Don't know....

Kevin Breel is 19 years old, a standup comedian, and depressed.

Three adjectives, or maybe—he might say—two adjectives and a stigma. Because that’s what mental illness is, he argues in his TED talk—there’s still a lot of shame and blame about being sick in that part of your body behind the eyes….

Well, as someone who swallows 20 mg. of Lexapro and 15 mg. of Remeron daily, I was more than prepared to listen. Also to consider the question: has anything good ever come for me from my long years of depression?

Change a life—I had never known those many, many dark days when it was only habit and custom that got me out of bed. I never sat in those toilet stalls at Wal-Mart weeping silently, never canceled classes and sat in my classroom and stared at the walls, trying to banish the thought, “I want to kill myself,” which had become the mantra echoing through my mind. I woke up every morning, felt happy, and went about my business.

In short, the forty years of depression never happened—they felt as good as I feel today.

First reaction?

God, do I wish!

Breel argues that one of the benefits of depression is that it allows you to see the bright side of life, and that you have to know the valley to appreciate the mountain. Yeah? I’m not sure; would I appreciate walking more if I had spent time wheelchair bound? Don’t think so….

The depression may have made me more sensitive to others—that’s true, I think. It also gave me a certain strength—if I survived those years, I’ll probably get through today.

And yes, I’ve read Thomas Moore’s books and I think they’re good—and I don’t buy in. Sure, if you’re going through a divorce, or a significant loss, or a major life change—you may experience the dark night of the soul. But there is one hell of a difference between a major life event and a major depression.

Consider it—I was in a stable, long-term relationship; I had a job, a home, pets, and a loving family. I was also excruciatingly depressed. Yeah, you could argue that the job wasn’t the right one, that a creative side of myself was unexpressed. But no matter how hard I tried, I couldn’t shake the depression. The only answer was medication.

Sorry—but to say anything else is just more stigmatization, another way of saying, “oh just buck up and adopt a positive attitude.” And so, by the way, is the recent spate of articles saying that antidepressants don’t work.

Yeah? Let me tell you what doesn’t work—exercise, music, writing, time spent in contemplation, meditation, talking with friends. How do I know? ‘Cause I do all of these things on a regular basis, and guess what? If I miss two days of Remeron, I start to feel shaky and anxious. That happened to me two weeks ago, but I was smart enough to go to the pharmacy, explain that I had run out of the pills two days before, and that I had an appointment with my doctor in a couple of days.

They know me, nodded, and got me the pills. I took the Remeron immediately, though my hands were shaking so hard I could barely hold the glass. And I felt perfectly fine forty minutes later.

I feel now that I’m spinning my wheels—that I need to write something and I don’t know what and it’s scary. I’m not undisciplined, I’m not a coward—but something is blocking me. So I may do the dark night of the soul—why not?—and sit down and confront myself. But trust me—no depressed person could do that. That takes every molecule of mental health—a depressed person doesn’t have the strength even to think of it.

That said—I wonder if there really is a stigma today about depression or admitting to a mental illness. Part of it is having come out as a gay man—after you do that, admitting to depression is a sort of snore. But it may be true—for many years I could not get help, and it took a screaming brother and a panicky husband to drive into the arms of a psychiatrist.

“I want to die,” I once told a student, who popped back with, “that just means you’re not listening to God.”

The fury that surged through my body was liberating—perhaps nothing she could have said was more beneficial. And so we come to the theory that depression is simply rage or some other negative emotion suppressed.

Maybe—but can we just do whoever-it-is theorem? Remember—the idea that when there are two or more competing explanations, go with the simplest? Here it is, then.

We’re gonna have to go back to the idea that there are two major types of depression—one situational and reactive, the other biochemical. And we absolutely have to get through our heads—asking anyone with a biochemical depression to do anything except take medicine is like asking a diabetic to adjust his blood sugar without insulin.

