Uncomfortably numb — (The Globe and Mail)

SSRI Ed note: Talented writer describes her loss of emotional response while taking antidepressants.

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The Globe and Mail


March 13, 2008 at 9:28 AM EDT

Have you ever tried Ecstasy, or heroin? How about Xanax, or Placidyl, the sedative on which former U.S. Supreme Court chief justice William Rehnquist was reported to be heavily “reliant” for nine years? Any of the opiate or sedative drugs will lend you a sense of how my druggy relief was immeasurably sweet at the start. It felt heaven-sent. Waking up in the predawn hours, in the peaceful silence of my home, I felt a profound sense of safety. My children were sleeping soundly; the city was at rest. All were joined in an unassailable purpose: to lie vulnerably down and to snooze. I was a citizen of Whoville on Christmas Eve, with no inclination to suspect the coming mischief of the Grinch. I treasured this early morning serenity. It was some kind of gift, in those first weeks on an antidepressant.

Alas, the sleepy sense of glory was brief. As my grief faded, the intense treasuring of peace began to fade too. After a spell of three months or so, I realized that I had come to feel nothing much, one way or another. Everything was fine, the way a tidied house is fine. Splendid, we’ve cleaned up the mess. So … now what? How do we proceed to inhabit this showroom?

I began to live in an emotional half-light, a state of being that was secure and yet largely disengaged. It reminded me of my sojourn as a bureaucrat in the mid-1980s in my first job out of college, when I took a position at Ontario’s Ministry of Labour, ghost-writing letters for the minister.

“Dear Person Whose Leg Was Mangled in a Wood Chipper,” I would type on a typical day, “thank you for your letter protesting that the Worker’s Compensation Law is a ‘total joke.’ I have forwarded your concerns to the appropriate department and asked them to respond to you shortly.”

Patricia Pearson, author of A Brief History of Anxiety (Yours and Mine), says that while she was medicated, she began to feel faintly sociopathic, and that a kind of apathetic insincerity came to define her existence. (John Morstad for The Globe and Mail)

I did not enjoy this ghostwriting job, mostly because I spent the day responding to genuine human calamity by (a) pretending that I was someone else, and (b) lying. Yet, it was effortless. Paperwork and coffee breaks and lunch, all at a placid pace. I watched the clock a lot, waiting for it to hit five. “Dear Widow Whose Husband Drowned in a Vat of Toner at the Wallpaper Factory, thank you for –” Oh, five o’clock, gotta go.

This kind of apathetic insincerity came to define my new existence on Effexor. Pay the bills, oversee the children’s crises in a faintly exasperated manner, hug the husband, breeze around doing this and that. I’d watch movies without being stirred by them, listen to music without real interest. In truth, I began to feel faintly sociopathic.

“The self that emerges from a depression through the use of Prozac,” notes Alice Bullard, using the word Prozac generically to refer to all of these drugs, “is a mystified self rather than a mystical self. The drug offers a small island in the abyss; a bit of land in the deep chasm into which one’s soul is disappearing. Slowly this bit of land grows until the abyss is covered over – covered over or filled in? What happens to the abyss? Is it simply hidden behind a facade? Can this ‘land’ built with drugs be real? If so, what is the nature of its reality?”

Reading Bullard’s words, I was reminded of the figure of the Psammead in the book I’d been reading to Clara, E. Nesbit’s Five Children and It. When the children realize that the amazing sand fairy they’ve discovered on the beach will grant them a wish, they ask to be beautiful. And he grants it, without bothering to advise them that in becoming beautiful, they will become unrecognizable to themselves.

Those who post to websites about antidepressants invariably remark upon the “emotional flatlining,” as one user put it. They talk of feeling “numb,” of losing desire, of nonchalantly telling their bosses to “go fuck themselves” and then being “duly relieved of employment.” (Been there, done that.) They concede that their lack of libido has marred their marriages, or relationships. They yearn for their sorrow back, because with it comes the intermittent prospect of joy. The journalist Seth Stevenson, writing for Slate magazine, described coming off of Paxil: “A new phenomenon has taken hold. When I get teary-eyed watching a horrid chick-flick on a cross-country flight, I recognize it: feelings. On Paxil, I barely noticed they were gone. Now that they’re back, even overcompensating, I never want to lose them again. Bitterness, anger, jealousy, sadness: they all make me happy.”

Interesting that we need this emotional texture. Why do sociopaths crave thrill-seeking behaviours? Why do psychopaths reach for the extremes of power and rush through murder? Apparently, it isn’t in our nature to rest content with nothing. We are compelled to feel something. In one of the most perceptive imaginings of hell I’ve ever encountered, the novelist Kelley Armstrong assigned a group of serial killers to a small, bucolic village surrounded by meadows and daisies, where nothing ever happened and no victims wandered through.

