brain chemicals: why i take medication, part one of two.

raven on a chimney, early morning Aberdeen, May 2012

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I have never liked taking medication. As a young child I had to be bribed into it, because early experiences with penicillin made all medicine have pretty unpleasant associations, as did bad reactions to decongestants and cough suppressants. I remember tolerating the one penicillin that didn't  wreak havoc on my system, the infamous 'banana medicine', but that was it. I learned to accept that ibuprofen could do fine things for a tension headache, and take a few hours off a migraine even if it did nothing for the pain. Half a dimenhydrinate makes nausea evaporate. But I was always (and continue to be wary) of what was going into my body because of the element of the unexpected, the understanding of their power, and I still am. I remember learning in biology about the load many medicinal substances place on the liver and the kidneys, and I worried about my body's ability to handle these substances; I understood that it should be fine if drugs are taken sparingly, but what about something you take every day?

I do agree with many opponents of psychotropic medications; I think it is terrifying that you can walk into a doctor’s office and blithely ask for an anti-depressant or anti-anxiolytic of your choice; this has happened to me and a number of others. I want these drugs to be available, but I am concerned that many doctors really know little about them, because from my experience and stories I've heard, patients are rarely told about the trials and hazards of going on and off medication (or that their concerns are explicitly dismissed or downplayed). They can have very serious side effects and consequences and should never be taken lightly or without a lot of consideration, because they cannot be discontinued abruptly. And most definitely they can be worse than reasons why you're taking them; I have no doubt about that. But that doesn’t mean they’re worthless and should all be condemned, as they can be very effective.

I thought about providing links to medical studies and articles both for and against anti-depressants, but frankly, it's pretty easy to find these sorts of back-and-forths everywhere online, by psychiatrists and other clinicians as well as those who have experienced the drugs. Yes, it's true that we know very little about the brain as a whole, and also only a very small bit about what causes mental illness and about the mechanisms of these drugs we use to treat it. However, I just can't understand how anyone can make the leap to 'these drugs are no better than placebos' just because it is not precisely known at this point in time how and why they work. Some brain chemical imbalance theories may be outdated or (partially) debunked, but we do know that somehow these medications, these chemicals, can bring relief to symptoms by affecting the function of neurons. They did something for me.

I feel awkward writing this, because I really don't want to dismiss the fact that others have been miserable on them, and have found their conditions to worsen and become more debilitating. But I am also tired of having to downplay or deny my own experiences-- especially since it was not an easy decision for me to make, to take these drugs in the first place. I am tired of the subtle but insidious judgment that comes from taking them; the misunderstanding that it's a cheap and easy way to 'happiness' makes me seethe. I have done a fuckload of work to be able to function, before and after starting this medication. This is not the easy way out. I do not take these to be happy. These do not make you happy. I am not happy all the time. I sought out this treatment because I could not feel anything but pure terror and I wanted to have other feelings. I still get anxious. I still have periods of depression. But now I can have more than one feeling. Now I can deal with these things, most of the time. 

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I don't know where my anxiety comes from. I don't really know if this predisposition comes from brain chemicals, even though I use other chemicals to help fix it. I think a lot of it comes from my brain, though, and I have memories of anxiety and panic for nearly as long as I have memories at all. It's been with me for a rather long time. I had a very un-tumultuous early childhood, with attentive and supportive parents, but I could really having a full-blown, hyperventilating panic attacks that came out of nowhere. When my dad found me crying and shaking on my bedroom floor, I didn’t know what to tell him. Even then, I realized that if you were upset, there had to be a good reason to be so upset – and it terrified me that I had no such reason. I made up stories; I told him that the girl next door had been mean to me. (That happened sometimes, and made me anxious too.  And I knew it was okay, it was normal to be upset about that, because that was a thing that happened. It was real.)

As I got older, I developed many more persistent anxieties. Some of these things were because of things that actually existed in the world, things that make many children anxious (being harassed in elementary school, etc.) and others, were not so rational, and definitely not so external. This duality that I could see developing in hindsight tells me something, too -- that in some ways, my anxiety and depression is Janus-faced: some of stems from my responses to my social and environmental factors, and yet some of it arises within my own mind, for reasons that cannot be traced (despite years of therapy). Many people, like Ann Cvetkovich, write that depression is 'the symptoms of a response to a fucked up world or a fucked up life' (see Depression: A Public Feeling, p. 15) and I do agree. I still get anxious, I still get depressed, even after a decade on psychotropic medication. However, when I look to the causes of this anxiety and depression, I can generally always link it to something in the world, in my life, that is shitty. Because there are awful things, both great catastrophes and daily microaggressions that build up and weigh us down. (And honestly, I find people who do not react to kyriarchal oppression as a little suspect, because things are pretty dire). I think anxiety and depression are completely normal responses, to certain things.

But then there are these other things, things inside my head. They can be exacerbated by less ideal conditions in the world, but they feel so internal, so idiosyncratic that they seem to come from my brain. Like my migraines can be triggered by things I ingest or by conditions in my environment, but also can just spring up from no traceable cause, so can my anxiety. And this is the kind that led me to not be able to function. The symptoms of this kind is what I like to remind myself about when I want to stop taking my medication.

