I am a huge fan of the benzos because I believe that Xanax saved my life when it alleviated my insane anxiety. I have used Xanax and Valium for sleep when I am in agitated periods. I have gone through miniature benzo withdrawal a good dozen times. It is important to use the benzos only for their primary purpose, which is to allay anxiety; this they will do fairly consistently at fairly consistent levels. When my anxiety is high, I need more of the benzos; when it is moderate, I need less. Nonetheless, I am aware of the dangers of these drugs. I have made little forays into substance abuse, but I had never been addicted to anything until Xanax was prescribed for me. I stopped taking drugs abruptly at the end of my first go-around with depression. It was not a good strategy. The withdrawal symptoms from Xanax—which I had been taking on doctor’s advice for several months at a rate of, on average, two milligrams a day—were horrible. For at least three weeks after I stopped taking Xanax, I could not sleep properly, and I felt anxious and strangely tentative. I also felt the whole time as though I’d had several gallons of cheap cognac the night before. My eyes hurt and I had an upset stomach. At night, when I was not really asleep, I had unrelenting, terrifying half-waking nightmares, and I kept sitting up with my heart pounding.
I went off Zyprexa, the drug that saved me from my mini-breakdown, a few weeks after I finished a draft of this book, and I had another round of acute withdrawal. I put myself through it because Zyprexa had caused me to gain seventeen pounds in eight months, but while I was getting off the drug, I felt unspeakably awful. My dopamine system was dysregulated, and I was anxious, withdrawn, and overwhelmed. There was a knot in the pit of my abdomen that seemed to tighten like an internal noose around my stomach. If I had not had hopes for improvement, I would have contemplated suicide. The horrendous strung-out feeling was worse than I could have remembered. I kept poking at my little potbelly and asking myself why I was so vain. I wondered whether I could control my weight while on Zyprexa by doing a thousand sit-ups every day, but I knew that when I was on Zyprexa, I didn’t have the wherewithal to do a hundred sit-ups every day. Going off Zyprexa just turned up all my energies—it grated in the same way that a perfectly nice piece of music will suddenly turn painful and distorted if you shoot the volume way up to the top of your stereo’s range. It was hell. I put up with this for three long weeks; and though I did not have a breakdown, I felt so low by the end of the third week that I lost interest in seeing whether my body could bring my dopamine system back into line. I chose fat and functional over slender and miserable. I forced myself to give up the sweets I always loved and to do ninety minutes of exercise every morning, and I stabilized at a weight that didn’t please me. I gradually cut my dose in half. I soon lost ten pounds. To get my energy up and going while on the Zyprexa, my psychopharmacologist added in Dexedrine. Another pill? What the hell—I take it only when I’m at my worst.
I no longer take Xanax regularly, but am I addicted to the little cocktail of antidepressants—Effexor, Wellbutrin, BuSpar, and Zyprexa—that allowed me to write this book? Am I dependent on them? The most acute version of this question is whether the drugs I have been taking will all remain legal. Heroin was originally developed by the Bayer aspirin people as a cough medicine, and ecstasy was patented by pharmacologists in Germany before the First World War. Drugs regularly move from the world of medicine to the world of abuse and back. We seem currently to endorse any drug that does not essentially impair functioning. I think about the effect that Zyprexa had in my most recent round of battles with depression. What is Zyprexa really doing inside my brain? If going off Zyprexa gave me all those fidgety, anxious symptoms of withdrawal, then was it a drug on which I was reliant? How would I react if someone told me that in the wake of recent discoveries, Zyprexa had been positioned among the enemies in the war against drugs?
