Talks Many Moons

The Fog Creeps in on Little Cat Feet (Part 1) November 2, 2009

“The fog creeps in on little cat feet,” says the poem by Carl Sandburg. As I read that I think that Sandburg has to have had personal experience with chronic depression because that is what depression is like. It is insidious, creeping over you slowly, stealthily so you aren’t aware until you are deep within its grasp and unable to get out.

I have dealt with chronic depression for years, mostly very well with the help of medication until last December I did what is hard to understand- I went off my meds. The reasons are varied—we were going through a rough financial patch and trying to save money every way we could; I felt really good and didn’t think I needed them; I ran out and just didn’t have time to get the prescription renewed. And so on and so on. Yes, I went through withdrawal—mainly incredible nausea, but I weathered it, welcoming the loss of the few pounds that would surely accompany it.

There were advantages to not being on the meds—most notably I wasn’t sleepy all the time. See, the thing with drugs for mental illness is you seldom take just one, because they all have various side effects so you have to take several to balance out all the side effects and all the symptoms. The drug I took for depression also made me tense and gave me tremors and didn’t do anything to calm my panic attacks so I took another drug to balance that out. That drug works really well to handle the tension and panic but also makes me sleepy. One drug revs me up, the other calms me down, and I need both of them to function. Yes, it’s weird, but that’s mental illness for you.

At first there was this euphoria to being off meds that everyone told me I would be taking for the rest of my life. It’s the stigma of mental illness, the dislike I had for owing my daily ability to function on a couple of pills. Yes, I’ve taken thyroid medication for years but that has a real, quantifiable measurable effect. My doctor can tell that it’s working by looking at my lab results. The same with my cholesterol medication. The same with my blood sugar medication. But there’s nothing physical to look at with anti-depressants. The only way to tell they are working is by asking me how I feel. And for a brief period of time I think I feel really good. I relish those times. It’s almost a mania as I feel better than I have in years, creative, full of energy. My creative juices flow- I write, I work out, I start new activities, I reach out to talk to friends I haven’t heard from in years.

But then the ebb. The way too many times my husband asks me if I’m okay, if I need to talk to the doctor, if I need to start my meds back up. The times when I am unable to do more than lay on the sofa in a black haze and wish the world away. The times when I am at the bottom of a deep, dank, dark well, a pit of blackness. I cannot remember what it was like to feel good. I can’t remember anything but the darkness. I don’t want to climb out of the well; I just want to stay there, alone in the dark. I don’t care if I never see light again.

Before long the depression has taken over me and I spend more time at the bottom of the well until one day I finally admit to my husband that I need to go back on the meds. But this, like everything else in mental illness does not come easily either, for there is a price to pay for going off the meds. When I start taking the pills again, I go through reverse withdrawal. My body punishes me for taking away the medicine by ratcheting up the side effects. The nausea is unbearable and for days I am unable to eat. The pain is physical—the tension settles in my brow so I feel as though any minute I am going to burst into tears, but I hold the tears back until they press inward on the nerves of my face and skull, pounding and throbbing until they explode. My teeth clench and my jaw shudders and the back of my head aches from pulling against my teeth. My hands tremble so that I cannot type, cannot operate a computer mouse; at any given moment something I am holding might slip from my grasp. My feet and legs tremble so I stumble when I walk.

I curl into a ball on the sofa and clench a pillow to my stomach and think about retreating back into my well because at least there I couldn’t feel anything and that would be better than what I am going through now. I wonder if I really want to go back to the balance of the different medications required to keep me functioning, and I think about how much worse it must be for those with major mental illness as opposed to my relatively mild chronic depression.

I think about my daughter who deals with bipolarism and depression with incredible bravery. In the last two years she’s gone through the withdrawal and re-acclimation process twice. She went off her meds at first because she couldn’t afford them and with the bravura of youth she thought she’d be okay without them. Psychotropic drugs are expensive and many of them have no generic equivalents. Insurance companies don’t understand the delicate balance of neurological drugs, how one medication that works perfectly well for one person can do absolutely nothing for someone else, how the unique biochemistry of our brains determines which medication we will respond to and the insurance company’s definition of preferred drugs has absolutely nothing to do with it. My daughter’s insurance company prefers one psychotropic medication; her brain prefers another.

She didn’t tell us she went off her meds, knowing we would disapprove, wanting to handle things herself, until it got to be too much for her to handle. Unable to get to work, she quit her job, only telling us weeks later as though it were no big deal. Unable to pay her rent, she called us one night, frantic, sobbing, and we brought her home and moved her back in with us.

Back to the doctor she went and started the process of getting adjusted to her meds again, a long, painful year of sleeplessness, nausea, mania, brain zaps and mental exhaustion. Just when she thought she had achieved a balance and was starting to put her life back together again, she had a reaction to one of the medications, a reaction so severe that it shut down her liver. She had to stop the medication that maintained her emotional equilibrium and start the long slow process of stabilization again, only this time she had the additional burden of recovering from her physical illness at the same time.

(to be continued)