Prozac and Cons

On Tuesday I walked with my best friend, Katie.

My bond with Katie was forged in the fire of anxiety.

Ask us how we became friends and we’ll tell you a story about hiding under a big concrete ping pong table at the swim club, quaking in fear as a thunderstorm rolled in. Confessing to each other how, while the other kids continued playing like nothing was wrong, we were sure that this was the end for all of us.

We found comfort in our shared fears throughout the rest of our childhood.

We were afraid of nuclear war.

We were afraid of failing.

We were afraid of dating.

But most of all we were afraid of illness.

Every temporary pain or twitch of an eyelid was surely the sign of a larger, more serious problem that would result in our untimely death.

As we became adults, these fears only increased.

Over the years, if we weren’t careful, an entire phone call could go by before we realized that we’d mostly talked about the symptoms and illnesses we were most concerned with at the present moment, or which specialists we’d recently had appointments with. It’s something that we’ve both worked on as we’ve faced our anxiety.

We go to doctors a lot.

I remember the first time one of them diagnosed me with anxiety.

It was after an episode I’d had towards the end of a work day, when I suddenly felt like the movements of my fingers swiping over my phone had disconnected from my brain.

I felt dizzy, like a weight was pressing down on me. I made my excuses to the staff I supervised and laid down on the couch in the teacher’s lounge.

Matt came to pick me up, and by the time he got there I was feeling mostly better, just a bit embarrassed.

Still, I was sure that I had MS, or a brain tumor, or some other issue with my nervous system.

So I made an appointment with my GP, who did a full neurological exam and bloodwork.

When nothing seemed amiss, he said, simply, “You have anxiety. It is, unfortunately, extremely common. I see it in women your age all the time. I’d be happy to prescribe something for you.”

I declined.

It was a decision I would make time and time again, in new cities with new symptoms and new doctors.

Each time the conclusion was the same: you have anxiety. It’s causing your physical symptoms. You could take medicine to treat it.

And yet I refused.

If I had cancer, or diabetes, or any other physical ailment, I would have done exactly what the doctor recommended.

But mental illness felt different. It felt like some kind of moral failing to admit that my mind wasn’t functioning optimally. It felt like something I should be able to handle on my own, that taking medication was the “easy way out.”

(Now, having dealt with the side effects of ten different psychiatric medications in various permutations and combinations this year, I can promise you that medication is not the easy way out).

In grad school, I finally agreed to try therapy and found it extraordinarily helpful in dealing with my generalized anxiety. But when my health anxiety still would not quiet itself after two years of therapy, I decided that it was finally time to give medication a try.

I went to the community health clinic that was conveniently located between our apartment and my office. I told them my symptoms. I got a Prozac prescription. I took it, and I felt great.

Really great.

My anxiety was completely gone. I was confident and excelling in work. I got excited about ideas easily, and explained them at a rapid pace that my coworkers struggled to keep up with.

Matt got swept up by this new, more confident me. We considered buying a historic theater instead of a house. We went to Vegas and had the time of our lives (even if maybe we spent a little too much money). I seemed to be living my best life, a sort of last hurrah before settling down and having kids.

So when the doctor who had prescribed my Prozac recommended I stop taking it before trying to get pregnant, I was a little disappointed. Still, it seemed like one of those things you just gave up as part of the price of having a baby. Like sushi or alcohol.

But when my anxiety came back around my 14th week, I started to consider whether the benefits of being mentally healthy while growing a fetus outweighed the small risks of being on antidepressants in the second trimester.

I had spent so long battling anxiety on my own before finally accepting medical intervention the first time. I vowed that I wouldn’t let myself suffer unnecessarily again, nor would I let my anxiety do any damage to my unborn baby.

“Do you want to ask about Zoloft?” Matt whispered to me at the end of our 16 week appointment.

I had heard that that was the safest SSRI to be on while pregnant.

“Did I hear the word Zoloft?” The doctor asked.

He reassured me that it was very safe, and that it was important for me to be healthy in order for my baby to be healthy.

“That being said, if you do want to go the natural route, that’s a fine choice too,” he said, “Babies are born to mothers in the midst of all sorts of stressors, like war and famine. They’re resilient.”

I’d think about that comment a lot in the three weeks of the pandemic before I gave birth, when I was panicking about whether or not Matt would be allowed in the room with me.

I decided to go on the Zoloft, but at the lowest possible dose: so low that it was unclear whether the effects I felt were placebo or not.

Either way, I felt great for the rest of my pregnancy.

And to get ahead of the postpartum anxiety that we were sure I would face, we increased my Zoloft dose as soon as Bailey was born.

Little did I know that I had bipolar, and the increased serotonin from the Zoloft would only act to accelerate my postpartum mania and psychosis.

Months later, when I’d finally recovered from my mania and the depression that followed, I was still struggling with extreme anxiety.

I remembered how long I had suffered with it before. How instantly the medication had relieved it.

“Is there any way I could ever get back on Prozac?” I asked my psychiatrist, innocently. “It was just so helpful for my anxiety.”

She actually laughed at me.

Then apologized.

Then said, “No.”

She paused and considered for a moment. “Well, I suppose if you went to another provider and asked them for it… but no, I’d still call them and tell them not to put you on it. Sorry.”

She explained to me that the reason I’d felt so good on the Prozac was because it had actually made me hypomanic, and that I’d been just teetering on the edge of losing myself that whole year.

“You felt good, sure,” she said, “But you weren’t well.”

Have I ever been well in my life? I wondered, as I tried to twist this new narrative to fit into my understanding of my own story.

I read and reread the symptoms of hypomania over and over again.

“Upbeat, jumpy, or wired.”

“Distractable.”

“Talkative.”

They read like a list of my character traits.

Where was the line between personality and pathology?

If what I’d thought were my best times were my sickest, what was I trying to get back to? What did a healthy version of me even look like?

I’m still discovering the answer to that question.

My new medications, that are finally tailored to both my bipolar and my anxiety, are helping.

But they’re not a magic fix.

Therapy is amazingly helpful. I wish I could talk to a therapist every day.

But I’m not made of money, and my therapist has other clients to treat.

There is no easy answer, no quick fix when it comes to treating mental illness.

It’s sort of like a video game, where you have different weapons of choice that must be selected for the right moment. You add different tools to your backpack: therapy, medication, mindfulness, exercise, writing, friendship.

Doctors are important guides in using these tools, but even they make mistakes.

Brains change over time, and what seemed to work at one moment may end up setting you back a few levels at another time.

So you have to carry all the other tools with you wherever you go, so you can fight each new battle that comes along and find your own version of what it means to be well.

It’s a long road.

But the best thing you can do is take one good step at a time.

And don’t take the steps alone.

Listen to your doctors.

Listen to your therapists.

Listen to your gut.

Listen to your friends.

Bring them with you when you decide to get out from under the ping pong table and face the storm.

Thanks for reading,

PsychoSister

15 miles