My therapist has been bringing up anti-depressants every few months since I started seeing her in December 2015. The first time, I said there was no way I was going to take medication. My response was like a reflex. Where does such a reflex come from? Partly, I think I wanted to love my brain as it was. I wanted to think my brain was normal and good and, on the days when my brain did not treat me kindly, that I could wrestle it back into shape using behavior modifications, exercise, and my writing. My depression has never been the debilitating, can’t get out of bed sort. It’s chronic and low grade with occasional dips into major depression mixed with suicidal ideation. It’s not pleasant, but most of the time I can appear functional, and sometimes my brain will start doing some weird warped thinking that I can put into a story.
The second time my therapist brought up antidepressants, I said I’d think about it, and I thought about it for a few days, and then I said again, no way! I love my brain! And, to be honest, I had become very interested in writing about, and through, the low points of my depression. I felt like I was being given an opportunity to explore this weird dark murky awful landscape as a writer, and the writing I did while in such a place was dark, murky, weird, but also interesting to me.
Then recently I had a Very Bad Weekend, where my suicidal ideation ratcheted up a step, and it freaked me out a little, and also I was spending so much energy trying to answer the question “Do I want to be here anymore?” that I was having trouble doing anything else for a few days other than surviving and writing. (An awful complex fact: I think the writing I did during this time is actually pretty fascinating, and weird, and dark. I’m hoping to turn it into a creative non-fiction piece. So I don’t think my depression ever ruined my writing, though it did narrow the focus of my writing to me me me me me.) At my next appointment, my therapist brought up medication again, citing some reasonable evidence based data: that meds + therapy have been shown to be more effective than meds or therapy on their own. That I have been working very hard at therapy for 1.5 years and maybe it was time to try something a little different. She mentioned the possibility that maybe I didn’t have to go through so much suffering in order to write or to live my life. She doesn’t believe that artists need to be depressed in order to be good deep artists. Sometimes freeing one’s self from depression can actually help one’s art, she said. I said okay, yeah, I’ll think about it, and this time, I did actually do some thinking and some questioning.
Here’s what I thought about. How useful was my suffering or my depression? And who was it useful to? Was it useful to my writing? What kind of writer would I be without my depression, and without access to that very deep dark hole of a place in which I fell from to time? Would taking meds mean I was agreeing that my brain wasn’t normal? Was I just buying into society’s idea of a normal brain? What if my husband liked me better on meds? What if I liked myself better on medication? Was I participating in the over-medicating of American society if I started taking anti-depressants? What would meds do my writing? And, of course, there was the question, how much did I want to be here?
I had no idea the answers to any of these questions, so I started reading about writers and medication, or at least googling about it. I found some essays on line.
Lev Grossman wrote, in 2010, about how SSRI’s (selective serotonin re-uptake inhibitors) weren’t great for his writing:
“When I look back on the writing I did during the 18 months or so that I was on SSRIs, it doesn’t seem terrible. Actually I won two awards that year for journalism, something that never happened to me before and hasn’t happened to me since. But I don’t think my fiction was all it could have been. There was a blankness to it. I feel like when I’m writing something worth reading, I’m doing two things: I’m saying something, but at the same time I’m reacting to what I’m saying, and I’m building that reaction into the next thing I say — I’m iterating, feeding back into myself, forming strange loops. Somehow that second stage wasn’t firing while I was on Serzone. The loop wasn’t looping.”
Lev Grossman writes, also in 2010, about how Wellbutrin was much better for his depression and writing (Wellbutrin is a norepinephrine-dopamine reuptake inhibitor (NDRI), so it doesn’t mess with serotonin). He makes Wellbutrin sound really nice.
“The fact is I was falling in love. With Wellbutrin. I had found my drug. I could get out of bed in the morning. I did less ruminative thinking. I didn’t write and rewrite the same sentence 50 times. Whereas before I would get stuck and blocked ten times a day, now I kept on bulling forward. It was like I’d been water-skiing my whole life, but the boat had been going at half-speed, and I kept sinking down into the water until it burbled up around my knees and eventually I dropped the rope and fell over. Now the boat was going full speed. I was skipping along. I was finally getting somewhere.”
In 2013, Alex Preston seems to suggest in The Guardian that antidepressants are mostly bad for one’s creativity, though occasionally the drugs are portrayed as a necessary evil, depending on who you ask.
“Within three weeks of my own Prozac fog lifting, I was writing again. Yes, I still felt down, so down some days that I couldn’t work and buried my head under the duvet, but the trade-off was days when my fingers couldn’t move fast enough over the keyboard, my pen struck sparks from the page. In Deborah Levy’s Swimming Home, the heroine, Kitty Finch, has just quit Seroxat. “It’s quite a relief to feel miserable again,” she says. “I don’t feel anything when I take my pills.” It’s been five years since I took my last SSRI. The happiness I get from my writing is deeper seated and more authentic than anything that could be confected in the laboratories of Big Pharma. The drugs didn’t work for me and, more importantly, I couldn’t work when I was on them.”
