Please Don’t Judge Me or My Superpower
By Susan Keller
My superpower is spelled SSRI.
I’ve taken 40 mg of citalopram (generic for Celexa) daily for 12 years. Citalopram is used in the treatment of depression and anxiety.
My reasons for taking an SSRI (selective serotonin reuptake inhibitor) are varied and defensible.
I grew up with an alcoholic father and a drug-addicted mother. This description of childhood seems so tragically common, it’s beginning to sound cliché. But it affected me. Deeply. And later, when I experienced rough patches in my life, my childhood did not help me find my way through those difficulties. I lacked the resilience that might have been born of a stable, loving home life. Nothing can rewrite that history. But I’ve found a way to work around it.
In her memoir, This Close to Happy: A Reckoning with Depression, Daphne Merkin asks, “Was I medicating a bad childhood or a chemical irregularity?”
Does it matter? I don’t think so.
Depression is a complex illness. Causes can include genetic, environmental, and psychological factors. Depression also manifests with different symptoms in different people: anxiety, sadness, apathy, hopelessness, irritability, change in appetite and sleep patterns, suicidal thoughts and tendencies.
Depression is also common. One in five white women in the United States take antidepressants.1 That may shock you. It shocked me, and I am one of the five. Yet use of antidepressants is not widely discussed. The stigma of needing help for a mental health issue is alive and well. An educated, intelligent writer friend of mine took a look at this essay and in the margins, he wrote: 12 Years!!!
Yes, 12. Would he have had the same response had I been taking long-term meds for diabetes, asthma, or a heart condition? I doubt it.
Importantly, SSRIs are not opioids and do not lead to addiction. Unlike opioids, they do not block pain or create a rush of euphoria. Those are the reactions that can and do cause addiction. When you take an SSRI you feel nothing, trust me. Nada. Over the course of weeks, SSRIs will reduce the varied symptoms of depression, but if you are looking for a fast, feel-good drug, an SSRI is not going to deliver. At all.
My first bout with a serious depression came at a time of super stress. In 1996, my husband and I commuted into San Francisco to work; my job was a pressure cooker; and my husband’s mother was living with us because his father had been hospitalized for a major depressive disorder requiring weeks of in-patient electro shock therapy. We were also parents of a pre-teen daughter.
My work deadlines were crushing. Some days I’d be so overwhelmed that I became paralyzed and hardly accomplished anything. There was a revolving door of hires and departures. The huge irony was that I worked for a healthcare company whose mission was to improve patient outcomes. What a joke. Improve patient outcomes while your staff collapses under the strain.
Every day, I’d get home from this job so stressed that all I managed to get down was a small bowl of ice cream along with several glasses of wine. Then we (my husband, daughter, mother-in-law, and I) would visit my seriously ill father-in-law in the psych ward. We did this for six weeks. I couldn’t sleep and lost twenty pounds. My stomach had a rock in it. Certain that I had an ulcer, I went to my GP who told me I was depressed.
I didn’t believe her.
True, at times, it took all of my willpower not to sob in the middle of a shopping mall. And some days, when the telephone rang, I didn’t have the strength to answer it. But everybody has moods, right? Why label my stomach problems as depression?
She prescribed an antidepressant. I don’t remember what it was but I begrudgingly began taking it. She warned me about the dry mouth. I dealt with that, but worse was the way the pills made my heart pound. And my depression — or whatever — was still there; but my mood was tinged with an artificial giddiness, a sense of “it’s okay,” even though it wasn’t. My illness hovered above my left shoulder. I felt feelings but saw myself as an observer of myself, like one of Marc Chagall’s angels floating in the spaces between people and things. The side effects were so bizarre and awful, I quit the antidepressants and the torturous job. My father-in-law got well and my in-laws moved back to their home. I left the wine and ice cream diet behind — although it was a year before I could read a restaurant menu, the thought of all that food was overwhelming. Eventually I began to cope again and then thrive.
Nine years later, I was diagnosed with a rare and frequently fatal lymphoma. After months of grueling chemotherapy, a septicemia that almost killed me, and a devastating drug reaction, I was admitted to Stanford Advanced Cancer Center to receive a bone marrow transplant. My recovery from cancer was unexpected and phenomenal. But six months out of treatment, I was diagnosed with graft versus host disease (GVHD).
The bone marrow transplant (the graft) donated by my brother to cure the cancer was attacking me (the host) as a foreign entity bent on my demise. My liver was its first target. Long story short: After an onslaught of steroids, the GVHD disappeared, but I became depressed. The lymphoma was not done with me. I might still die of the transplant.
