My chemical romance, part three

Some romances are destined to be short-lived. After less than two weeks on Celexa, I've decided to return to Lexapro. I could compensate for the price increase ($13 per month for Celexa, nearly $100 per month for Lexapro) by going to therapy biweekly rather than weekly, and as my money-management advisor, Moorea, wisely noted the other day, mental and physical health are things you can't put a price tag on, because everything else hinges on them. (Similarly, in tonight's Nextbook salon on Jews and the body, we discussed the idea that our corporeal selves are on loan to us from God, so we're obligated to treat them well; I think sticking with the medication that works absolutely qualifies.)

Anyway, I look forward to returning to Lexapro, since even my brief time off it has been marked by trouble concentrating and, amazingly, problems articulating my thoughts -- a situation I rarely find myself in. (Even if my thoughts are ridiculous, I can almost always spit them out coherently.) Here's hoping I don't have too much longer to wait until the contentment I've enjoyed since Thanksgiving comes back to me.

My chemical romance, part two

At the beginning of this month, I switched from Basic Health to Group Health Cooperative thanks to my job at Childhaven. I hoped that the Lexapro I'd been taking since late October would be covered, but alas, GHC only covers it if you've tried a variety of other SSRIs and they've all failed you. So I, like my friend Elana, agreed to make the switch from Lexapro to Celexa. This is likely old news to those of you who've been on Lexapro and tried to get it covered by health insurance, but it made an impression on me.

Specifically, it reminded me that people on prescription medication are at the mercy of a system that's looking out as much for its own good as theirs. (In other words, Sicko was right.) I was reluctant at first to give up the medication that had helped me so much, but my doctor quickly assured me that Celexa is simply a less concentrated formulation of the same stuff that makes up Lexapro. (Hence, 20 milligrams of Celexa is a suitable dose for someone who, like me, was on just 10 milligrams of Lexapro.) The fun part is that Celexa, with insurance, costs me $13 or so per month, versus nearly $100 per month for Lexapro.

I've been on Celexa for a couple of days now, and I haven't noticed anything out of the ordinary. The pharmacist told me that some people have side effects when they switch, but those tend to be the people who are more prone to SSRI side effects in the first place. Since I experienced only mild side effects when I started Lexapro, and those went away quickly, I decided to do what the pharmacist said works for many people: take my last Lexapro one day and my first Celexa the next. So far, so good.

Of course, there's something slightly troubling about the fact that insurance rules prompted me to switch medications, rather than any kind of problem with the Lexapro itself, but if they really are virtually the same, and I don't notice a difference, I'm not sure it's worth getting too worked up about. I've been thinking about my previous (non-Group Health) psychiatrist's statement that if a medicine works -- that is, if it makes you feel better -- it must be a good idea to take it. This, I'm finding, is also a very popular view among people who aren't psychiatrists. When I mentioned the Lexapro to my dental hygienist, she regarded it the way insulin is seen vis-à-vis diabetics, or heart medication for cardiac patients -- a targeted drug for someone with a diagnosed problem.

While this view might not apply to SSRIs, whose exact way of working scientists remain notoriously unsure of, it's hard not to value the experiential over the theoretical. Theory suggests that SSRIs might merely mask whatever problems led the troubled soul to seek them out in the first place; the moment he or she goes off them, back come the various problems, and has any progress really been made? In practice, I think, there are rough patches in life, and antidepressants can help us out of them and onto higher, more stable ground.

I have no idea what happens when I quit an SSRI, but I've heard accounts from other people who have weaned themselves off antidepressants, and they're mostly positive. My meditation teacher in Brooklyn emphasized that we, his students, shouldn't take his word for things; instead, we should try out his suggestions and see where they lead us. Experience can be deceptive, but at certain points in our lives we lean harder on experience than on theory, and I think that's okay.

Update, 10:09 p.m.: Just looked at Philip Dawdy's latest post about the maker of Lexapro and Celexa. Troubling.