I want to see the colors, Pt. 2a: Doing Drugs

A brief note about seeing the colors:

One of the several cruel things about dysthymia is that it eventually comes to seem that it has always been with you; it may even seem to be part of you, or perhaps part of some broken interface between you and the world. It eventually becomes just part of the texture of the way things are, and sufferers learn to accept it with resignation; it becomes impossible to imagine anything ever being any different. Somewhere in my chaotic pile of notes relating to depression and dysthymia I have a quote from a woman whose dysthymia lifted when she began taking anti-depressants. She said* that after she went on medications it was like finally being able to see colors after a lifetime of seeing only grays. It was a nice analogy, simple and precise. And how nice that must be, I thought, to see the colors, to look around the world and perceive a depth that was previously unknown, to experience the small joys that most humans feel as a matter of birthright.  That, I thought, is all I really want.

I read about that women's experience after I had tried Therapeutic Lifestyle Change (TLC).  When I started TLC,  I was hoping to avoid drugs, given their low success rates, side effects, and discontinuation issues. My plan all along, really, had been to try the most natural treatment option I knew of—TLC—and THEN, if that failed, to move on to drugs. Unfortunately the TLC delivered limited amelioration, and after a long wait, and with the dark affective claustrophobia of impending winter, I knew my next step had to be drugs. 

So let's talk about drugs.


This past winter, as SAD was wearing down my psyche, I was finally forced to confront the obvious: that the TLC program was no panacea. It had improved things, and I'm very grateful for much of what it has brought to my life, including my return to exercise and (short) distance running. These things HAVE increased my sense of well-being. But after the program ended I was still dysthymic, and last autumn I still wondered, as winter approached, whether I had the emotional resources to survive the dark months.  December brought the usual mid-winter affective crisis and I finally called the local mental health clinic. Once they screened me they set me up with:
1) Cognitive-behavioral therapy, which I could start immediately; and,
2) An appointment with a shrink, three months down the road.

In Part 3 of this series I'll talk about cognitive-behavioral therapy (CBT). Though the TLC program emphasized somatic issues, one of the components was anti-rumination, which is essentially CBT Lite.  For now let's just say that I'm skeptical of these more psychological approaches, and my first two encounters with the CBT therapist at the mental health clinic did not go well.  There is something about CBT that seems uniquely, stupidly American. But more on that in Part 3.

Waiting three months to see a psychiatrist is something that should not happen in an advanced nation with pretensions to civilization, but in a land with such a dysfunctional health care system it is probably not an unusual wait for someone without insurance. Like me.

But eventually I got in to see the doctor. She asked the usual questions, I gave the usual answers, and I walked out with a prescription for citalopram (more on citalopram from Wikipedia  and Crazy Meds). NOTE: I highly recommend Crazy Meds if you need to read up on any psychopharmaceutical product; the info there seems pretty solid, and the site has lots of well-informed people commenting. But, this is the internet, so grain of salt and all that.

Citalopram is the generic name; it was originally sold in the US as Celexa. Since becoming available as a generic it has become quite inexpensive and widely prescribed. It is also about as efficacious as anything else out there. For these reasons, if you are about to try anti-depressants for the first time and your psychiatrist or doctor does NOT start with citalopram, you may have cause to wonder if your doc is getting kickbacks.  Citalopram is one of WalMart's $4 per month prescriptions: a 30 day dose for four bucks. That is a bargain if it ends or even just alleviates your depression. The key word being, of course, IF.

Once I took the pills home I stared at them for awhile, wondering if I was certain I wanted to go down this road.  But this did not last long. It is no exaggeration to say that dysthymia has ruined my life to this point, nor is it an exaggeration to say that if I knew, knew with certainty, that I could never overcome this condition, that it would continue to ruin everything—jobs, social situations, relationships—until the day I died, I would have no qualms about choosing the peace of death over the certainty of interminable years of pointless suffering. Because my life's status quo promised more of something I already knew to be barely endurable, I read over the lists of potential side-effects with something of a detached bemusement.  As always, there is a scale of severity of effects, from the more common but more mild (weight gain, nausea, sexual dysfunction) to rare but pretty severe (convulsions, fatal heart arrhythmyia). The way I saw it, being fat, nauseous ,and impotent would be a small price to pay if I were also happy or at least content. I was especially amused by the potential sexual issues: It might cause me to lose all interest in sex! It might cause an erections that would never go away! If the later were to happen, I figured, I could always head to California for a job in the porn industry.  It wasn't exactly my dream job when I was a child, but what else is a guy with a full-time boner to do? (yeah, I know: a guy is to seek medical help. Thank you, Viagra ads!)

So even with the potentially severe side effects, there was never really any chance that I would not take the pills. And take them I did. Here is what I noticed:
1) My negative rumination went away in about a week and a half. This is good.
2) Orgasms took a very long time. This is a mixed bag, depending on circumstances and company.
3) I quickly descended into a weird state that does not seem to be covered in the lists of side-effects. It was not nausea, really. More like a delirium, but not a pleasant one. If you have ever fainted you may remember that sensation just before blacking out, when the world seems to become slow and surreal and you feel detached from everything and all your experience seems to become encased in shell of silence and darkness. It was like a severe form of the temporary altered states we would generate as children by hyper-ventilating. Or a severe form of the diminished consciousness that accompanies high fever. My waking moments were mostly like that, with the strongest effects (greatest deficits of perception and cognition) coming in the afternoon and early evenings.

This was not good. But because the negative rumination went away, it seemed that I wasn't really depressed anymore, though maybe my consciousness was just too impaired to notice.

Sometimes it takes time for our bodies to adjust to anti-depressants, and I hoped the delirium would fade over a few weeks. It did not. When I returned to the doctor several weeks later she took me off the Citalopram and put me on Cymbalta. Which will be the subject of Part 2b.


 *The actual quote is from an academic book on affective disorders; I can't find the citation or the exact quote just now. See above re. "chaotic pile."

Musical interlude: How Can A Poor Man Stand Such Times And Live