The other thing we need to do? Interventions—because a depressed person cannot get help by himself. I robbed myself of forty years because I couldn’t reach out and couldn’t get to a shrink. Until the crisis came, I was stuck. So it’s simple—we ask everyone close to us if they’re depressed. If the answer is yes, we call a shrink, make an appointment, and tell the person, “I’ve made an appointment for you, and I’ll go with you.” It’s the only way to do it.

Was it really 40 years? Were there really no good times, happy days, smiles, light moments?

Yes and no. Of course there were good times. But depression is a psychic pair of sunglasses that seem to get brighter and darker on different days, but never seem to be taken off. Change the metaphor—depression is the movie in black and white, when all the rest of world is watching in color.

And if the medium is the message? In other words, was I watching a different movie because I was seeing it black and white?

Don’t know.

Think so. 

Don’t know….

To the edge once again

It’s the reason so many psychiatric patients eventually exhaust all but the most devoted of their support system.

Come clean—I stopped taking one of my meds.

But be fair—I told my doctor, my psychiatrist that is, and though skeptical, he agreed.

It’s called Remeron and it has two faces. The first is to lift the spirits. I looked it up on a great website—crazymeds.org. OK, maybe not the most reliable, but definitely more readable than the drug-sponsored sites.

This guy’s take (site is obviously written by a manic)?

Remeron is legalized marijuana.

Might be. Because it does exactly what dope did to me, those many years ago when I was young and experimental.

Remember the munchies?

“Coffee ice cream!” I shouted over my shoulder at Raf, who was puzzled—why was I going to CVS at 11PM? And why couldn’t I stop and answer, so urgent was the craving?

Oddly, I don’t actually like coffee ice cream—but four hours after taking Remeron 15mg PO at HS (that's for Ruthie, to remember her nursing days) I would commit armed robbery to get it.

Well, it wasn’t doing my blood sugar any good—to say nothing of my cholesterol. And my other antidepressant—Lexapro—had worked fine for two years, until Wal-Mart sacked me when I was working my way through the death of Franny. 

I convinced the psychiatrist. And I tapered off the drug, as instructed.

First days were fine. Actually, almost better than fine. I was in Culebra and had an exalted moment. I was on the morning trot, listening to The Creation, when it hit me, how uncannily apt the music of my journey had been. Starting with Winterreise as I went into the bottom of death and despair. Then Beethoven, the Heiliger Dankgesang—as I moved through sickness to health. Lastly, The Creation, as I gave birth and set forth a Franny—a new Franny, my Franny—into the world again.

The Creation—get it? The gods aren’t subtle around here....

We came to a hill, Franny and I—she was trotting alongside of me—and the Haydn came to a long, achingly beautiful ascending—acsending, catch that word?—passage.

Right, so we were three: Franz Joseph, Franny and I.

So I had Franz Joseph in my ear. I reached out and grabbed Franny by the shoulders and hugged. And we sailed up the hill together.

Right—all was well for the next couple of days. But then I stopped writing. Got off my normal schedule. And two days ago, had a very strange thing happen.

Hypoglycemia.

Well, it’s happened before. And somehow, it was 2PM and I hadn’t eaten anything. So I went to the café, and they made me a very good, very large tuna sandwich.

Oddly, the sensations didn’t go away. For me, hypoglycemia is about anxiety. I get desperate / frantic to eat.

You do, and it goes away.

Why wasn’t it?

Right—went to CVS and bought orange juice. Drank the full container. 

Still felt hungry.

Then Miss Taí calls—she’s sensing a rat, or maybe something fishy. I tell her about the hypoglemia. Call tomorrow.

By the time Raf arrives, I’m pretty much a wreck. Now I’m having muscle cramps, and I decide I need magnesium. And oddly, the muscles cramping are ones that never cramp—my fingers and the top of my ankle. Then I notice that I can’t really breath. Well I can, but not easily. And damn, what’s going on with my blood sugar?

Why am I so anxious?

And why was I still feeling strange the next day?

And feeling dammit it’s not fair why has my life been so fucking hard I’ve had to STRUGGLE FUCKING STRUGGLE for fucking years now and I’ve never had it easy and fuc kingf can fuqeiufam l;alcqm09rinf             p’

Phone rings. Miss Taí, wondering how my mood is? 

