I'm Tired All the Time, And I'm Going To See If Going Off Anti-Depressants Helps

My acupuncturist tells me that my liver is fatigued, and I know that antidepressants are harsh on the liver. So.
Publish date:
October 28, 2013
depression, mental health, antidepressants

The first time I took antidepressants, it was 2007. I perked up a bit on the Zoloft, lost a little weight and flitted around feeling what it was like to have that soft ego blunt that comes with the right psychotropic cocktail. It was almost like having a little buzz on, which I was prepared for because the psychiatrist said that if I liked feeling a little drunk because my critic-brain shut off -- which I told her I did -- then the effect could almost be similar.


A friend of mine who had similar depression and anxiety had prepared me for this years ago. She said not to be so afraid of antidepressants because really all they did was "take the edge off."

Still, I was terrified to let any drug dare interact with my rare singular special sunflower talents and personality -- even if I was miserable a lot of the time.

But the sadness got a little socially awkward at a certain point.

I cried and cried on doctor's table after doctor's table. Phone numbers were slipped to me by many, urging me to see this or that psychiatrist who was just so great. Really! She can help you.

She can help people like you.

Ugh, is there anything more brandishing tarnishing stigmatizing?

Years before, around 2004, when I was getting divorced, I appeared such a mess that my primary care physician practically shoved some sample Lexapro down my throat, but when I did finally comply and get the prescription he gave me filled later that day, I read all about the interactions and warnings and terrifying Internet things online, and proceeded to flush all the pills down the toilet.

You won't get me, Big Pharma! I thought proudly.

I've always been both scared and wary of psychotropic drugs. Not because I don't think they can do a lot of good for a lot of people -- including me, especially me -- but because I do think that we are over-medicated as a society and I do think that the pharmaceutical industry is about as corrupt as they come in pushing pills where side effects are shrugged off by groovy "it's very rare, no worries" doctors.

Sure, it's rare. Sure, I'm probably not going to be one of those nightmare cases where the person detoxes off of Paxil and then suddenly finds that she can't stop sticking out her tongue like a lizard uncontrollably (boy, if you had social anxiety before, huh?). But all the same, it was not a decision that I took lightly. Or wanted to face at all.

To me, rattling pill bottles sounds a little too much like home.

See, I grew up around a lot of psychotropic drugs. My mom has depression and obsessive compulsive disorder, and I've watched since I was a young age all the different effects various drugs have had on her. I've watched her as she lay in bed for hours on end, and I've resolved to myself I never wanted to lay in bed for hours on end.

She will die inside when I read this aloud to her to make sure it is OK to publish this before I do, but we've had a back and forth tug-of-war about me writing about her OCD before, and as long as I do not sensationalize it, she usually consents ("Mandy," she has said in the past, "when I would obsessively wash my hands I did not do it until the skin bled. That's just you trying to make it more exciting.")

All I knew is that I never wanted to be a zombie. Not that my mom was a zombie. Really. She's not. ("Oh sure, adding the 'Really, she's not,' is going to make a big difference in what people think, Mandy," my mom says when I read those particular qualifiers aloud to her. At this point, the two of us starting cracking up into hysterics at the absurdity horror insanity of it all. My mom adds rather soberly in between all of our laughter-to-the-point-of-tears: "I do think this is really healthy for you to write this, Mandy." I agree.)

So my mom, when it comes right down to it, is someone who has been pretty medicated most of the years that I have known her.

Sometimes that has felt scary because I didn't feel like I could reach her. When I was younger, even before I had a real handle on the whole MD-prescribed drugs, I remember finding marijuana in the fridge and sobbing uncontrollably because of the programming of my D.A.R.E. classes afraid that she would be carted away by the police -- forever, but she did eventually stop that.

Still, it wasn't before a certain level of shock and crazy was always acceptable in my household and from her in particular. "What are you going to do? What are you going to do before the parent-teacher conference?" I remember asking annoyingly when I was in middle school as I've always been pretty annoying and insatiable (I was listening to someone who would. not. stop. with the questions on the subway the other day and thought: Jesus, I'm exhausting.)

My mom told little middle-school me, "I'm going to smoke a joint and then masturbate."

Oh, Christ. That shut me up.

