In the Company of Myself

“It’s your decision.”

That was all Jack would say whenever I mentioned antidepressants. His answer had never bothered me until now. Why wouldn’t he give me his opinion?

Now I had the prescription for Paxil from Dr. Washington. My decision was no longer hypothetical. So I pressed him.

“I know it’s my decision, but come on, what do you think? I don’t want to start taking it and find out later that you’re not okay with it.”

Long pause. “Look,” he said. “I guess my opinion is that it’s your decision. I hope the Paxil helps, but it makes me nervous. I don’t like the thought of you needing all this medication. What if you can never go off it? What if something happens that we can’t predict?”

“Like what?”

“Every day, people find out that drugs they thought were safe are giving people cancer or deformed babies or something. I don’t want anything to happen to you. Of course, I trust you and your doctor . . . but that doesn’t stop me from worrying.”

My chest felt tight. What he said reflected my own fears. I realized I had been hoping that he would be more positive — that he would say I should try it out, and trust my doctor’s advice and my instincts. But he was feeling the same apprehension I was. He was just being genuine.

It dawned on me that Jack could help me talk it out, but ultimately it was my body, and making this decision about antidepressants was my responsibility. I had to live with his mixed feelings — and my own — and accept the consequences of my decision, good or bad, alone. I had to rely on myself.

I thought about what I had learned from Dr. Washington. She explained that in the days before and during my menstrual cycle, my estrogen levels were dropping and so less serotonin was getting to my brain. That was where antidepressants came in. Paxil, a selective serotonin reuptake inhibitor (SSRI), would allow my brain to absorb the serotonin I needed. Dr. Washington had instructed me to take the Paxil ten days out of the month, to cover my premenstrual period. I was to track each day of the month on a chart she gave me, which had spaces for me to describe symptoms, make notes about my emotions, and record meds taken. This way I could look at the data over time, and it would help me judge my progress.

I was surprised that antidepressants could work that way, so I did some research. The general assumption up until around that time had been that antidepressants couldn’t be taken intermittently, but studies were being done to show that this form of treatment worked for women with sensitivities to drops in their hormone levels. Paxil had recently been approved by the FDA for premenstrual dysphoric disorder, which is also known as premenstrual depression. I had thought that it took a long time for most antidepressants to kick in, but it turns out that Paxil was faster acting than other antidepressants and that Paxil CR (controlled release) could control the levels of absorption of the drug in the body.

All this sounded very convincing. There was something so relieving about having my “problem” explained so rationally. But the relief was frightening. What if the ease of having a solution clouded my judgment? This decision was just too hard. How could I figure it out all myself?

Part of me wished there were someone in my life who could just tell me what to do. I wanted someone come up with a treatment plan and assign it to me. But it was becoming clear that in order to recover, I was going to have to piece together what I could from the smartest people I could find and then do something about it — on my own.

The last “smart person” on my mental checklist was my therapist, so I sounded out my fears about taking the antidepressants with her. “It’s just that if I take them, or even admit I need them, it’s like admitting that I’m crazy, damaged,” I told her. “That there’s something wrong with me.”

“Like your father or like your mother?”

“Well, both, I guess.”

“Neither of them used therapy or any other kind of treatment to get better when you were growing up. Are you like that?” She asked pointedly.

“No.” I wasn’t like that. I wanted to take care of myself — for me and for my little boy. “I want to try out all my options. How will I ever know if I could be better than I am now if I don’t try? Maybe I’ll give it a month or two as an experiment.”

As I walked home, I felt a new confidence. I had consulted with each of the important people in my life and found out what I could.

My next step would have to be my own.

So I tried the Paxil. And the act of making the decision was nearly as freeing as the medicine itself. I could explore my own treatment. My depression had narrowed my thinking, and I had convinced myself I was incapable of making good decisions, and started believing my own worst thoughts. I needed to get my faith back, to reconnect with the confident woman I once was. I used to be smart, ambitious, and in charge. I wanted that woman back. So I started to reclaim her authority.

I waited until the eighteenth day of my regular (fortunately) twenty-eight-day cycle, and that night, I took one of the pills. The next day, I felt like a different person. I couldn’t believe it had worked that fast. The anger was gone, and I felt clearer and more relaxed.

It scared the hell out of me.

I called Dr. Washington. “I’m worried. Do I feel too good? What if I should be feeling sad? Will I be able to feel all the different emotions?”

“Rebecca,” she responded patiently, “the fact that you are worried proves that you are feeling the proper range of emotions.”

Did I detect a bit of amusement in her voice?

“Give it time,” she continued. “As long as you aren’t having abnormal physical symptoms, you’ll be fine.”

She went on to explain that it was a bit earlier than normal for me to be feeling the effects — the average time was within one to four weeks — but I weighed barely over 100 pounds and was sensitive to medication. It was also possible that my sensitivity to changes in my hormone levels made my brain chemistry more susceptible to the increase in serotonin.

“But, what if — ” I began.

“Dear,” she interrupted, more emphatic this time, “Dear, what I’m trying to say is that it’s working. Go with it.”

Was it okay to feel good? Why did that somehow tinge the air with guilt? I waited out the week, continuing the medication. I felt calmer, more capable. Jack was late one night and I got mad, but not furious. I slept at night instead of ruminating. And the song lyrics went away. The words inside my head that said “stupid” or “whiney shrew” when I’d feel out of control simply weren’t there.

Okay, I could get used to this. But should I? Maybe that question would always be there, like a balance point. That was something I could accept. I’d live with the uncertainty and move on.