Better Living Through Chemistry

I think the time has come for me to discuss my relationship with psychotropic medications. In my last post I wrote in some detail about the spiral I found myself in with anxiety and depression compounding one another until I reached a point where I simply could not pull myself together. I credit medication for ending this spiral, but that does not mean I believe these pills are the magic bullet for curing depression.

I fought the use of medications for a long time. I was a pilot and taking these drugs meant the end of a career that was just getting started. I had spent four extremely difficult years in college working towards the goal, and spent well over one hundred thousand of someone else’s dollars to complete my degree. The idea of throwing it all away was more than I could bear. It took consecutive events in airplanes to convince me it was time.

I was well trained and qualified to fly in bad weather. I actually really enjoyed flying when I couldn’t see. It required a level of precision that the perfectionist in me got a great deal of satisfaction from. I was training to teach others these skills when I lost control of an airplane in the clouds. I am not sure I actually physically lost control of the airplane, but my mind convinced me there was a problem and the instructor had to take control of the plane from me. The experience scared me, and the next day I went flying in good weather alone to try and shake it off, but I was terrified from the moment the wheels left the ground until touchdown. I knew something bad was going to happen if I continued so I parked the plane walked into the Director of Flight Operations office and told him I needed to be taken off the schedule because I was medically unfit to fly. I stood in front of a man who had over 600 hours of combat flying experience in Vietnam and worked as a test pilot on the F-16 program and told him that I was afraid to fly. I had tears in my eyes and have never felt as small as I did that day.

I followed this good butt painful decision with a poor one, but one that I sure many others have made. I went to my primary care physician rather than getting a psychiatrist recommendation from my therapist. I am sure my doctor meant well, but she had no business messing around with these drugs. I don’t even recall the names of the first few she tried, but they are not names most would recognize. I do remember I got no benefit and a pile of side effects. I recall one drug made me horribly dizzy and made my vision weird. I went into the bathroom looked in the mirror and could watch my pupils change size from larger to smaller and back again. Other side effects included fatigue and feeling mentally sluggish. I was dismayed that I had lost my career to experience this.

Finally she landed on the SSRI Celexa. No freaky side effects were immediately apparent and after a week or so I noticed an unbelievable improvement in every area of my life. I truly thought I had found the silver bullet. The catch was soon to be discovered. When I started these pills my future mother-in-law was staying with us. She and my future wife were going to Florida together, and she had arrived a few days early. The size of our apartment and the presence of “mom” precluded any activity of a physical nature between my girlfriend and I. When they left and I had the place to myself I settled in to let off some of the pent up energy. I was more than a little disturbed to discover that something was terribly wrong. I felt aroused, I could get hard, but orgasm was another matter. At this time I was probably about 23 years old and had not had sex for a week. I should have been able to masturbate to orgasm in minutes if not seconds. It took over thirty minutes, required aggressive stimulation, and the end result while technically being and orgasm was less than satisfying. It was my first experience with what I came to call the pleasureless orgasm. The physical response could be made to happen with a great deal of effort, but sometimes I felt almost nothing.

Having my life back was enough for me to accept the side effect, and life moved on. My future wife was extremely understanding about the side effect even after it became clear that I would never be able to orgasm through intercourse. She always did whatever I needed to get over the top. There were times when this would go on for forty-five minutes or more after we gave up on intercourse.

The initial experience with medications had led me to make an appointment with a psychiatrist, and even though the Celexa seemed to be doing the trick I kept the appointment. He kept me on the Celexa and added Klonopin. The Klonopin was for the anxiety, and made it nearly impossible to have a panic attack. In the rare events that the panic did break through I could take another pill and in twenty minutes or so things would settle down. This drug can be habit forming and I was told would show up on drug tests making any thoughts I may have been having about lying to the FAA about my condition and flying anyway mute. I stayed on this combination of drugs for a long time.