In 2014, Gila Lyons writes in The Millions how SSRI’s changed her writing (she had severe anxiety). Summary: she was glad she is taking SSRI’s, though the drugs did change how she wrote.
“I agree that powerful art is created out of a deep need, and bears the imprint of the essential raw self or soul. But if my anxiety really is a biological disorder, as doctors and psychologists have repeatedly insisted, then my essential self isn’t the anxious thoughts and existential dread I used to constantly feel. My essential self would lie underneath the layers of catastrophic images and anguished mental chatter. It’s possible that the medicines I take could help me travel a clearer and more direct path to that place, avoiding the potholes and back alleys of phobias, anxiety, and panic. Though it takes more discipline to sit down and write now, since I am not doing so to save my life, I am practicing writing from a place of curiosity rather than pain, fascination rather than desperation, forging my way more safely into a different dark.”
On Vice, Amy Smolcic writes in 2016 how antidepressants (Lexapro) were bad for her writing.
“Lexapro turned me into a zombie, riding through the motions of life without feeling. Things that made me angry became irrelevant. There was no twinge of sadness watching Tom Hanks in Philadelphia. If you’re wondering whether something is off, that’s a sure sign. Whenever I picked up a pen to write, I had nothing. I couldn’t even write about the damn rain. If you’re a creative writer who can’t poetically describe the rain, you’re in trouble.”
There are a lot of forums where people who enjoy writing at various levels say antidepressants either killed their creativity or it was okay or maybe it even helped (here’s one discussion at reddit).
“I write more frequently now, because I don’t have to fight against the fatigue and hopelessness to even get started on a story. I did have a bit of an adjustment period in my work, but that could be attributed as much to how I drank pre-meds as anything; I had to encourage myself to write as fearlessly sober as I did drunk. The idea that medication is guaranteed to ruin your work is horseshit. Yes, some people have reported that, but others have had the opposite experience, and I can’t help but wonder how many people have avoided a treatment that could’ve saved their lives based on that fear.”
And then there are the numerous articles and more articles and even more articles about how we are an over-medicated society. This 2 part book review, by Marcia Angell in the New York Review of Books in 2011, is kind of famous (here’s part 1 and part 2) (Peter Kramer, noted below, does not find Angell’s arguments to be accurate, by the way).
“The books by Irving Kirsch, Robert Whitaker, and Daniel Carlat are powerful indictments of the way psychiatry is now practiced. They document the “frenzy” of diagnosis, the overuse of drugs with sometimes devastating side effects, and widespread conflicts of interest. Critics of these books might argue, as Nancy Andreasen implied in her paper on the loss of brain tissue with long-term antipsychotic treatment, that the side effects are the price that must be paid to relieve the suffering caused by mental illness. If we knew that the benefits of psychoactive drugs outweighed their harms, that would be a strong argument, since there is no doubt that many people suffer grievously from mental illness. But as Kirsch, Whitaker, and Carlat argue convincingly, that expectation may be wrong.”
Even my beloved Dr. Weil chimed in on the overmedication of America in The New York Times this week (by the way, what Dr. Weil says below sounds like an extreme generalization and does not sound like a good idea or a viable solution):
“Here’s another example: I would only use antidepressants for very severe depression and then only for a year at most. With long-term use, they can intensify or prolong depression. For mild to moderate depressions I would try other measures: regular exercise, reducing caffeine, acupuncture, cognitive therapy, vitamins B and D, St. John’s Wort, fish oil — and spending more time in the company of happier people.”
There has been some pushback to the overmedicated narrative thankfully, though I think those voices are generally quieter. One example is Peter Kramer’s Ordinary Well: The Case for Antidepressants. I just started reading this book, and it is great so far.
“To state Kramer’s position bluntly, SSRIs work—not all the time, and not for all people, but in lots of ways for lots of people. How they work remains a partial mystery, and how well they work has a subjective component—as do the afflictions the drugs treat—but murky borders do not mean there is no country. Pharmaceutical companies may have pushed a cartoon claim of “chemical imbalance” to suggest that some people need supplementary serotonin the way others need extra iron, but Kramer bases his assessment on 30 years of clinical experience as well as his own immersion in the literature of drug trials.”