The panic attacks that came on in class suddenly, that sent me running for the washroom often at school to hide there, because I often couldn’t explain what brought them on. And even if I could, it was a thoroughly awkward thing to do. And when not feeling that dizzy wash of fear, the accelerating breathing, the crush in my chest, I felt a constant tightness in my shoulders, a constricting mass in my throat, a vague nausea nearly every morning. When I was 10 and 11, there were times when I could hardly eat anything, terrified I would choke on each bite I took. I was underweight, my blood pressure was low, and my resting heart rate sometimes spiked up like a terrified rabbit until I thought I would black out.

There was the kind of anxiety that made me feel as if I was going crazy. It crept up for no reason. I deeply feared  losing my mind, forgetting who I was, saying and doing horrible things. I don’t know where those thoughts came from, what they arose from, what brought them on, but they definitely felt different than the other things that triggered anxiety, the people, the situations, my fears about things actually happening in the world outside of my thoughts. In high school, when I began seeing a psychologist, she helped me understand I probably had a mild form of obsessive-compulsive disorder (my sister and uncle have been diagnosed with a severe form of this), because I created rituals to assuage the anxiety: I washed my hands often, til they bled, not because of germs but contamination by frightening thoughts. I repeated phrases to myself over and over, mantras before I slept each night, a certain number of times, to make it so that everything would be okay. Looking over notebooks I kept at the time, I see pencilmarks in the margins tearing through the pages, fervently underlining the magical words I needed to write to prevent these awful thoughts, to straighten them out, to keep them in check.

As I got older, some of these rituals fell away. But when the tension in my body was too much, or I had a panic attack where I couldn’t stop crying, I learned to dig my fingernails hard into my palms. This sudden pain caused my focus to shift, and provided a momentary release from this internal intensity; it led to me scratching harder, and eventually cutting my skin – little vents for the anxiety, sort of like trepanning but for my flesh instead of my skull.  It helped at first, but eventually caused me greater anxiety for doing it, especially when I confessed it to others and received little empathy or support. This is when I started seeing my psychologist, because I was at a loss as to how to deal with this (I once had believed everyone dealt with anxiety like this, but trying to explain my feelings to others had come to understand this most likely wasn’t true) and was becoming afraid of myself in a way I could not handle.

With my psychologist, I engaged in Cognitive-Behavioural therapy, to help me deal with the moments of intense anxiety and the panic attacks. And so they still came, but I learned to manage them better, to fend them off as best I could without resorting to cutting or burning. She always told me that medication could be an option if I decided I’d like to try it, but we would work without it unless I asked, and I was still very much against it.  And I was doing fairly well managing with the CBT for awhile, but then things started cropping up again. Near the end of my first year of university,    I wasn’t particularly stressed about things in the world, external things; I was managing the new routines and workloads fairly well.

Then one day I had a very severe panic attack that coincided with a migraine that sent me to the hospital, and I was convinced I would die. The headache and panic attack subsided, and then a few days later I woke up with another one. And another one, and then suddenly every moment felt like constant anxiety, more continuous than it had ever been before; panic attacks were mere spikes on a high plateau of frantic unease.

It felt like my thoughts had aphasia; they came out in chunks that raced around and I felt nauseous trying to round them up. I felt lost in my own head, unsure of how I would ever make sense of anything again. The OCD-like fears returned, mantras were needed, but sometimes they were not even enough, and my mood began to sink when I realized that I really could not even trust my own thoughts anymore. I wanted to practice my CBT techniques, but I could not slow my thoughts enough to do so, could not even begin to do it no matter how hard I tried. Walking around the block, let alone running, was too terrifying, so I could not clear my head that way, feed myself the endorphins I hoped might help. Eating became difficult again, and I lost 15 pounds in three weeks. I would wake up shaking, convinced I was going crazy and/or was going to die. Nothing could convince me that I actually wasn’t.

I would have panic attacks that seemed to only subside when my body was too tired to keep shaking, too dehydrated to cry any longer; I then became afraid of always having a panic attack. When I wasn’t awake and worrying, I often had terrible nightmares, chaotic and violent; in the moments when I would wake from them I had the most scrambled thoughts, and it took all my energy to sort things out in my head enough so that I could get out of bed.

School term was over, I was working but kept having to miss shifts or leave early because I could not focus. Functioning was a little difficult though I tried so hard to not let on what was happening inside my head, and then I would feel worse because I could not function. But one day in the moments before waking I had by far the worst dream of my life, and I thought it was real, and I woke up and a cascade of thoughts started and I can’t even begin to explain it, can’t even type it out, could never even speak a word of it to anyone, but suffice to say that my shaky traitorous brain took about three seconds to convince me that it would come true and I would do a horrible thing and I was so fatigued and so tired that I had no energy to even summon up one of my spells to compensate for that hideous thought that I had another massive panic attack and decided that I needed to die, to not exist, to not be anymore.

I can’t express these thoughts very eloquently. I wish I could. I write them out and they feel suitably frenzied, but I do not know how to convey the terror and sickness I feel when I think of them, remember them; I can’t seem to capture it on the page. But this is why I decided to take medication. I can’t do justice to the lows I felt that day, I could not even calm down enough to speak until later that day when I went in to see my psychologist, and that was when I told her that perhaps I would like to try something, because at this point I was willing to try pretty much anything, frankly, that could even possibly make these particular feelings stop, because they were not really compatible with living anymore, and I thought I still wanted that.

So that, in a hastily explained, incomplete nutshell, is why I take medication for my anxiety. Not for the kind that comes from living in a problematic world and having feelings about it. Not the kind that is linked to my self-esteem and my place in the aforementioned world, but from living with a brain that antagonizes me and is uncooperative for reasons I may never quite discern, but seem to lie within it.