I went back to my doctor. He played with his Palm Pilot (he’s a bit of a gadget freak) while he listened to my concerns. He has never taken drugs in his life, so his ontological expertise is a bit hazy on this point. But he studied me for signs of distress.

“You look better,” he said approvingly.

“Do I? Well, maybe that’s because I don’t care about a goddamn thing any more. I wonder if you know how that feels?”

He did not. What he knew is that I came to him harrowed and now, drugged, my face looked more relaxed. I was no longer pacing. I had been calmed. He seemed to feel that he’d done his job.

Technically, what he had done via his prescription pad was to shock my system with such a high level of serotonin (by preventing its “reuptake”) that my brain cells had had to compensate by dropping levels of dopamine, the neurotransmitter involved in feeling pleasure. This effect, which the Harvard psychiatrist Joseph Glenmullen calls the “Prozac backlash,” refers to the way that our brains adapt to the over-stimulation of one neurotransmitter by pulling back on the release of other key chemicals. The result of the dopamine drop in response to the serotonin flood is flattened mood, apathy and loss of sexual desire, among other things. That is not the only result of forcing high levels of serotonin to circulate. Only about 5 per cent of serotonin actually resides in the brain. The remainder circulates in our bloodstream, regulating the gastrointestinal tract, the genitalia, the heart and the nervous system. This is why antidepressant users can feel nausea, develop tremors and tics, gain weight, have acid reflux, and experience other ailments.

The idea that people need antidepressants because they have a “chemical imbalance” in their brains has evolved into a sort of urban legend. People are depressed or anxious – so one person advises another, be they physician or sister-in-law, for levels of expertise don’t seem to enter into who spreads the word – because their brain chemistry is out of whack. Sufferers have a “serotonin deficiency” that can be corrected by selective serotonin reuptake inhibitors (SSRIs) or, in the case of Effexor, serotonin and norepinephrine reuptake inhibitors (SNRIs). …

The trouble with this soothing explanation, as several researchers and an increasing number of journalists are now pointing out, is that serotonin deficiency is an insupportable claim. … According to researchers with the U.S. National Institute of Mental Health, the fact that SSRIs may help to relieve depression or anxiety – although placebos have been shown to work nearly as well – “cannot be used as primary evidence for seratonergic dysfunction.” Put another way, as physicians Jeffrey Lacasse and Jonathan Leo have, “the fact that aspirin cures headaches does not prove that headaches are due to low levels of aspirin.” They add flatly: “There is no such thing as a scientifically established correct ‘balance’ of serotonin.”

In 2004, both the FDA and Health Canada released warnings related to new concerns about SSRI use, having to do with serotonin-stimulated behaviour. By this, they meant specifically agitation, hostility, insomnia, acute anxiety, suicidal ideation, and – here is the one that made me a fool – “disinhibition and emotional lability.” Both federal agencies cautioned that all such behaviours were potential “adverse effects” of antidepressant drugs. The warning is sublimely dry. The lived experience careers from the tragic to the deeply embarrassing.

In my case, the warned-of adverse effect was triggered by adding Zyban (also known as Wellbutrin) to my usual dose of Effexor in an effort to quit smoking. Whereupon, “disinhibition and emotional lability” ensued! I promptly made a pass at my daughter’s friend’s mother at a neighbourhood Christmas party, shortly after flirting with every married man in the room.

I have no memory of doing this; nor do I have the slightest idea how I got home that night. I assume that I walked, although I may have diverted my path and visited a brothel, or stolen stuff from the 7-Eleven. Since I was in what is apparently called a “walking blackout,” the options for what I actually did with my time are pretty much limitless. Maybe I shot a cat. Luckily, I have several eyewitness reports from the Christmas party. My friend Paula, for instance, confiding, “We were really, really worried about you.”

“Why? Because I’d just asked Fran to go upstairs?”

“No. I’d never seen you like that before. You weren’t acting drunk. You were perfectly poised. It was like you were … psychotic. You were acting normal, but your behaviour was totally abnormal.”

“You mean, because I asked Fran to go upstairs?”

“Partly that,” Paula agreed, laughing. Naturally, this had become a major source of amusement among the moms, that I’d hit on Fran. Nobody seemed to think that I’d come out of the closet, including me, for I’d also thrown my arms around Fran’s ex-husband. My behaviour was all the more startling for being so indiscriminate: “I’ll go upstairs with anyone, really, anyone at all.” The family pet. A peanut butter sandwich. My own husband would have been a good prospect if he hadn’t been at home, sound asleep.

The Zyban went into the garbage the next day. I dearly wanted to jettison the Effexor while I was at it, but I didn’t dare. By now, I was very familiar with the heroin-withdrawal-style experience of missing a single dose. A family friend who had forgotten her pills at home when she travelled for a weekend had fallen down and had a seizure in a department store. I was cowed. Like street addicts, I began putting off the struggle to come clean.