Eventually after having felt relatively normal long enough the sexual side effects of the SSRI became annoying enough that I asked what could be done about it. The first attempt the psychiatrist made was to give me a coupe sample packs of Viagra. Other than erections so hard I could have chiseled marble I got no benefit from the little blue pills at all.

The next attempt was to switch me over to a newer drug called Lexapro. This was supposed to be a purer form of the Celexa and have fewer incidents of unwanted sexual side effects. That too had no effect. Next they added Wellbutrin which acts on norepineperine and dopamine rather than the serotonin targeted by the Lexapro. I was told that adding Wellbutrin to regimes of SSRI’s had helped with the side effects. Again I got zero benefit from this combination. Over time my body adjusted to the SSRI a little and post intercourse hand jobs that had been lasting forty-five minutes or more got down to twenty minutes or so. Adding pornography to the equation would speed things up further, sometimes I could even come through intercourse with porn in the background, but we only did this rarely. I did not want to become dependent on pornography.

For years this was as good as it got. I took Lexapro and Klonopin, and dealt with the side effects. After I had been married about four years the side effects really started to bother me again. By this time I was in a different state so I sought out a different psychiatrist who decided to try adding Wellbutrin again, and again I got nowhere. The next step was to build up to a maximum dose of the Wellbutrin and wean off the Lexapro. This led to my first experience with serotonin withdrawal. The symptoms of dizziness, headaches, and confusion were unpleaseant, but were plenty tolerable and only lasted a few days. The upside was that within a week of being completely of the SSRI my sexual function was completely back to normal.

For awhile life was good. We conceived out first child during this time, and things were generally normal. I don’t recall exactly how long I was off the Lexapro, but in time symptoms returned mostly in the form of constant stomach upset. I put up with the stomach aches and the building depression for a long time, but eventually I felt I was getting too close to dropping into a deep funk, and I started the Lexapro again. Within two days of taking the first pill, well before I felt any benefit, I was again suffering from anorgasmia.  The doctor decided to add Abilify to the drugs I was taking to see if that would help both my mood and the sexual dysfunction. I got no benefit either way, but I did experience the unsettling side effect of feeling like my skin was alive. It gave the term “my skin is crawling” a whole new meaning. It was an awful side effect that didn’t seem to be getting better so I dropped the drug.

I stayed on the Lexapro for a year or so when a growing difference in sex drive between my wife and I led us to seek out some help. During conversations about this it came out that the marathons were wearing thin and adding to her lack of interest. I decided to try dropping the Lexapro again, and this time the withdrawal syndrome was awful. I suffered from dizziness, vertigo, confusion, and these awful feelings like electric shocks in my brain. I little research on my part turned up what they call “Brain Zaps” as a withdrawal side effect. These effects lasted three weeks before finally passing.

Today I am on Wellbutrin and Klonopin only. I have tried to drop the Klonopin in the past, but the results were not good. Over time tolerance builds to Klonopin and I have found the frequency with which I add a second pill to my regular dosage increasing. I have been off the Lexapro for about six months and I am again feeling the steady creep of depression and increased anxiety. The stomach discomfort has been back for several months already. This is the cruel reality of using medications for the long term treatment of depression. I have to choose between two significant quality of life issues. I either take the pills and destroy an already strained sex life, the effect of which will add to my depressive mood, or I don’t take the drugs deal with the symptoms of depression and anxiety to make the most of my sex life. The jury is still out this time around. This blog is one effort to keep from having to take the drugs again. If I go back on them I don’t know what will happen to my sex life, and the thought of facing the withdrawal syndrome again to come off them is more than I can bear.

To those that are in a real bad place the benefit of these drugs is undeniable, and they can be great for giving you a chance to reset, and for many who don’t experience these side effects they may be the ultimate solution. For the rest of us the decisions we make are going to be deeply personal and extremely difficult. Ironically the cruelty of having to make this decision feeds into my depressive mood as there is a significant feeling of loss with either decision. There is no right or wrong here and what works for a person may change over time as the circumstances of life evolve.