I was always so mortified to be alive in this world with truths like that. My mom, my parents: Pushers of the boundaries, always. "I raised you to feel like you were always part of one big encounter group," my mom told me years later. It all made horrifying, exhilarating, boundary-less sense.

Of course, I love my childhood, my mom, blah blah blah, be sure to take care of your parents' feelings, Mandy.

But it was not always the easiest in terms of feeling like I was operating in the land of the sane and the dependable.

My mom's drugs sometimes just felt like they exacerbated this. Not the marijuana, which was out of the picture pretty soon once I was into high school -- and then by this time they found me smoking a joint and said I couldn't go to college and then I coined the term "hippie-crite" -- but the other drugs. The legal ones. The Prozac-BuSpar-Trazodone-everything-whatever-OCD-pharmaceutical mix. It was always in progress. It was always there. She was always being experimented on like a lab animal.

I don't know which I thought came first: the depression or the pharmaceuticals, but I knew that to acknowledge that this was an area that I too struggled with was to put me squarely in the same camp with an area that I wanted absolutely nothing to do with.

Please, God, I wanted to be normal.

Did I mention my parents had a personalized license plate on their red Honda that read: "Why be normal?" Yes. Yes, they did.

The defining moment that solidified my hatred of pharmaceutical drugs was when I was about in the 4th grade. I had this surgery called "sternum excavatum," where they adjust a concave chest, and I remember being terrified out of my mind, crying out to my mother, and she was too zonked out on whatever meds she was on to even hear me. God, I resented her medication.

By the time I crawled into the psychiatrist's office and finally was convinced to give them a try, I felt so hopeless I would have tried heroin. Granted, a big part of the reason was that I really needed a good talk therapist to help me sort out the traumatic events of the past few years -- my parents' divorce, my divorce, my parents' subsequent remarriage to each other, moving to a new city, starting a new job -- and the binge drinking and eating I did as a substitute wasn't quite as effective as you'd think it'd be.

"You shouldn't take medication if you have your own stigma against it," the psychiatrist advised. The reverse psychology worked. I didn't say it, but I remember thinking, "Oh just give me the damn drugs already."

I liked what Zoloft did. I like what it has done. If anything, it has shown me that I don't have to be so wrapped up in my head, in the obsessive thinking and perfectionism that can be debilitating. I saw that I could maybe just be. Just, you know, relax. Sure, I blacked out when I drank with it, but when I got sober in 2010, that wasn't a factor. And then I got off them again. And then I got on them again. It was confusing because I really didn't want to be in my job anymore at that point, and I think in a way, the Zoloft helped cushion against my rage and frustration (which, yes, were absolutely and totally first-world problems -- how lucky I was to have a job, I do realize).

Since that first dose in 2007, in the six years that have followed I've gone off antidepressants a few times. The last time was after I left The Post in 2012, and I knew that I would be on COBRA for a while so I thought: Why not give it a shot?

I ended up getting back on Zoloft when I found myself weeping uncontrollably in a Starbucks. Yes, my life was nuts then -- I had moved from New York to LA to San Diego and everything was topsy turvy, but it was a good Band-Aid at the time, especially when I couldn't afford talk therapy.

I remained on them when I started xoJane, and a year ago, I was having a really hard time in my life when I had to find a new apartment, my love life (and friend life, honestly) was fairly crap and I found myself staying in bed, sleeping in my coat, and occasionally venturing into the city to go to an AA meeting so that I could hopefully have some human contact in the form of a hug. The psychiatrist I was seeing told me it sounds like I was in the throes of a major depressive episode and to see if increasing my dosage would help.

It did. She added Wellbutrin and increased the Zoloft.

But the past year, I've felt run-down physically. My psychiatrist just switched me to Prozac and Wellbutrin, but I don't know, it all feels the same: tired and run-down. I need to figure something else out.

Whenever I see my acupuncturist (who saved my health -- she was the only person to get my period back after I had stress-induced amenorrhea for six months in 2005 following my divorce), she always tells me when she sees me that my liver is my main issue, and obviously, I know that antidepressants are very hard on your liver. It's always a trade-off with these things.

She hasn't advised me to get off anti-depressants as she is also a realist. But I want to see how it plays out -- now that I'm ensconced again in talk therapy that I can feel is helping.

