A quick recap: Doctor #1 was a bombastic bull in the china shop of my already-cracked emotions. And Doctor #2, despite her better bedside manner overall, also managed to gaslight me at a time when — like a Californian during an earthquake — I was unsure of the ground beneath my feet.
In a sane world with a sane health care system, I would have looked for Doctor #3, preferably a mental health specialist. Someone who could offer psychotherapy of some kind. But in this world, and in this country, I had been charged over $200 for my two doctor’s visits (despite them consisting of no tests, just conversation), plus another $70 for a third-party blood test. I wasn’t about to break our frugal family bank by going to a specialist whose services would likely, unconscionably, not be covered by our insurance. I already felt unreasonably guilty for what I had spent on being depressed.
So I tried to soldier on. The problem is, as The Killers once sang:
“I’ve got soul, but I’m… not a soldier.”
Which is not to say, in the slightest, that beating depression is a matter of just toughing it out. There is no emotional weaponry that can, on its own, defeat genuine depression. When you’re going head-to-head with a serotonin deficiency in your head, it’s not a fair fight.
I wasn’t able to soldier on, not because of any internal deficiency of emotional toughness. I wasn’t able to soldier on because depression is a mental sickness. I never fully understood that before. I always thought of depression as beatable if you simply deployed the right behavioral and emotional tools. I now realize that this perception of “the darker angels of our nature” (to modify and totally recontextualize Lincoln’s words) is deficient.
But I’ll get back to that later. For now, let me try to lay out the pharmaceutical sequence of events as best as I can. The plot line of my summer meds was almost as convoluted as a Christopher Nolan screenplay, and I’m not sure I remember it all myself. (Which, incidentally, is also true of most Christopher Nolan screenplays).
Doctor #1 didn’t prescribe me anything after my initial visit, even though he would have been glad to, because I insisted that he not prescribe me anything.
A week later, I relented enough to accept hydroxyzine, a fairly mild anti-anxiety prescription, from Doctor #2. She also recommended I get some over-the-counter melatonin to help overcome my debilitating insomnia. Both of these options were based on me still adamantly not wanting an antidepressant (heretofore referred to as an AD). It was also based on Doctor #2’s own preference of using alternate methods before going the full pharmaceutical route.
So now it was mid-June and I had hydroxyzine and melatonin at my disposal. Did they help? Well, the melatonin provided mild assistance with sleep for 2 or 3 days and then stopped having any noticeable effect. So that was a non-starter.
The hydroxyzine, which despite being mild Doctor #2 instructed me not to take before driving, marginally calmed my anxiety and gave me a “muted” kind of feeling. That was a welcome relief, albeit fairly mild, but it barely even brushed up against my underlying depression. Anxiety and depression have some overlap, but they are two different wolves that prey on your mind in two distinctly different ways. Not to mention that the “mute” function, in a sense, further exacerbated my already-unsettling inability to feel or enjoy anything.
I was still having an awful time falling asleep, staying asleep, and experiencing the natural effects of serotonin during the day. In short, I was still right back at square one. And I was starting to panic. After weeks of waiting for my first appointment (which was a bust), waiting for my second appointment (which was a bust of a lesser degree), and waiting on the effects of the hydroxyzine and the melatonin, I was bruised, burned out, and beaten down.
Instead of setting up yet another appointment with either doctor, I messaged Doctor #1 through the UPMC online portal and told him I was still struggling mightily. And I did something that I had stubbornly insisted to myself for years I wouldn’t do.
I asked him for an antidepressant.
When we had discussed ADs at our visit, I had insisted that if I ever took one I would want it to be something mild that I could get off when needed without detoxing. And he had recommended Lexapro (i.e. Escitalopram) both because it was a milder option and because it didn’t have some of the side effects associated with the Prozacs and Zolofts of the world.
So after I messaged Doctor #1, he wrote back quickly and said he was sending in a prescription for Lexapro. I was both nervous and relieved at this prospect, but my back was against the wall. I had tried doing the things that normally give me a natural serotonin boost (running, music, exploring nature with the kids) but they all fell flat, face down in the mud of my inertia and despair. And as a result of these efforts falling flat, I felt even flatter.
So I lunged for a life preserver. Even though I wasn’t sure that thing would be buoyant.
I have an image in my mind of the day when I first solidified that I would (seemingly) surrender some of my will to Big Pharma and go the AD route.
We were in the lovely little town of Boiling Springs on a beautiful day, watching ducks and swans at the lake with the kids. Which all sounds idyllic, but nothing feels remotely idyllic when you’re depressed. And for a reason I can’t recall, but had to do with poor planning on my part, that moment, with my kids next to me, was the one when I called to confirm my prescription.
Danielle and Violet ventured into a local restaurant to get some coffee. (It was for Danielle, not Violet, who is organically hyper-caffeinated by nature.) Meanwhile, Greyson played by the lake and I, of ravaged body and tortured mind, placed a phone call to UPMC and ended up talking to a woman for close to 15 minutes. I felt compelled to ask her, just person to desperate person, if she had any knowledge of Lexapro. And oddly enough, she told me that she herself had taken it in the past. Her impression of it was only positive (or at least that’s what she told my jittery self), and I nervously and needily interrogated her about the medication from multiple angles.
Part of the reason I remember this specific moment is because I vividly recall — on a fundamental, elemental human level — what an absolute burden I felt that I was in that moment.
Greyson was playing by the lake and wanting me to play with him. Wanting to talk to me. And I was stuck on this very poorly timed 15-minute phone call that was consuming all my emotional energy. Greyson was clamoring for my attention, which he fully deserved, and I was so lost in trying to find an off-ramp out of my depression that in that physical moment, in the shade of a tree and next to a lake, I had almost zero bandwidth for my sweet son. All I could handle was making sure he didn’t fall in the water. But I was totally absent from him emotionally as I sweated nervously, profusely and asked this woman on the phone about an AD that I was about to take, but which I wanted to be reassured would not somehow hollow me out and render me an even worse dad than I already felt I was.
It’s knowing that Greyson needed my attention that sticks in my head. Knowing that my depression had become, in that moment and in so many other moments last summer, an actual chasm between me and my children. The two most priceless treasures I have ever known, or will ever know. For 2 or 3 months, I couldn’t see their faces clearly, or hear their voices vividly. Because I was lost in the dark, wandering blind through the bat-infested caverns of my mind.
I forgive myself now, of course, for not paying enough attention to Greyson in that moment. And at the same time, there is nothing to forgive.
Because depression is not a moral deficiency. It’s a mental ailment.
And shame has no place at the table. Only empathy.
Warm empathy for others who are struggling. And warm empathy for yourself and your own struggle. Your current self and all of your past selves.
All of them deserve to be understood.
All of them deserve to be loved.
And all of them deserve to be at peace.