In addition to this fear for my life, I was having an existential crisis. My husband had retired, and questions plagued me: Is This All There Is? Is This the Beginning of the End? Are We Old Now? Consumed with dread, I woke up nights with a heart-thumping anxiety. The worst would come. I just didn’t know in what form, or when.
I made an appointment with a psychiatrist who specialized in treating cancer survivors. Once again, I was prescribed an antidepressant. This time it was citalopram. Tapering into it, I had no unpleasant side effects.
In two weeks, my anxiety and feelings that I was going to die had all but vanished. The existential questions lost their urgency. Citalopram helped me sleep and made me a way-better version of myself. I felt GOOD. Not weird good — like fuzzy or floaty — but me good. My husband was a lot happier with me too. My SSRI enabled me to be productive, to engage with others, to be curious. How can that be wrong or bad?
Some people — intelligent, educated, and liberal thinkers — may be rolling their eyes and saying, “Oh, come on, put on your big girl pants and deal with life. Get off the dope. Your problems are behind you.”
While this attitude might not be the norm, the stigma of relying on drugs for mental health issues exists and stems, in part, from the belief that we all can, and should, yank up our bootstraps and fix just about anything that comes our way. Some believe that antidepressants are as malign as controlled substances: Oxycodone, Klonopin, or benzodiazepines (all addictive). Does this opinion have any basis? I rationalize my own use of a drug without immediate psychological or physical effects and figure SSRIs are innocuous. But are they? Even I wondered after I forgot them.
Prior to COVID, my daughter asked me to travel from the Bay Area to Los Angeles. Her husband was working away from home for a couple of weeks and she needed help with her two young sons. Of course, I would help. I’d love to. Their home was under construction, or deconstruction, as the outside kitchen wall was being demolished to install expansive new glass doors and windows. Would be beautiful when completed but at the moment, it was deafening.
The first night there, I realized I hadn’t packed my citalopram. The next morning, Friday, I phoned my husband and asked him to overnight them to me. Delivery was guaranteed by Saturday morning. No worries. I was super g-mama: strong, loving, patient, and never tired of pushing the kids in the swing. I read them piles of books, strolled them to the local market, and made gourmet dinners. I was an ace driving in L.A. and skillfully transported them to play dates, soccer, pre-school. No problem. Lean on me.
Repeatedly, I checked the mailbox Saturday and Sunday. No meds. But I was feeling fine and was still super g-mama. Monday morning, the fifth day with no SSRI in my system, I began to worry about what had happened to my “overnight” delivery.
My daughter and I went to Trader Joe’s where — between the Inca Corn and the Organic King Coconut Water — the smiling, take-charge, mighty g-mama lost her superpower. Rapid withdrawal from citalopram, and other SSRIs, causes an almanac of symptoms including: agitation, confusion, depression, irritability, nausea, sweating, and tremors. I had them all.
Back at my daughter’s, I’d received an e-mail from USPS saying that at 11:55 A.M. the meds had been delivered “to or around” her mailbox. To or around? But they weren’t in the mailbox. Nor by the front gate, or anywhere else.
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After a prolonged search on the USPS website, I found a customer service number. Perhaps my meds had been delivered to the wrong address. The recorded message announced, without apology or shame, that the wait to speak to a staffer would be 45 minutes to an hour. With poor cell phone reception, I prayed that I could be understood.
While listening to the endless on-hold message, I emailed my husband to tell him that the meds were nowhere to be found. Then my USPS call was dropped. No one would help me. The construction noise was thunderous, it was pouring rain, and the baby was squalling.
Another long story short: Angry, panicked, and beaten, I spent the afternoon on the phone attempting to get my med. I was helpless against the dying battery in my cell phone, a poor satellite signal for which I had to stand outside, the typhoon-like weather and the dripping tarp over my head, the misery of phone trees, and my body’s coup d’état against the free-falling level of antidepressant in my system.
In the meantime, my stand-up-guy husband received my email, called my doctor, and had her phone the Rx down to the local Kaiser facility. Why didn’t I think of that? Because I couldn’t think of anything but my pain.
I entered the kitchen where the babysitter was making dinner for the boys. I began to cry and said, “I hate my fucking phone, and construction, and the rain.”
