Lexapro vs. everything else

Someone responded to my most recent post about antidepressants by asking whether I'd tried non-Lexapro meds. The short answer: Yes, I gave Celexa a whirl, and it seemed to diminish my verbal abilities. This was upsetting but not entirely unexpected, as I'd been warned many years before that some SSRIs have that effect.

Lexapro is ridiculously expensive at roughly $100 per monthly supply, but I'm reluctant to mess with other meds when this one has worked, on the whole, so well. I also know that my weight gain is almost certainly due to a variety of factors -- Kibbutz food, waves of mild depression that elude the drug, etc. -- so I'd be more likely to drop meds in general than to go searching for a "better" one. It probably doesn't get a whole lot better than this.

Abnormal psychology

I've written here about my struggles with depression and disordered eating, but not so much about my obsessive-compulsive tendencies. They've died down a bit since I went on Lexapro more than a year ago, but I still find myself battling irrational cause-effect relationships in my mind. It's not "If I lend this camera to my friend for the night, he'll break it," but instead: "If I lend this camera to my friend for the night, I'll be unable to stop worrying about whether he'll break it and thus my work will suffer." It's a step removed from actually not trusting the friend.

It's not (usually) that I'm an ungenerous person, it's that I let my neurosis hijack my behavior and prevent me from being as giving as I want to be. (And yes, I'm the one letting this happen. I'm getting better at fighting what I call "pre-worry" or "meta-worry" -- worrying compulsively that I'll worry -- but I still have a ways to go.) Sometimes it's hard for me to separate my mind's obsessive-compulsive "reasoning" from valid logic or meaningful emotion. It's the same problem I've long had with ambient noise, a big pet peeve of mine.

Sometimes I have reason to complain about noise (i.e., a "normal" person would), while at other times I'm unusually sensitive to unwanted sounds (a "normal" person wouldn't be upset, but I am). Figuring out the boundary between reasonable and unreasonable discomfort remains tricky for me, though again, I'm improving. Using earplugs, which I began doing when I moved to the Kibbutz in August of 2008, has been a minor revelation. How did I survive without them all those years? How much tension could they have relieved when I was in high school and college?

I don't have a lot more to say about this at the moment, except that I've gotten better at making decisions, and not whipping myself into a total neurotic lather in the process, since starting therapy in late 2005. I'm grateful to have somewhere to go each week -- or every couple weeks, now that I'm in a money crunch -- where I can decompress, talk through my issues du jour, and realize how much stress I carry around. I still prescribe exercise and meditation for my problems, but I'm having a devil of a time getting myself to fill the prescription.

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.

My chemical romance

I've been on Lexapro for almost exactly six weeks, and as far as I can tell, it's helping me. I first noticed its effects the day before Thanksgiving, when I spent hours on a plane in front of two people who insisted, while everyone else tried to sleep, on having an animated conversation. I'd forgotten my earplugs, and I felt it wasn't my place to tell them to hush so I could try to get some rest. So I boiled and bubbled with frustration, as I usually do in such circumstances, and shot meaningful glances their way from time to time. (Meaningful to me, that is; evidently, not so much to them.) Finally, I put on my headphones and distracted myself with the soundtrack from Avenue Q. When I finally left the plane, I noticed that my frustration over the in-flight annoyance was melting away; it was harder than usual -- nearly impossible, as a matter of fact -- for me to hold onto it, nurse it, make it into something that could ruin my morning. I didn't think too much of my unexpected ability to release my tension, but it was the beginning of a string of changes to my normal way of thinking that would continue throughout the weekend, and that would follow me back to Seattle.

I'm not always aware of what my daily dose of 10 milligrams is accomplishing. Last night, I spoke warmly to a friend who was about to go on vacation, and I detected something in my tone -- an unusual generosity, a carefree quality, a greater concern for another person than for myself. A short but memorable trip outside my own personal travails, in short. It's a wonderful feeling, to be the kind of person you've watched others be for years. I've also recovered, partly, the feeling I had about writing as a teenager, and to some extent as a college student: that life is too rich with incident and meaning to go unanswered, and that the best way for me to answer is in writing. Writing, in other words, as a necessary, vital activity, not something I have to drag myself into. Also: writing without crippling perfectionism. It's like Roger Ebert's description of why characters burst into song in musicals (he was talking specifically about Everyone Says I Love You): They simply don't know what else to do. There's nothing else they can do, no other form of expression that's conceivable. That sense that I need to write, that I can't let life go by without responding to it, is a welcome sensation -- one that I hadn't felt in years.

I've also been experiencing an increased sense of gratitude for my friends, and I've tried to show it as best I can. I know that what I'm able to feel and do thanks (in part) to the medication is stuff that was already inside me -- tendencies I had in the past and lost touch with. During a particular evening of my Thanksgiving visit to Detroit, I felt a bit adrift, unable to connect with anyone the way I wanted to. In the past, such a turn of events might have plunged me into (unproductive) despair of the teenage-melancholia sort: Why am I such a hopeless case? Why can't I make connections like normal human beings? Why does everyone smile when inwardly they must be roiling the way I am? And so on. Of course, some people smile precisely because they're happy, not because they're "phonies" in the Catcher in the Rye vein, but that fact used to escape me. Now I kinda get it, because sometimes I'm actually one of them.

As surely as I know that Obama isn't the Messiah and won't solve all of America's problems, I know that Lexapro isn't a panacea that can make life's every difficulty evaporate. But that's not what I expect it to do. I felt stuck and needed a push, and now I'm more able to give myself that push. Like so many things we consume -- food, shoes, clothing, alcohol, cars, jewelry, travel, cultural experiences, and on and on -- this kind of medication is a mixed bag. Do I feel, sometimes, the sense of emotional mutedness that's often cited as a drawback of SSRIs? I do. Does it trouble me more than my depression did before I got started with the drug? No, it does not. I believe life is full of trade-offs, and we don't always know what to give up and what to hold onto. Our principles naturally evolve over time, and while we may cling to some -- vegetarianism, teetotalism, religious faith -- even they can and do change in small ways. For now, this medication has given me a sense of capability and hope that I appreciate, and as long as I dutifully observe its influence as best I can, I think I'm doing what's right for me. There's no certainty, of course, but that's something I'm trying to learn to live with, too.