Dear Lily June,
Every morning (assuming I remain diligent), you’re going to watch your mother reach out for the little case she keeps on her side table. The case is red and has the words “Keep Calm and Take a Pill” written on it. Inside, there are (assuming I remain diligent) dozens of salmon-colored pills, one of which I will remove and pop into my mouth. It will look like candy, but you cannot have one until and unless a doctor decides you need it. This pill is not candy.
I will swallow this pill with the hopes that it will slow my mind enough to take the day on as most people do–one minute, moment, and hour at a time, instead of, as I would normally do, take the day as an opportunity to Only Contemplate Potential Disasters (an acronym associated with my condition, Obsessive Compulsive Personality Disorder). I have anxiety and depression, Lily, and I take these pills for me. And I take these pills for you. And I will continue to do so until and unless they find something better. And you need to understand why.
My Pharmacological Summer
In the summer one year after the tornado, I recognized that my life was becoming unliveable. I had returned, for the first time in years, to my lists, sprawling 20-plus page masterworks that contained every possible item I needed to accomplish, from practical tasks like work-related items or home maintenance (cleaning, cooking, etc.) to things ridiculous to schedule like calling friends or going to the bathroom. While I thought of the list like an internal cruise director, setting my agenda for the day, the list was really a dictator, only allowing me to take certain actions if, by a pattern I’ve talked about in other posts, I “landed” on that item. I was controlled by my need to control, and I needed to get control of that.
I spent the summer using the employee assistance program my university offered for free mental health intervention. I went to a counselor and a psychiatrist, and I began a trial and error dance with medications. My first dance partner was Wellbutrin, a drug my father, your Grandpa Edward, has taken for almost the entirety of his life (which doesn’t, unfortunately, seem to calm his occasional bouts of rage).
But Wellbutrin and I didn’t dance well together. My thoughts began to waltz around so that I couldn’t catch a single one, and racing as they were, my heart pounded, my palms shook, and my mouth started talking at a speed generally reserved for Lamborghini’s on the autobahn. I ended up in an Emergency Room begging a doctor not much older than Doogie Howser for help. He admitted he’d never heard of Wellbutrin (really?! It’s one of the most common antidepressants on the American market!), and told us he’d go Google it.
He returned with a shrug and an offer made to Ryan to tote me, involuntarily, to a psychiatric facility, telling us, “You should take this seriously. We had a psych patient in last night who’d shot himself in the face.” Horrified that I wasn’t in that state, I plead with your father to take me home, and as terrified and uncertain as we were, he did. I stopped the Wellbutrin immediately.
From there, the pleas went out to my doctors for something different, who dutifully shifted my prescription over to Zoloft with a Klonopin chaser for moments of extreme panic. I started to feel like Dr. Jekyll and Mr. Hyde, with one pill that made me placid enough to sit on our porch serenely for hours, wanting nothing more than to stare into the Southern sunset, and another pill making me so euphoric, if I were a dancer, I felt as though my mind were cutting not a rug, but a cloud. Zoloft felt to be what my mother, your Grandma Raelyn, warned there never would be, the “magic pill,” while Klonopin lifted my consciousness to the skies.
When the effects of Klonopin wore off, though, I’d, like a cartoon character who’d stumbled over a cliff and looked down to realize the effects of gravity, fall hard. Not only would my anxiety return, so would irrational aggression and anger, and I’d tear into your father emotionally like a cat trying to sharpen its claws on shrapnel. That Ryan stayed with me, that he fought through that time in our marriage to come out not only on the other side but would go on to become your father, was truly the only magic of that summer.
Unfortunately, Zoloft had sexual side effects for me, and I could no longer physically enjoy intimacy with your Dad. It was a sacrifice I wasn’t willing to make. I wasn’t going to trade in the sexual pleasures with and from a man who’d already sacrificed so much for me. (I know it may be uncomfortable for you to read that, Lily, but you need to know the physical realities of antidepressants in case, as is likely your biological predisposition, you ever find yourself in a similar position of having to choose what works for you.)
And so began Trial #3 with a drug called Celexa or Citalopram (though I much prefer its Argentinian name, Humorup), the final dance partner I’d take on in the Charleston with my own mental illness, and the one that worked, if not the best, than the most reasonably for me. And that’s what’s in my little red case today.
My Past & Present with Worry
When I was a very little kid, and my parents would leave my sister, your Aunt Loren, and I with a babysitter, I would construct elaborate fantasies in my mind of their demise. I didn’t want them to die–quite the opposite. I was terrified that on their rare occasions away, they would. And so, I’d lie in bed, refusing to play and staring up at the ceiling at each pair of car headlights pouring in from the windows to illuminate shadows, imagining this time, this car was holding the officer who’d walk to our door to deliver the news of a horrific accident, and of my parents’ bodies, so mangled in twisted pretzel metal the jaws of life couldn’t pry them free. And I would weep, sure I’d lost my mother and father forever. That they always came home didn’t seem to quell the anxiety of the possibility that one day, they might not.
