Paxil is Forever

doctor please, some more of these

 

In 1994, Jessica Porter(not her real name) went to see her nurse practitioner for a checkup. She had lost a lot of weight, and on being quizzed by the nurse she admitted that she was depressed and anxious. "I was in a somewhat desperate space," she recalls. "I was really unhappy and I felt like I was wasting a lot of my life."

The nurse suggested she try Paxil. Porter was quick to agree. "I had sort of had it in the back of my mind," she says. "I just never felt like I was sad enough to seek out therapy." The nurse gave her a prescription for a supply of 20-milligram tablets and a pill cutter. Porter was to start out taking 10 milligrams and work her way up to 20. If she had a particularly hard time, she could increase her own dose to 30 milligrams. "It had a decent effect," she says. "It put a floor underneath me. With the drug I still had down times and anxious times, but they were never as bad."

Porter stayed on Paxil for three years before she started having stomach problems. By that time, the nurse she had been seeing had left her practice, and Porter didn't feel like she could call the psychiatrist who had renewed her prescription during brief annual visits. So she just quit taking the pills on her own. After a couple of days, she began to feel electrical shocks in her head. "Every time I turned I would have these zaps," she says. "It felt like I had blacked out for a few seconds.

"I was feeling really bad, and feeling really anxious about feeling bad," she says. "I was thinking, 'This is me. This is what I'm like without any drug. How can I live like this?'" She called the psychiatrist and was told to go back on the drug and begin tapering off five milligrams at a time.

After she took her last pill, however, the symptoms returned. "I sought out a therapist, but I was having so much trouble with crying that she said, 'We need to get you on something and then we can talk.'" She went back to the psychiatrist, who put her on Prozac. The doctor assured her she'd be able to stop taking the new medication if she wanted to quit.

Porter has grown used to the idea that she'll take an antidepressant for the rest of her life. "Still, I always have the feeling that I ought to be able to do this myself," she confesses. "My issue about it is sort of feeling guilty about it. Like, I have a good life. I have this, I have that, I should be able to get through this."

Porter does have one major cause for remorse, however. A onetime poet, she has stopped writing and she's sure it's because of the antidepressants. She can't articulate why she can't create while she's on medication, but she has accepted it as an inevitable side effect.

If Kevin Turnquist were to meet her, this part of her story would probably trouble him the most. He has a theory that a lack of novel experience--good and bad--puts unhealthy stress on the human brain. "Mundane jobs, boring routines, and the absence of real struggles for survival may all prove to contribute to depression's increasing place in society," Turnquist wrote recently in The Humanist. "We cannot discount the possibility that the activities that seem to add diversity to our modern existence don't provide the sort of stimulation that healthy brains thrive on."

The latest research indicates that there is a connection between the size of the piece of the brain involved in the formation of memories, the hippocampus, and depression. "One study suggests that the hippocampus may shrink by an average of 19 percent in depression," Turnquist reports. "Other research has found that SSRI antidepressants and shock treatment, among other factors, restore the hippocampus to more normal volume. This increase in the size of the hippocampus is now considered to be a possible mechanism by which these treatments promote recovery from depressive illness."

In Turnquist's experience, many of the people who have a hard time quitting SSRIs are young women. Many didn't respond well to the drug in the first place. "What you never see are studies about the characteristics of the people who have trouble getting off of this medication," he says. "My guess is that these are people with chronic, low-grade depression. A lot of them have had awful childhoods. Some have been abused. One of the effects of an abusive childhood is a smaller or misshapen hippocampus.

"The drug companies work like crazy to keep them out of their studies," he continues. "When you look at the entrance requirements for these trials, they don't want people who are suicidal, they don't want people with long-term depression. They want people with nice, circumscribed depressions. They don't want people who are going to sue them."

Nor is GlaxoSmithKline likely to pony up to fund research into Turnquist's theory. After all, a prescription to do something new and stimulating--to exercise, travel, or turn off the TV--isn't going to do anything for the price of the company's stock.

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