Michael Pollan has argued in the New York Times Magazine that there is in fact no truly consistent basis for declaring substances legal or illegal and writes, “The media are filled with gauzy pharmaceutical ads promising not just relief from pain but also pleasure and even fulfillment; at the same time, Madison Avenue is working equally hard to demonize other substances on behalf of a ‘drug-free America.’ The more we spend on our worship of the good drugs (twenty billion dollars on psychoactive prescription drugs last year), the more we spend warring the evil ones (seventeen billion dollars the same year). We hate drugs. We love drugs. Or could it be that we hate the fact that we love drugs?” In principle, addictive, illicit drug taking crowds out all other activities, while antidepressant drugs make you function better than you would without them and do not cause long-term harm. William Potter, who formerly ran the psychopharmacological division of the NIMH, comments, “We’ve made a judgment that drugs that prevent you from experiencing appropriate emotional response are not acceptable. That’s why cocaine is illegal. There are too many problems when you cease to detect warning signs and threats. You pay a price for an excessive high. That’s not moralizing; that’s just my observation.” In contrast, “No one gets an intense Zoloft craving,” says Steven Hyman. “No one would ever kill to get a Zoloft.” They also do not produce either euphoria or supersize relaxation. One does not speak of a diabetic as being addicted to insulin. Perhaps our society’s emphasis on deferred gratification is so intense that we simply prefer those drugs that make you feel bad (side effects) and then good (mood effects) to drugs that make you feel good (high) and then bad (hungover)? Still, are new-generation antidepressants anabolic steroids for the brain? The psychiatrist Peter Kramer, in his famous book Listening to Prozac, wondered whether people who take these drugs have an unfair advantage, thus creating pressure for others to take them. Will they reproduce the effect of modernization, which has been not to give people free time but to raise expectations and speed up life? Are we at the brink of making a breed of Supermans?
It is certainly true that antidepressant drugs are hard to give up; I have in two years tried three times to get off Zyprexa and failed every time. Getting people off the SSRIs can be very difficult. The drugs are not intoxicants, but they make you feel better and they do have a lot of adverse side effects—mostly adverse for the individual rather than for the society, but distinctly adverse nonetheless. I feel some concern for my overall state of mental health, and I exercise considerable care around readjusting my brain chemistry: I am terrified of plummeting back into the abyss, and no high could be worth that. I’m too mistrustful of recreational drugs to get much pleasure out of them these days. But on the rare occasions when I have taken them and had a high, I have had to contrast that heady feeling with the effect of the prescribed medications on which I am now reliant. I wonder whether the permanent repitching of my personality just a notch higher is not somewhat akin to the heady high. I actually write pretty well in altered states: I have come up with good prose at the end of a night of drinking, and I have spun out some ideas when I was flying on cocaine. I certainly wouldn’t want to be in either state all the time, but I wonder just where I would pitch my personality if anything were possible. I’d definitely bring it up a few levels from where it is now. I’d like to have the boundless energy, the quick precision, and the apparent resilience of, say, Wayne Gretzky. If I found a drug that would give me those properties, would it necessarily be an illicit one? Much is made of the fact that antidepressant medications do not provide immediate relief, while substances of abuse mostly give you a desired high really fast. Is it simply that speed of effect that so disturbs us, that eerie bewitched-before-your-very-eyes phenomenon? If someone made up a powder that didn’t deplete neurotransmitters and that didn’t bring about a crash and that instead allowed me to function like Wayne Gretzky so long as I inhaled it every five hours, would that necessarily have to be illegal?
To my mind, I am no longer independent. The medications are expensive, though they are at least regularly and conveniently supplied. I don’t mind the idea that I am reliant on them, nor the idea that reliance is a cousin of addiction. So long as they work, I�
��m pleased to take them. I carry pills around in my pocket all the time every day, so that I will have them in case I can’t for some reason get home one night. I take bottles of pills on airplanes because I have always thought that if I were hijacked and held prisoner, I’d try to keep the medication secreted about my person. Janet Benshoof recalls being put in prison in Guam and calling her psychiatrist from jail. “He was frantic about my having a depression in prison, not to mention withdrawal, and he was vigorously trying to get antidepressants through the security system for me. It was hysterical; I was hysterical too.”
