It’s funny,

not funny ha ha but funny weird how I went to the psychiatrist today, told him that I was planning to try going off medication in around a month and a half, and yet somehow managed to walk out of there with something new prescribed to me. Yup, I have a bunch of little boxes of Effexor XR in my purse right now. Effexor is a SNRI (hitting both the serotonin and norephinephrine receptors), and quite frankly I am scared as hell to start taking it. There are a couple of reasons: 1. I have read about the horrible withdrawal that some people go through when they try to go off of this med, so is it really the type of thing that you really want to just “try” for a couple of months? 2. At the low dosage that has been prescribed for me (37.5 going up to 75), it’s probably not even going to hit the norepinephrine receptors and basically work as an SSRI for me. SSRIs are not typically kind to my system, but I’ll get back to that in a second. The only good news is that I have been on Effexor in the past (not surprising given the fact that I’ve been on literally 20+ psychotropic medications in my life) and lived to tell about it.

Now, I am not a doctor in any way, shape or form and if you are reading this, please do not look at this as advice. This is only about me. So, what I do know about myself is this: I am not in severe danger at this time of hurting myself or others. I know why he prescribed it to me: I probably did qualify for a major depressive episode (being depressed for 2 or more weeks) over the past couple of months from a clinical standpoint. However, I’m feeling all right today. I have been on and off medications for long enough to know that finding the right drugs is a long, often painful process of trial and error and I have no idea whether this is specifically a problem in the field of mental health or whether the same thing happens with other types of illness. If I could wish for one thing, it’s that someday there will be a blood test or a brain scan that will be able to tell a person exactly what is occurring neurologically/biochemically and therefore be able to be prescribed the right medication that specifically targets the right problem. I don’t really know the scientific literature well enough to be able to say how close we are to having something like that or if it’s something that I will see in my own lifetime. If I had to guess, I would say no.

In any case, the point that I am trying to make is that I am currently trying to decide whether I want to start taking this drug and my personal thoughts and feelings on the matter, developed over years of experience, are that JUST BECAUSE A DOCTOR PRESCRIBES SOMETHING FOR ME DOESN’T MEAN THAT I HAVE TO START TAKING IT. I am sure that my psychiatrist is a smart man. I am sure that he knows more about the brain than I do, or at least I certainly hope he does. He has a magical ability to write down the names of drugs on magical pieces of paper that allow me to go buy them. This is what he can do that I cannot do. But what neither of us can do is predict exactly how I am going to feel when I put this pill in my mouth, what side effects are going to occur, and whether or not it will ultimately prove to be a positive or negative experience.

In the fall of 2001, I starting feeling incredibly nauseous all of the time and basically couldn’t eat anymore. I starting throwing up and would even make myself throw up sometimes to help myself feel less nauseous. I had diarrhea. I lost 30 pounds. I thought that I was dying. I was incredibly anxious all of the time. I went to my primary care doctor (who insinuated that my physical problems were caused by stress) and two prominent GI specialists in the city where I was living at the time. I had bloodwork done and the full gamut of GI tests, which range from vaguely unpleasant to thoroughly disgusting. I could barely work, and ultimately believe that I was fired from a job because of this (but that’s a long story for another time). No one could figure out what the hell was wrong with me. Can you guess where this is going? Guess who ultimately diagnosed my problem. Yeah, that’s right, it was me. What all of these brilliant doctors couldn’t figure out was that my problems had started at the same time that I started taking Luvox, an SSRI. I stopped taking Luvox and presto, like magic, my problems went away. This was one of the biggest learning experiences of my entire life: doctors don’t know everything and, in fact, completely suck at diagnosis a whole lot of the time. It didn’t even OCCUR to any of these people to question to medications that I was on. All right, I said that I wasn’t in the advice giving business here, but if I did have one piece of advice to give it would be this: you need to be aware of your own body. You need to monitor your own side effects and pay incredibly close attention to how you feel when you take any medication. I will say it again: PAY ATTENTION.

Luvox was by far the worst drug experience that I have ever had. It was the worst because it dragged on for close to a year. It was one of the worst years of my life. However, I came out of this a whole lot wiser and with the knowledge that when I take an SSRI there is a large chance that it will 1. make me extremely anxious – it is possible that maybe some of my GI symptoms were related to the profound and intense anxiety that I was concurrently experiencing and 2. may make me unable to eat. Frankly, if I wanted a pill that had the primary effects of making me thinner and more anxious I would go pick up a box of diet pills. Since the hell that was Luvox, I have started taking other drugs and stopped them after about a week or so due to side effects. Many of these have been SSRIs; I think that I have referred to the problems that I had the last time that I tried Lexapro. Actually, the worst that I have ever felt after initially starting a drug was not an SSRI at all – after taking Lamictal for around a week and feeling like I wanted to die the entire time I stopped. But imagine if I had not made the association in my head and had kept taking it for a year. The truth is that a lot of these meds have horrific side effect profiles and if it’s truly what you need to take in order for your brain to work the right way you probably just need to learn to live with it. But ultimately, it’s a personal choice and involves weighing a lot of pros and cons and the key is full awareness at all times.

So, yeah, about that Effexor? I’m sort of thinking no.