I want to see if some of the energy I desire will be found if I taper off the antidepressants again. Because, honestly, that will make me very happy.

But, to be clear, I also know: It's not worth having a small measure of more energy or a cushier liver if overall my mood crashes and I'm so depressed I don't think I can function.

If that's the case, I will go back on -- and perhaps seek out an option that is not as hard on the liver.

Now, full disclosure: I hesitated even writing this because whenever you give the public personal details about your life, you risk having to deal with comments or blame being assigned to the personal details you have provided. "You're being kind of a bitch. Do you think it's because you're not taking antidepressants anymore?" "Calm down, calm down. Take a pill." "I think you were better at writing/comedy/friendship/work/editing/interviewing/dating/being a daughter when you were taking Zoloft."

But the positive change I'm seeing in my life overall -- something that has been on an uptick swing fairly consistently over the years in my 30s -- is just caring less about everyone and everything. As in: It's easier to not care if I do get that kind of flack from anyone.

Of course, I'm a human being, and I want to be liked and loved, but that severe inner-worth-contingency-depending-on-value-accorded-from-others seems to lessen every day. Part of it is age, part of it is having spun around the block a bit professionally and personally, and a big part of it is recognizing how the only pleasure that I'm guaranteed in life is that of my own making and choosing. No one is going to choose or pick or save me -- ever. It's always up to me, just as my health is up to me.

Now that I'm back in talk therapy, I can feel the weight lifted off of me as tears come out as I talk about grief and frustration and anger. I feel more of a lightness about my life in general. Sometimes it's hard. Sometimes it's sad. Sometimes it's blissful. Sometimes it's happy. But I feel connected and alive and in perspective.

Let me be clear: I am a fan of antidepressants. Of "better living through pharmaceuticals" as is the snappy way to say it. In fact, I always point to Sarah Silverman's line about Zoloft when she compares her depression to someone who has, say, diabetes. You would never ask a person with diabetes when or if they were going to get off their diabetes medication. It is just accepted. It is a condition with which the medication helps. End of story.

But I think that antidepressants are an incredibly personal area. I think medicine is not at all black and white, and I'm a big believer in embracing Western medicine wholeheartedly -- while also embracing the National Institutes of Health-supported methodologies of the East (like Chinese herbology and acupuncture).

I think psychotropic drugs are like anything: Intelligent when used wisely. But I also think that it's important to constantly assess and monitor what seems to be working for you -- and experiment with how you might be able to tune up your life better.

That's my philosophy with a lot of things in life, actually. Don't be so quick to fully accept or reject anything. God and spirituality? I'm open and a believer, but I'm also not a lemming and always maintain a highly critical eye. Science? It is what I trust more than anything, but I also recognize that it is conducted by good old fallible mankind. Terrible, terrible things have been done to humans and humanity in the name of both science and religion.

And, in terms of monitoring myself and my mental health, I also don't fully trust anyone or anything -- especially just relying on my own opinion. I think it is very important to have people around you who will be brutally honest with you. Not co-workers, not fake-friends, not acquaintances, but people who know you and love you whether you have $2 in your pocket or $2 million. People who I try to extend the same courtesy to in return.

It is that circle of people, along with the medical professionals I trust, who can help me maneuver these tricky waters, no one else. And I feel good about doing so with their love by my side.

"By the way," my mom interrupts me as I read her the entirety of this piece. "I have the ending to your story."

"What's that?" I ask her.

"Well, it turns out: I actually haven't taken anything for a while either, because the pharmacy was out of the medicine I had been taking that my very young psychiatrist resident prescribed me -- you know, he's so young I call him 'Dr. Littleboy' -- and that was Wellbutrin that I was on last. So I just said, screw it, and I stopped taking it. So far, so good."

"Mom, you know, I have some Wellbutrin left over," I tell her. "Do you want me to send it to you?

My mom laughs again, which gets me laughing, and it's hard for the two of us to stop.

"No, Mandy!" she says. "What kind of a dope-ring family is this?"

No one makes me laugh like her -- and, down to every last detail of my childhood, I really am so proud she is my mother.

Now: Let the tapering begin.


Find Mandy long-form at http://tinyurl.com/stadtmiller.