I pop about twelve pills a day to keep myself from getting too down. Frankly, if I could accomplish the same effect with two good drinks (and I know people who can), that would be a perfectly satisfactory alternative, so long as it didn’t turn into three drinks or four drinks or eight drinks—which, if you are fighting depression, it usually does. A dependence on alcohol may be fully socially acceptable even if it interferes with REM sleep. I was charmed by someone I used to know who would at six o’clock sharp cry out, as he decanted his whiskey, “Every fiber of my being cries out for alcohol.” He had built a life that accommodated his evening vagaries, and I think it was a happy life, though when he once visited a Mormon household in which alcohol was unavailable, he hardly made it through the evening. It would be stupid to put such a man on Prozac instead. For other substances, the law often creates trouble instead of controlling it—or as Keith Richards put it, “I don’t have a drug problem; I have a police problem.” I have known people who used marijuana and even cocaine in truly controlled and disciplined ways that improved their states of mind and being. Ann Marlowe’s book how to stop time: heroin from A to Z convincingly describes reasonable controlled manipulation of mood with heroin. She took heroin on and off for many years without ever becoming addicted to it.
The big problem with self-medication, far worse than the selection of inappropriate substances, is that it is so often inept and ill-informed. “I deal with bad cocaine abusers,” says David McDowell of Columbia. “People who are using a hundred fifty dollars’ worth of cocaine a day at least twenty-two days a month. And they don’t like the idea of medication and think it sounds unnatural. Unlike what they get from Billy the dealer! These substances are unregulated, and utterly unreliable.”
Many of the people quoted in this book have had substantial problems with substance abuse, and many of them have blamed substances for their depression. Tina Sonego is unusually frank about the interaction of the two kinds of trouble. She is a woman with unusual vitality, a rich sense of humor, and staying power. Over a span of three years, fifty letters, and dozens of E-mails, she created an intimacy with me purely by supposing it. She took to “freebasing my dark moods on paper,” as she described it, and the result was a remarkable set of documents of rising and falling moods. Her struggles with self-destructiveness and addiction and depression are so tightly bound together that it is nearly impossible to see where one breaks off and another begins.
Tina Sonego is a flight attendant for an international charter airline flying the U.S. military to engagements and flying customers for cruises and group holidays. She calls herself a “people pleaser” who has spent a lifetime trying to be nice enough to people so they’d like her. “I am funny,” she says, “and loud, and cute, and sexy—I’m everything you’d want a stewardess to be. I form completely happy emotional attachments to my passengers, for eight hours, and then they’re gone.” She is in her midforties, and her upbeat manner belies a lifelong struggle with depression and alcoholism. She has a quick mind, but “intelligence was not a thing in my family; no one ever even thought of it,” and since she suffers from dyslexia, she never got past high school. Her grandmother was a maid who was expected to provide sexual services to her employer in Morocco; her grandfather was a furniture maker who grew hash there for export. She was born of first-generation immigrants on both sides and grew up in a Moroccan enclave in California, speaking a mix of French, Spanish, and Arabic at home. Mental illness had no place in this world. “I was asking questions that didn’t have any place in our house. So I learned to perform, and I had an outside persona so that no one would ever see the sad, self-loathing woman inside me. I was split in half. And depression was what happened when the halves hit.” Tina’s father was moody, perhaps depressive, a man who had to be sheltered from anything upsetting; her mother “needs TLC but does not give it. She told me years ago, ‘Honey, I can’t make myself more sensitive just to understand you.’ ” Her sister was the same. “I was watching TV with her a few years ago, and I said, ‘Who’s that character?’ and she told me everything that had happened in the character’s life for the past twenty years. And she doesn’t even know what guy I’m going out with. I grew up thinking I was damaged goods.” After Tina’s father died, her mother remarried. Tina adores her stepfather and gives him much credit for her relative good health today.