I know, Little Lily, that every mother is a worrier, that it’s part and parcel of the job description. But I find myself, once again, gripped in terror by the possibilities. When I lay you down for the night, my mind tinkers and toys with what might happen if, by morning, when I go to fetch you, you are no longer alive. That SIDS exists is, for a mother with anxiety, like a cognitive itch that my brainstem scratches and scratches until my thoughts ache and practically bleed. Sometimes, it keeps me up half the night, turning again and again to your bassinet and hitting its tiny white light so that I can see your chest rise and fall, fall and rise, and know, okay, alright, she is alright, she is alright this time, this time, she is okay, she is alive, she is my light.
I wish I could say the pills take that away. I wish I could say I looked at you with nothing but joy and delight, but you, my darling dear, are so cherished, the thought of losing you now is the darkest one I can dig from the well of my worry, and so I drop that bucket down and down again, imagining what it must be like until it almost drowns me. And then I wake and take my pill again, and sometimes the very act is enough to soothe me.
My Thoughts on the Placebo Effect
Doctors don’t really know why SSRIs sometimes work. The full term is Selective Serotonin Reuptake Inhibitor, and the use of this particular kind of drug to relieve anxiety and depression goes back to the 1950s, when it was found during an experiment with anti-tuberculosis agents, that certain neurotransmitters in the brain, like dopamin and serotonin, were thought to have an impact on those TB patients’ moods. The theory was generalized and retested on those who were actually suffering from psychiatric disturbances, and it was found that SSRIs, that increase the brain’s production of serotonin, worked. About half the time.
That antidepressants only improve the lives of about 50% of the patients who take them is disheartening and says to someone like me who tries to live with some scientific rationality, that we need more inquiry into something better. In the meantime, antidepressants have become somewhat controversial, with more and more studies showing that patients may be benefiting from no more than the placebo effect, essentially the idea that they get better not because of the drug, but because of their belief in the drug’s efficacy.
Lily June, once, when he was no older than a toddler, your cousin Martin came to me holding his belly and whining that his tummy hurt. It was another family function where his presence had blended into the background–he had a new baby sister in the limelight–and he was struggling. I told him he needed to take some pills for the stomach pain, and that I’d get them immediately. Post-haste, I rushed into the next room and scraped the candy coating from an M&M, presenting the “magic” medication to him as a panacea for any tummy trouble. He took it, and his eyes lit up. Suddenly, he said, his belly felt much better, and he ran to play with your Uncle Denny (his uncle, too, who he’s older than–true!) in the next room.
Moments later, both of them came back for more of my chocolate “snake-oil” holding their bellies and moaning, and we played the game of “Doctor” with those pills until I realized the sugar they were ingesting might eventually lead to actual trouble. But the point is this: Someone in authority (his older Aunt Alyssa, me) told Martin that a pill would fix his problem, and when he took it, he believed. And he legitimately felt better for having taken the confectionery treat.
I say all this to say, despite my tendency towards logical thinking, I don’t care if Celexa, my pill, is made from careful pharmacological discovery or, deep down, sugar. I take it each day to know that I’m doing something active towards treating my mental health, and in taking that agency, I feel better. And then I work harder towards taking other steps–like talking myself off the ledge of my worries when I lay awake at night thinking this might be the night you might not be breathing the next morning. And sometimes, Lily, precious though you are to me, if I work hard enough at evaluating the lack of logic in my obsessive fears, I can ignore the compulsion to roll over in bed and hit your light. And on nights like that, a switch stays turned off in me that I’d rather not compulsively flick and flick until none of us can see.
I admit, Lily, as unashamed as I can be, that I know I suffer from a mental disease. I know it impacts the way I look at life, and I know it is my responsibility to myself, to your father, the love of my life, to you, the light of my dreams, and to my whole extended network of friends and family and coworkers and colleagues, to keep treating it.
I hate the comparison of those with mental illnesses taking medication like a diabetic takes insulin–because both groups need to–as I think it cheapens the important differences between a physical and a mental illness, and denying those doesn’t make the two groups equal, any more than denying the differences between men and women constitutes effective feminism. But where the comparison is fitting is in the fact that, left untreated, any illness hurts not just the person who has it, but the people they love, too. If a mother dies because she wouldn’t take the insulin for her diabetes, her children suffer. And if I were to stop taking the SSRI for my OCPD, I would eventually spiral into such anxiety and depression that I might, as I have in the past, want to take my own life. And I won’t do that to you, Lily.
For as long as I can control the symptoms of my condition, I will keep trying, keep researching and reading, keep learning and coping, because I’ve finally reached the point in my life where I WANT to live. And I want to inspire you to want to want to, too, no matter what illnesses–physical or mental–or struggles you might go through. This life, Lily, always comes to a point where it’s worth fighting for. Believe me, my lovely, as I might not have believed it myself ten years prior. I live for love. I live for hope. I live for me. I love and hope and live, in great part, for you.
- “FlattenedRoundPills” by Slashme at the English language Wikipedia. Licensed under CC BY-SA 3.0 via Commons – https://commons.wikimedia.org/wiki/File:FlattenedRoundPills.jpg#/media/File:FlattenedRoundPills.jpg
- “Doogie Howser Cast Photo” by Source. Licensed under Fair use via Wikipedia – https://en.wikipedia.org/wiki/File:Doogie_Howser_Cast_Photo.gif#/media/File:Doogie_Howser_Cast_Photo.gif
- “Citalopram structure” by User:Mysid. Licensed under Public Domain via Commons – https://commons.wikimedia.org/wiki/File:Citalopram_structure.svg#/media/File:Citalopram_structure.svg