Armed with such random and inclusive research, I decided to keep researching. Because I like research! And as long as I was researching, I could put off the decision of whether or not to start taking meds. I kept talking to my therapist about medication. I wrote to one of my favorite writers Andrew Solomon, who has struggled with depression, to get his opinion. Andrew Solomon generously wrote back this very solid advice:
“If you look at my books, you will see that antidepressants have not gotten in the way of my writing as well as I ever have. If you try the meds and feel they interfere with your writing, you can stop taking them (under a physician’s directions). If you never try them, you’ll never know.”
I thought about Daphne Merkin, who wrote This Close to Happy, a beautiful memoir about depression, while on meds. I thought about how 25% of American women aged 40-50 are on antidepressants, a fact which freaks me out and makes me so sad (what is it about this world that makes so many women that age incompatible with living happily on the planet)?
I told my sister I was worried my writing would suck on meds. She asked me, “Would you rather write well and be miserable, or be happy and not writing well?” I said, “I think not writing well would make me miserable.” The deep dips of my depression had been giving me something to write about or write against. My therapist said maybe not being depressed will give me more energy and focus to write. But usually I had been able to write through my depression, and I wasn’t often distracted by it, except when I felt compelled to research the effectiveness of various suicide methods, which I always felt could be used for a story, anyway.
I talked with the writers in my writing group. One friend asked did I know how many writers were on meds? Another said we were talking about SSRI’s here, right? It’s not like we were talking about clozapine. I tried to explain my hesitation: I wanted to love my brain as it was. “Well, fine,” said a friend, “go ahead and choose to be miserable!” But it was more complicated than that. I was exhausted from my suicidal ideation that had been haunting me for years. I was tired of having to justify my life to myself, which, on good days, I kind of could do, and on bad days, I couldn’t. But I wanted the world to go on meds instead of me. Unfortunately, that wasn’t going to happen.
So I picked up the phone, called my primary care physician, and made an appointment.
My primary care physician is a lovely MD with a holistic bent. She likes yoga, lentils, and breathing exercises, and she has never in the 15 years I’ve known her been an enthusiastic prescriber of drugs. This is one reason why I like her. But I thought my situation would be an exception. When I went in and said, “I’m depressed! I want anti-depressants!”, it’s true I expected fanfare, or at least for her to say, “Congratulations! You’re here after hours and hours and days and weeks of research and thinking! You’ve made a healthy decision! You are not ruining your writing in any way!” Instead my doctor looked disappointed. She promised that she would write me a prescription, but then went on to talk to me about diet changes, positive thinking, meditation, and walking for a long time. I felt like a junkie. This was not the response I was looking for. I left thinking, have I not tried enough? Are weekly therapy sessions, and trying to implement a whole host of healthier thinking habits, and having an emergency plan, and a list of coping strategies, and yoga, and running when I’m not injured, not enough? On the one hand, I appreciate the amount of time my doctor spent with me. On the other hand, I think (and hope) antidepressants are warranted with depression, and with some kinds of depression, lifestyle changes are not a substitute for meds.
I started taking a low dose of generic Lexapro.
I’ll be honest, at first I felt like I was poisoning myself. I know that sounds dramatic. But my body physically felt so bad, bad headaches, nausea, like I had the flu. I thought it was my body’s last ditch effort, that it was crying, “Please, please, stop!” Then the tiredness set in. I didn’t tell my husband I was trying out meds for the first two weeks. Instead, I pretended I was sick. I’m not sure I’d recommend this approach, but that’s what I did. I didn’t want to have my husband say, “I am so excited that I will not have a super depressed spouse anymore, hooray, go medication go! Can you take more or maybe up the dosage?” (I did eventually tell him, and he did not say any of this). I listened to a lot of The Hilarious World of Depression podcasts during this time. It’s a brilliant, lovely show where comedians talk about their experience with depression, and a lot of them are on medication or have used medication to get through their depression, and it was such a healing relief to hear creative funny people talk about meds in a positive light.
After a week, the headaches and nausea did go away. The tiredness didn’t. It’s still here, in fact, sitting in my lap. It’s a tiredness that reminds me of how I felt when I had a nursing newborn in bed, and I would wake up in the morning feeling like I hadn’t slept, and then I’d continue to feel that way the entire day. It’s a tiredness that is like a weight attached to my limbs. It’s uncomfortable and a pain.
The good things about medication? I am able to talk to my husband again in the evenings. That voice in my head exhausted me to such a degree that all I wanted after dinner was quiet, which is fine if you have a quiet spouse or if you don’t have a spouse at all, and also if you don’t have any kids, but I have a spouse, and he likes to talk, and I have kids. Also I feel like my sadness has a floor on it now. I’ve only cried once in the last 4 weeks. I am not thinking of suicide every day or multiple times a day. Last week I didn’t think about it once. Things bother me less. Should things bother me more? Probably. But it is relaxing, to not watch the evening explode or catch on fire or burn down after one bad interaction with my husband or my children. And sometimes it’s nice to be able to not be thinking anything.