Tina had her first full-fledged breakdown when she was nineteen, traveling in Israel and planning to write a book about kibbutzim. Her sister had to come and rescue her and bring her home. A few years later, she decided to move to Rome to be with a man she loved, and when she arrived, “the relationship turned metallic, sex was beyond impossible, and I had nothing to say.” She had sunk into another depression. Like many depressives who abuse substances, she suffered from particularly acute self-loathing and was drawn to criminal people who would treat her violently. A few years after the Rome episode, she married a Dane and moved to Copenhagen. That lasted less than two years; after the murder of her husband’s mistress, both she and her husband were questioned at length. Though they were both released, the marriage had been destroyed; he threw her out, and she had another breakdown. Her work at the time was flying soldiers to Desert Storm. She was on a layover in Rome and suddenly found she could not go on. “I still remember the moment. I ordered a chicken salad and it tasted like chalk. I knew I was depressed. And I went downhill so fast. That’s when I really started drinking. I just did everything to fuck myself up to the bitter end. I would just black out and drink and black out and drink and black out and drink. I always left suicide notes: if I don’t wake up, call my mother. I was using alcohol to kill myself. It was the easiest drug I knew; it was cheap; it was accessible. And it is respectable.”
She entered a psychiatric hospital in South Carolina, which was “like a holding area, where they were supposed to try to fix you, and the depressed people never got any attention because we didn’t make noise like the other crazies. I felt like Chicken Little, like the sky was falling. Oh, the anxiety! Anxiety in depression is this feeling like you have a terrible secret, and everyone’s going to find out, and you don’t even know what the secret is.” She went on antidepressants and some other prescription drugs and mixed them with alcohol in an attempt to overcome anxiety. She had two grand mal convulsions as a result and ended up unconscious for three days in another hospital.
For Tina, depression was not numbness but pain. “I felt like a sponge that was waterlogged with passion, heavy and bloated. I was not silent in my pain. I would stay up all night writing letters to God in the dark. I was not born to be happy, joyous, free. If my body had its druthers, I’d be depressed all the time. When I was a little girl, my mother used to tell me, ‘Be happy or go to your room with that sour face.’ I wasn’t being deliberately like that. It’s just that that’s who I am.” Interaction with other people is often acutely painful for Tina Sonego. “Dating, to me, was the most excruciating thing that God ever made. I used to throw up in the bathroom. I got married to escape the pain—it hurts me to death, wondering why no one asks me out.” Tina Sonego soon married her second husband, a Malaysian living in the United States who got in trouble with the law and returned home. She followed him to his mother’s traditional Islamic household. The constraints were simply beyond her. “My breakdown spiraled fast when I was there; I flew home sicker than I had ever been in twenty years.”
Back in the United Stat
es, she continued drinking; it was the only way she could find to control crippling anxiety. Periodically she would go to rehab and recover partway for a short time—she has now been through full-scale rehab four times. Her insurance didn’t cover treatment for addiction, but she was able to use the mental health diagnosis to get expenses covered. “The rehab program? It’s the last stop before Lourdes,” she says.
Tina Sonego went to her first AA meeting about a decade ago, and the program has been her lifesaver. She describes it as the only place she has ever been able to be honest with people. The program has not freed her of depression, but it has given her a different methodology for dealing with it. “Without the alcohol in your body trying to blot out the bad emotions, they all come out like firecrackers. But thank God I was at least a drunk, and there was something I could do about it. I went to a meeting of Emotions Anonymous, and I felt so bad for all those people because they had nothing to remove, nothing they could see to fix. Drunks are such hard-core people. There’s nothing like a drunk saying, ‘Well, did you take a drink over it?’ I can talk to them about depression, like I own it. It’s like getting a college degree, and then you have the right to talk about some things and not feel weird about them. That’s all us drunks really want, is someone to tell our story to, someone we know will listen.”
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