Needing to touch someone, I hugged her but think my soggy embrace made her uncomfortable. My daughter called from work and told me where to find an ancient Valium in her bathroom (prescribed to her before a complicated dental procedure and that she hadn’t taken). Oh yes, please, but to retrieve the calm-me-down-pill, a construction worker had to descend his ladder and move it into the shower. I gulped down the tranquilizer.
When my daughter got home, she drove me to Kaiser. The lovely clerk typed in my medical number and said, “Of course.” My shoulders dropped two inches. Her helpfulness and the Valium coming on allowed me take the first full breath I’d had since the day before. Ten minutes later, I swallowed a citalopram.
How can a medication with no noticeable side effects make you feel like you’re having a mental and physical Chernobyl when you stop taking it? This troubled me and I began to wonder if SSRIs are addictive. The next day I looked it up.
Doctors generally do not consider antidepressants to be addictive …. Antidepressants can absolutely cause physical dependence as evidenced by the withdrawal symptoms stopping or reducing antidepressants can cause ….
However, very few people give up their daily responsibilities to find anti-depressants because the reward is not big enough; there is no euphoric rush of dopamine from taking antidepressants. There are no cravings, no hazardous behaviors, no examples of prolonged addictive behavior from antidepressants.2
Very few people give up their daily responsibilities? Who? What study did this come from? No study is my guess. The description above is from an addiction facility where they will compassionately take your money to relieve you of your non-addiction addiction.
Do I sound shrill, defensive? Perhaps. But when one sees what true addiction to alcohol or pills can do to a child, to a family, there’s NO comparison with prolonged use of citalopram or any SSRI.
If you want to quit your SSRI, I applaud you; but please work with your doctor to safely decrease your dose and avoid withdrawal that can make you feel as if you’ve been locked inside the Bates Motel with Anthony Perkins.
I wish I didn’t have to take an SSRI, but for now I do. I am happy if you weren’t terrorized in your childhood. I am happy if you didn’t have a nervous breakdown from an impossible job. I am happy if you weren’t diagnosed with a frequently fatal cancer. Please don’t judge me, and I won’t judge you.
Who cares if somebody has their own quirky superpower that helps them cope, or if how they become their best self doesn’t look like yours? What about the guy who meditates two hours a day to get his head straight, or as Cathi Hanauer asks: “Is devoting 10 hours a week to hot yoga to feel at peace really better than popping a cheap, legal pill?” 3 I don’t know. Do you?
Three days later, the level of citalopram in my bloodstream was edging back to my version of normal. I had my superpower back, the strength to hoist the boys around, and my equanimity. While walking the baby through a smart neighborhood in Los Angeles, I passed two policemen questioning an African American man who appeared to be homeless. One of the officers said, “Are you in need of any medication?”
I slowed, waiting for his response. I wanted to help. I actually thought that if he needed an SSRI, I would run home and give him some of mine. Crazy, I admit.
“No,” he said.
On the verge of embracing and kissing the policeman, I was ready to tell him he was the best officer in the world. Did he realize how important his question was? I’ll bet he didn’t.
Don’t we all need a little help sometime?
The meds my loving husband overnighted to me finally came, a week later, snuggly nestled inside a throw-away grocery flyer.
Lastly, and this is out of left field, but super interesting: Researchers believe that slowing the buildup of amyloid in the brain holds the key to delaying or preventing Alzheimer’s disease. Additionally, some scientists report that SSRIs suppressed Aβ (the main component of brain plaques found in people suffering from Alzheimer’s) and lowered amyloid plaque load in mice. Now, a follow-up study indicates that the drugs inhibit Aβ production in humans, as well. And the SSRI the scientists are studying? CITALOPRAM.4
Wow, this study rocked my world. I’m not saying you should rush out and get your own prescription, but I am going to watch this work. Scientists admit that a lot more research is needed.
P.S. Citalopram is sold by Allergan, should you want to buy stock.
P.P.S. Don’t forget to pack your meds. Thank a cop. Please don’t judge if the way somebody else becomes their best, most authentic self doesn’t look like yours.
1. https://www.webmd.com/depression/news/20170815/us-antidepressant-use-jumps-65-percent-in-15-years#1
2. https://www.addictioncenter.com/stimulants/antidepressants/
3. Elle, October 27, 2017. https://www.elle.com/author/5416/cathi-hanauer/
www.susankeller.com, #Citalopram, #depression, #lymphoma, #gvhd, #AntidepressantTaper, #SusanKeller, #SSRI, #BloodBrother:AMemoir
