Three years ago I decided to take Abilify, an anti-psychotic medication, prescribed to me to boost the waning effectiveness of my anti-depressant. I had been on selective serotonin reuptake inhibitors (SSRIs) since the fall of 2001, and Abilify would be the third psychotropic prescription in my pill organizer. Almost immediately, though, Abilify wreaked havoc with my blood sugar and I was forced to weigh its psychological benefit with the physical risk of getting diabetes. And so last year I tried to taper off it.
In light of my situation, I have been reading Diana Spechler’s excellent ongoing series “Going Off” with keen interest. Spechler, a novelist and essayist, has been documenting her experience of going off her psychotropic medications for the New York Times column, Anxiety. Her regimen of medication, similar to mine, included an anti-depressant, Trazadone (a sleep aid) and Lorazepam, a benzodiazepine. Although she responded well — her depression mostly lifted — she was anxious about being on the medication. .
The more I read, the more I felt that Spechler was a kindred spirit who I wanted to talk to directly. At the outset of our phone conversation, she put me at ease about my decision to stay on medication. “My goal as an artist,” she said, “is to undo shame. My goal with the Going Off series is to chip away at the taboos around meds and mental illness by writing frankly about my own experience.”
My own history of anxiety and depression has a straightforward trajectory. I had my first panic attack in 1980 when I was nineteen. The dread and anxiety that took up residence in my mind and in my soul left me alternately agoraphobic and claustrophobic. Yet I was resolute about getting through anxiety without medication. In my twenties I opted for therapy and it helped. When Prozac came along I was tempted to try it, but there was no data about its effects on pregnancy.
Soon after, I married a wonderful man and gave birth to two children. Yet panic was always lurking, and sometimes outright stalking me. And then September 11th happened. My husband was out of the country, my children were very young. I felt utterly alone and frightened and my anxiety felt different — I couldn’t get through the panic.
I held my husband’s hand as I cried throughout the appointment with the psychiatrist. He was a gentle man who listened to my loop of why I didn’t want to take Klonopin or Lexapro. I reasoned that I had been so stalwart all those years without any help. But with childbearing behind me, there was my quality of life and the lives of my children to consider.
I took the medicine. And it did change my life in concrete ways. I slept through the night, I could sit still without worrying about panicking. I could drive long distances on a highway. But even on the medication, I occasionally slipped back into depression and anxiety. That’s where the Abilify came in. Shortly after I started Abilify the difference in my demeanor was notable. Yet when I looked at the crowded slots of my pillbox, it felt like too much. I wanted to go back to just taking an SSRI.
Spechler sympathizes. “I also worry about the long-term effects of these drugs, which are still relatively new to consumers,” she told me. And in one of her Times essays she wrote: “I worry about Big Pharma. My stomach clenches when I read about studies and the ugliest side effects of the very medications pharmaceuticals companies hard-sell to psychiatrists, including pediatric psychiatrists.”
At first I didn’t notice any withdrawal symptoms from the Abilify until a Sunday last April when I couldn’t stop crying. Sundays are historically difficult for me — a day of anxiously anticipating the week ahead. But on this Sunday I felt the anxiety of my pre-medication days. I went back on the Abilify and my mind quieted down.
Back in 2001, when SSRIs made such a difference for me, I swore that if anyone tried to take away my Lexapro she would have to pry it from my cold, dead hands. I was the SSRI poster girl, a recovering phobic, a long-distance driver. These days, though, I worry that my psychotropic medications have become a crutch and, given the bad reaction I had to tapering off Abilify, a liability.
Spechler’s essays have dovetailed with psychiatrist Julie Holland’s recent op-ed in the New York Times’ Sunday Review. Dr. Holland writes that, “one in four women takes a psychiatric medication compared with one in seven men. Women are nearly twice as likely to receive a diagnosis of depression or anxiety disorder than men.” Furthermore, she reports that Abilify outsells not just psychiatric medications, but all other drugs in the United States.
Although I own my ambivalence about taking psychiatric medications, Spechler is not advocating that I go off them. “One of the disturbing responses that I’ve gotten [to my essays] is that it’s going to encourage people to go off their meds. I want to clarify that I’m not encouraging anyone to go off her meds. I’m only acknowledging that this is something people go through, that it’s something I’m going through, and it’s not being talked about enough in mainstream media.”
My psychiatrist and I are aiming to try again to taper me off Abilify. This time I’m grateful to have Diana Spechler’s experience and empathy at the ready.