anxiety about school - from grade school to grad school - had me cowering under the covers. Now it seemed I was doing an Alfred E. Neuman, "what me worry" imitation: the Prozac had me feeling less agitated and obsessed; I lingered in bed enveloped in a drowsy, languid, "manana" haze. But once the haze lifted, I hated the fact that I was no longer hitting the floor running. My Type A New Yorker survival instincts were being chemically manipulated and suppressed. There was less depression but new frustration. This effect could not just be pushed to the side.
2. Sex. It's true. Prozac does diminish one's libido. Even occasional masturbation was losing it's attraction. However, this phenomenon evoked a meaningful insight. For years, I had been compulsively engaged in aerobic exercise (for the endorphins), high risk-takig career pursuits - the mass media, public speaking, violence prevention (for the adrenalin) and the romantic chase and sexual fantasy (for the testosterone and dopamine). Shoot...if I was working this hard to alter my body chemistry, was I unconsciously trying to self-medicate? Maybe there was a message: perhaps I was starting with (or had evolved) an abnormally low resting hormonal level, at least as it effected my mood state.
Returning to sex, I must say, even with medication, when engaged in the real thing, everything was just fine, thank you. (If Viagra, the new male potency drug, had been around back then, I wouldn't have been a candidate.) In fact, I remember saying to a partner in regard to my anatomical functioning: "Stronger than Prozac!" And while ejaculation time was a bit delayed during my 20mg phase, I don't recall any complaints. ;-)
I can't resist one final musing. What about a scenario where Prozac and Viagra, are on the same playing field, as it were? Is this a case of an "immovable object" vs. the "irrisistible urge," I mean "force." Or, is it an "irrisistible object"? That male ego never rests! And will a reluctant, yet opportunistic, spouse demand a pharmaceutical quid pro quo: "I'll let you take Viagra if you finally get on the Prozac"?
3. Chocolate. Believe it or not, upon taking Prozac for the first time, I found myself salivating over real chocolate. Previously, I was clueless regarding the existence of "chocoholics" or why people would mail greeting cards, "Things are desperate. Send chocolate." Though I had experienced faux chococolate cravings. About a dozen years earlier, a girlfriend created a surprise birthday confection. She made white chocolate truffles, with almond liqueur and bits of maraschino cherry....Wow! Turned on by the impostor and not the real thing...I should have known my biochemistry was all screwed up.
In summary, while Prozac startup had it's challenging moments, anything that has some liberating effects upon sleeping, sex and chocolate eating patterns can't be all bad. In fact, it can be pretty miraculous. Nonetheless, the right chemical, psychological and social balance may still need to be discovered. And next time, I will conclude with personal and professional insights gleaned from my supervised, yet adventurous, experimentation regarding the appropriate dosage, use and value of antidepressant medication. Until then, of course...Practice Safe Stress!
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