Excerpted from A Brief History of Anxiety (Yours & Mine).

Copyright © 2008 by Patricia Pearson. Published by Random House Canada and available March 11. Reproduced by arrangement with the Publisher. All rights reserved.


To view original book review click here

A Brief History of Anxiety, (Yours and Mine) by Patricia Pearson — (The Star)

For those of us old-fashioned types who generally self-medicate any anxiety or mania with drugs you don’t ask your doctor for, it can be a little hard to comprehend all these new-fangled disorders that seem to require the administration of prescriptions on a daily basis.

Now I, for one, would never presume to judge anyone who finds daily living easier with the assistance of mood-altering substances. But it’s hard not to feel that drugs you can take in the morning and then still operate heavy machinery safely, must be a little on the dull side. It’s also tempting to presume that in order to create a market for these very boring drugs, the manufacturers have an incentive to … well, to make some of these disorders up. After all, nobody’s great-grandfather ever had to take an anti-anxiety pill.

Plus there’s the gnawing fact that in developing countries, people are reportedly unconcerned about their lack of anti-anxiety prescriptions, focusing instead on such matters as the absence of good health plans and, oh, clean water.

So, when confronted with Patricia Pearson’s new book, A Brief History of Anxiety (Yours and Mine), which chronicles her own anxiety as well as a brief history of the runaway, best-selling disorder of the new millennium, I admit to feeling slightly anxious about her anxiousness.

Fortunately, Pearson, a Toronto freelance writer who has previously published two novels, a book on female killers and a collection of essays on urban life, is pretty skeptical of the whole thing herself, despite – or, perhaps, because of – a long battle with an anxiety disorder.

Pearson claims to be afraid of bird flu, flying, phone bills, ovarian cancer, black bears, heights and walking on golf courses at night. She recovered from her first bout of paralyzing anxiety in her mid-20s with the help of a little time out, family care and therapy. She went on to have an enterprising career in crime reporting, including work as a field producer for a Hard Copy-ish show called Confessions of Crime and, later, for what we call more legitimate, prestigious media institutions.

Buffeted by the sleazy and toxic environment of the tabloid TV agenda and the relentless exposure to gruesome details of hideous crimes including the Mahaffy and French murders, Pearson had a second breakdown, one that required something more than a brief respite. She eventually caved in to her doctor’s will and submitted to anti-anxiety medication. He chose the pills carefully; she was prescribed the ones he happened to have samples of in the office.

End of story, right?

Not so fast. Aside from such side effects as a diminished sex drive, weight gain, emotional blandness, an increased risk of diabetes and a mortifying walking blackout event that occurred when a doctor prescribed two anti-depressants which apparently don’t mix terribly well, Pearson’s real battle began when she was trying to get off the drugs.

You’ve probably been under a pretty big rock if you haven’t heard by now that withdrawal from these prescriptions is brutal – worse, many say, than those drugs Montel Williams is always warning concerned parents about.

But this book is not another boring addiction-recovery memoir. Pearson is an excellent writer who knows exactly when to exploit the black humour and absurdity in this quite serious topic, then pull back and expound on the root causes of our national anxiety disorder.

A lot of the blame is placed squarely at our desire for, and illusion of, being in control in a world where chaos reigns. What’s more, she ventures the idea that this control freak streak is primarily a phenomenon of modern Western culture. Pearson suggests that in the Third World, people are more apt to accept that bad things do happen (even if one has been faithfully following the rules of The Secret). Such people spend a lot less time in a state of anxiety over things that may or may not happen.

Her cross-cultural examples support the thesis. For example, where would you guess the happiest people in the world live? California, you might say. British Colombia, maybe?

But no. The happiest people, according to research published in New Scientist magazine, live in Nigeria. Maybe it’s all that money I keep sending over there in response to those emails. And when I get my share of the heir’s loot out of the Swiss account, I’m moving straight to Lagos – to be with the happy people.

Or, more likely, to Mexico. Pearson points out that Mexicans not only rank high in the world happiness index but also have almost non-existent rates of anxiety or depression.

Pearson’s point is clear. If you’ve got real problems – say, cleaning up and rebuilding after the two hurricanes that hit Mexico while Americans endlessly debated whose fault the slow and inadequate response to Katrina was – you don’t have time to get anxious or depressed about stuff that might happen, let alone hope for a diagnosis.

Lurking under the surface of this analysis and the other threads in Pearson’s excellent book (including rants on celebrity culture, the decline of poetry and working in the corporate environment) is a recurring message: get over it.

It’s a pretty timely message, one that seems to have helped the author deal with a good deal of her anxiety. It also brings comfort to an old-fashioned sort of reader who still thinks the three-martini lunch remains a pretty good way to combat fear of anything.

Christine Sismondo is the author of Mondo Cocktail: A Shaken and Stirred History (McArthur & Co.).