How has SSRI’s affected my writing?
The first week (which, I know, everyone says is too soon to feel any real effects, but whatever), I felt like a voice was shut off in my head. Sure, it was the voice that had been set on loop, the voice that would get stuck and tell me all sorts of awful things about myself and then go on repeat, or it would remind me, when I was really down, of the various ways that one could kill themselves. I realize none of that is at all useful. But that same voice would sometimes point out a reality not available to everyone else, a reality I wanted to write about. I miss that voice. The first week I imagined that poor voice bound and gagged and hurt. My therapist suggested there is a way to get the good parts of that voice back, but I don’t know how to do that yet.
When I first started to take meds, I would sit down to write, and all I heard, instead of that familiar voice, was,”OH MY GOD I AM MEDICATION, OH MY GOD I AM MEDICATION.” I was very self-conscious. I would change a word in a sentence and then go back and examine the change, and wonder, is this change any good? Would I have made this same change before medication or would I have been able to come up with a better word? This did not help my writing any. But eventually I chilled. This took 1 week, maybe 2. I got to the point where I might remind myself, “You’re on meds!” and the response would not be a freak-out but something more civil, like, “Yeah, I am.”
Once the panic subsided, it seems like I’m able to revise just fine, though the tiredness is an issue, and I tend to start falling asleep half an hour after I start writing, which means a long nap, from which I wake up cranky, because I hate naps, and after I write for a little more, I start falling asleep again. I’m thinking about seeing a psychiatrist and trying out an anti-depressant that isn’t known for fatigue. (It will be hard for me not to go in and say, “I want Wellbutrin!” As that is what Lev Grossman likes and used while writing the later books of his Magician series, and I like Lev Grossman, and I like his writing. But I need to remember Lev Grossman has his own brain and I have mine, and each brain’s response to medication is so personal and unique) (though I still might go in to the psychiatrists office and say this anyway, as I am tired of being tired).
In terms of subject matter, I don’t have the same drive or obsession to be examining my sadness and my depression in my writing. Is this a good or a bad thing? Perhaps it was time to move on. I probably have way too many pages written on this topic. It might be exciting to write about something more outside of myself. I don’t know. There certainly is less of an urgency to write as well, though I’m still writing just as much. It just takes more internal motivation. Maybe it’s that writing is no longer so tied to my survival. Will that affect the quality of my writing? I don’t know. I have to imagine this change will be reflected in my stories somehow. But I know a lot of great writers have not written out of a sense of survival. And I’m sure a lot of great writers have.
Am I part of the overmedication of America? Part of me thinks that a person’s individual depression, or anxiety, or reasons for taking medication is so complex, that perhaps everyone should mind their own business and stop being so judgmental about what medicine other people are taking. For me, the decision to take medication felt necessary, if I wanted to stick around, and it was through no lack of effort on my part. And I don’t think medication is so great that I would ever want to be on it if it wasn’t necessary. It’s not like, whoo-hoo I’m exhausted, and I want to take a nap, and I don’t care so much about so many things anymore, this is awesome!
Sometimes I feel like a character in one of my stories, who takes a pill so that she can be altered enough to allow her to stay in her current life. There’s nothing inherently wrong with this, I suppose, other than I would like my unaltered brain and my current life and the world to be a better match.
I like to go back and read this passage from the Guardian essay:
“For Lewis it was a decision between writing on Prozac or not writing at all. For Keeril Makan, the choice was rather different. One of America’s most celebrated young composers, he struggled for years with a depression that would often find vivid reflection in his work. He describes his music as “informed, almost viscerally, by my depression”, and spiky, atonal pieces such as The Noise Between Thoughts attack the listener with a bleak physical force. Finally, though, he reached a point at which he had to step away from the darkness. “Although I was still composing,” he told me, “it was such an excruciating process and was putting me in contact with these really difficult emotional places. I couldn’t go on with my daily life. I was creating music I was happy with and people were interested in, but I had to live as well.”
He started taking the antidepressant Wellbutrin and meditating, and found that his music gained a new depth as he dragged himself out of his depression. “Being on the antidepressants does change the type of emotions I’m experiencing,” he said, “but I think they can be just as interesting. If anything, this helps the composing. I was working on an opera recently and I don’t think I could have written it before. I was too one-dimensional, emotionally. Things were just dark but now there’s both – dark and light.” I confessed to admiring the raw power of his early work and he chuckled. “It’s true that I’m not as fully immersed in darkness as previously, but I guess I don’t care, because I couldn’t keep doing that. It was a question of living, or creating this music that was negative and violent. I made my choice.”
I’m still treating this whole thing as an experiment.