Passing For Normal

Decisions, they are hard.

TL;DR version: Since I went back on antidepressant meds four years ago, I've almost entirely stopped writing fic. I miss it dreadfully, enough that I'm considering switching to a different, less effective drug to see if that would help.

So the thing is that I'm a lifelong depressive; my neurochemistry has been out of whack pretty much from the very beginning, as far as I and a whole bunch of people with letters after their names can tell, though I didn't get a formal diagnosis or meds for it until my late twenties. (Much, much too long.)

For thirteen pretty good years I took a tricyclic (read: old) antidepressant called imipramine (Tofranil) and it worked pretty well. I went from invariably using my maximum allowed twelve sick days per year, putting me in constant danger of disciplinary action or even job loss, down to two or three – which is to say, when I stayed home sick, it was with a virus, not sick with depression (which is not something one could sell to any boss I've ever had, physiological reality notwithstanding). I still felt like me. I still had all my emotions; I just didn't get stuck in the downswings. I was no longer immobilized by the paralysis of will that is far and away the worst thing about this damned condition.

Then, due to a combination of deeply fucked up circumstances that aren't worth rehashing, mishandling of a stupidly mandated med switch further fucked up my neurochemistry and neither the new drug nor my old faithful meds worked very well. Additionally, they started causing some wretched side effects, the worst of which – and you have no idea unless you've lived through it – is drenching me in free-flowing rivers of sweat much of the time, regardless of temperature or circumstances. It's not just unpleasant, it's hell.

In hopes of finding a better solution, I got referred to an awesome psychiatrist who patiently worked with me for three and a half years trying to find a medication that would help with my depression and not cause the same or worse side effects. I tend to have atypical reactions to these meds (Prozac, for example, made me sleep all the time, a very rare but documented side effect). We went through a round dozen meds before he finally ran out of options.

This was pretty much simultaneous with my relocation from the Bay Area to the north coast of California where I live now, so I made the decision to go off all psych meds after the move (in a supervised dosage phase down, of course).

I lived off meds for several years and for the most part was okay with it. I was not as functional as I would've been on meds, but I didn't have to live with the hellish side effects, and that was great. Also, after going on and off so many mess-with-your-brain drugs over such a long time, it was really good to return to just being myself; it was wonderfully refreshing, almost a rediscovery, not to mention a relief. By that time I'd been granted permanently disabled status and started receiving SSDI (US federal disability payments) so I didn't have to worry about fiscal survival. It wasn't a lot of money, but I could manage.

It was during that time that I found fanfic and fandom, and shortly after that I started writing, which was a tremendously joyous thing.

Unfortunately I found myself in a major downswing about four years ago that went on and on and on for months, and it just kept getting worse.

Sidebar: One of the best measures I've found for exactly how depressed I am is how often I have suicidal thoughts, and how intense they are.

This is something nobody ever told me about when I was diagnosed with depression, and I really wish they had: Suicidal ideation isn't just a symptom of depression; it's a product of depression.

I remember the first time I was aware of thinking of suicide. It was so utterly foreign to my nature that I was startled by it – where the hell did that come from? One thing I'd learned about myself over many long years and many hard times is that I'm a survivor. I can and will survive pretty much anything I'm faced with. I may not do it well, I may fail at coping, but by damn I will survive. It wasn't even a question.

There's nothing like being severely neurochemically depressed as a baseline state and then going on and off a bunch of antidepressant meds to drive home how suicidal ideation works. Off meds, there'd be a constant flow of such thoughts. They even felt rational at the time – though fortunately I always knew better than to let those emotions overrule my rational understanding that they were irrational and, in fact, artificial thoughts. On meds, not only did those suicidal thoughts go away, but all of the life-and-circumstance challenges that felt so hopeless and overwhelming while off meds became things I knew with certainty that I could deal with. Off meds, the suicidal ideation comes back; back on the next drug, it goes away.

Back to the story: So about four years ago, the flow of suicidal thoughts swelled to a tidal wave, an overwhelming inundation. It took everything I had just to keep pushing them back. I was never in any danger of taking action – I know better than that; I'm too well-informed and self-aware about this – but it became very clear that I was headed in a dangerous direction and if I continued uninterrupted on the same path without taking some action, I could end up in a crisis that would require dramatic intervention, like hospitalization.

So I went to the doctor and got back on imipramine, my old faithful first medication, and ever since then I've been pleased to be more functional; unhappy to be wretchedly, hellishly drenched in sweat much of the time (it'd be nice to be able to wear dry underthings like, ever, really it would); constantly struggling to fight the sedation and pump enough caffeine into myself to just wake the fuck up; enjoying a modest but significant degree of general pain relief; and the suicidal thoughts are so mild, occasional, and fleeting that they're effortlessly dismissed.

But. BUT. I have almost entirely stopped writing since going back on meds. I've managed it a few times, yeah, but it takes extreme effort to get it started and the pressure of a looming and non-negotiable deadline.

I miss it dreadfully. I don't even have words for how much I miss it. It's like an amputation. I feel a constant sense of loss.

A year ago, pondering all this, I was all set to go off my antidepressant and try SAM-e instead since it has antidepressant (and other) benefits and is activating rather than sedating. Great plan... except that I got surprised with the diabetes diagnosis, for which I take metformin, which does not play well with SAM-e. Well, hell. Given that my sugars had reached scary high levels (close to 400) by the time I was diagnosed, the one and only priority was getting that under control. Which I have since done; that's doing pretty nicely now. The diabetes will never go away, but the numbers are staying where they belong and I know how to keep them that way.

Which brings us to now.

I want to write again without it being a constant, huge struggle. I want it so badly it's a physical ache.

So my latest thought is to go off my old faithful antidepressant and instead go on Wellbutrin (bupropion). I've tried it in the past; it was one of the dozen.

The upside is that it's not sedating (possibly even activating), it didn't cause the extreme sweating (some, but not nearly so much), it helps with pain in the same way as my current meds, it didn't shut down my libido, and it dramatically reduced my cravings, which in me are expressed in eating and particularly over-eating for a hundred reasons that have nothing to do with hunger. Taking it would make it even easier to stay on healthy diabetic eating and make it far more likely that I would also drop some weight, slowly and over time but eventually significant, which would ease the stress on my train-wreck knees and crappy hip joints.

The downside... it was one of the less effective meds I've tried in terms of treating the actual depression. It helped, but not as much as some of the others.

Yeah. I know.

Still, it feels like it's worth a try. It's always a trade-off with me. It's always going to be a world of compromises, whole stacks of them, and all I can do is balance them off against each other.

I think I may be ready to swing the neurochemical pendulum in the other direction for a while and see what happens. No guarantee that it would free up the creative brain and get me writing again... but it seems like a more sensible approach than going off meds altogether.

Worth a try? Maybe?

Comments and thoughts are entirely welcome, should anyone care to offer them, and actively solicited if any part of this happens to resonate with any of your own experiences. Anonymous commenting is allowed; IP logging is turned off.