Can’t talk, I need to eat, call me tomorrow.

But she made me think. This couldn’t be hypoglycemia. Come on, Marc—you’re an old nurse. Think it through. What’s different?

I go into the kitchen. Why am I here? Why is a banana in my hand? Am I supposed to eat it…..

You can eat it if you want. Now go back into the kitchen.

Why am I standing in front of the sink?

Water—you need water.

And now the pill.

I see the pill in my palm. I take it and swallow it. It is four fifteen.

At five, I am doing dishes. I am telling myself, ‘you’ve also been given stuff many people have not. You are way talented in ways many others are not. You see things others don’t. You had wonderful parents, and have a long stable marriage. Yes, it’s been hard. But others have had it harder….’

OK—so Taí?  Call me at four—let’s figure out how to sell this book.

And thanks!

Lexapro 20mg PO qd

If I had Internet, I could tell you.

Some guy—Robert Whitaker, I think, and how did we live without Google?—wrote a book about the drug industry and the explosion of mental diseases. His thesis went something like this—for most diseases, the incidence rate drops as new drugs are developed, patients are treated, and presumably cured. But ever since Prozac, we’ve had a spate of new antidepressants, and the rate of depression has…

…skyrocketed.

So what’s going on?

I know all about this because Eric is writing a blog for Psychology Today. He sent me a link for the book, as well as a quote from a psychiatrist at the University of Michigan, who says that exercise is at least as good as antidepressants in the treatment of major depression.

Oh yeah?

I did my three-mile walk today at 8 AM—I’m rigorous about doing it. I listened to the first two string quartets of Brahms—my walk time is also music time. I came home, tried to get down to work, and couldn’t.

I hadn’t taken my Lexapro.

Little things began to annoy me. The damn Internet connection is down again. I tried to write a post. My mood is apparent in the first line—“It’s 2500 bucks of sheer fucking frustration.” (I was writing about my Zen MacBook Pro….) I wasted time rereading some old posts. I began to wonder whether it was worth it all.

Cousin Brian popped into my mind. His words: I said to myself over and over as I read, "he's so brave." You hold nothing back: Franny's character, her love, her pepper, John's stoicism, the terrible tensions between you and Eric, your own utter devotion to Fran, your struggles with depression before, during, and after...it's remarkable.

Yeah? Well, this morning I wasn’t feeling so brave. I was feeling pissed. And sorry for myself. Why has my life been such a fucking struggle? Why have I had to fight all my goddam life? The titanic struggle with the cello, the battle with depression, coming out, moving to a land where I’ll always be a stranger / visitor. What the fuck have I NOT had to do?

Shit!

Right. So then I got mad at Eric. Fuck you, you mental health experts, I raged! Have you ever been so far gone that you felt your thoughts turn to voices? Have you ever been, as I once was, in a bus sitting in front of a deranged street person. The guy was furiously snarling obscenities at me—“you mother-fucking asshole. You fucking think you’re so great… Pussy! Cock-sucker!”

And I didn’t move away.

Why?

Because I wasn’t entirely sure that it was the guy behind me.

It might have been me, pouring out that venom.

So it’s easy for you guys, the experts, to talk clinically and analytically about antidepressants and the rates of major depression. Sit in a dark room at 3 AM and struggle, as I once did, through a ravishingly beautiful amen of Monteverdi.

And have that be the one thin thread that ties you still to life.

At some point in the morning, it became clear.

ONE day without my Lexapro is enough to start me off on the slide to despair, darkness, death.

Well, I am rigorous, too, about going to the shrink. And I had gone last week, and gotten the prescription.

So I went to CVS.

I took the Lexapro one hour ago.

I can now write. I am no longer angry at Eric. I know what I will do today. I have a to-do list, and will work my way through most of it. What I don’t do today, I will do tomorrow.

Yes, tomorrow I will walk and listen to music and contemplate the sea. That will make me feel better.

I will also reach for the one thing that apparently means life or death. 

Lexapro, 20 mg. PO QD.