Writing and Anti-Depressants, Part 2: Sex, Drugs, Suicidal Ideation and Stolen Shadows
The whole idea that you can’t write good fiction on medication is of course complete bollocks. David Foster Wallace wrote most of what he wrote on Nardil, which is a way harder-core med than anything I ever got near. (This argument is or is not effective depending on whether or not you like DFW’s stuff.)
It’s not like writers haven’t been self-medicating phentermine with alcohol since forever anyway. But we tend to be fussy about anything clinical or medical, i.e. anything that isn’t sufficiently self-destructive. It’s like Rilke refusing psychoanalysis because he thought it would kill his muse:
“Psychoanalysis is too fundamental a help for me, it helps you once and for all, it clears you up, and to find myself finally cleared up one day might be even more hopeless than this chaos.”
Spoken like a man who was sleeping w/ his shrink. (Which he was.)
But that’s how I felt myself after I went off SSRI’s. And I did not even have sex w/ my shrink.
After my Palm Beach adventure I stayed away from anything pharmaceutical for a year. As far as I was concerned writing required raw unaltered brain chemistry. If I was going to get anywhere with The Magicians, nothing else would do.
Then I found myself back in the weeds. One of the symptoms of atypical depression is something called ruminative thought, which means you return obsessively to the same issues over and over again and think them through in endless futile circular thought-patterns that go nowhere. I thought ruminating was where you sat in your armchair in a smoking jacket and swirled brandy in a snifter and had good ideas, but it turns out that’s a totally different deal from ruminative thought. Check the packaging on those two carefully, because they look alike.
That’s when my psychiatrist waved Wellbutrin under my nose. Wellbutrin isn’t an SSRI. The chemical mechanism is different. It doesn’t reduce your emotional range, at least in theory — the highs are still high and the jagged lows are still jagged and low. It just revs your mental hamster-wheel a bit faster. Keeps you from getting bogged down in apathy and ruminative thought. I pronounced myself ready to get back on the pharmaceutical horse.
The first weekend with Wellbutrin was a shocker. The effects come on much faster than an SSRI’s. That weekend I was apartment-hunting, in itself a not-undepressing activity. I felt jittery and chattery. I had energy.
I also had something I’d only read about but had never experienced: suicidal ideation. When I saw a speeding truck I thought, in a jittery, chattery way, how’s about we step in front of that truck! When I saw a tall building my first thought was, hey, wonder if there’s roof access?
So that was interesting.
In a way it was a positive thing. The way I figure it, my brain was developing a new, can-do, problem-solving attitude. The problem was the same, depression, but my internal conversation about it had changed. Where as before it went:
Brain: Dang, I’m depressed.
Other part of brain: Let’s order some General Tso’s, watch two hours of Adult Swim on your computer, drink a bottle of wine, take a bath, and go to bed.
Now there was yet another part of my brain, saying something like this:
Other other part of brain: Damn you and your half measures. Look, the problem is you’re depressed, right? We need a permanent solution. Like jumping off that tall building.
Brain: But wait. I’m soft and squishy.
O.o.p.o.b.: Exactly my point.
But that passed. Later my shrink said the suicidal stuff was actually a good sign. It meant my brain had been starved for whatever neurochemicals Wellbutrin supplied, and it was doing a big reorganization now that it had it in bulk. I remember once back in the 1990’s, I was troubleshooting a crappy 386 machine that I was trying to force to play Rise of the Triad, and the audio wouldn’t work. I did something and rebooted and immediately I heard a big beefy staticky SNAP from the speakers. The audio had finally kicked in. This was like that — this was the snap. Something in my brain was kicking in. It had been troubleshot.
I spent the next week in that same high-energy jittery state, but now my mood was up. If I could compare it to anything it would be — cover your ears, children — the high that comes with a little bump of cocaine. I haven’t done a lot of that, because hello, do I look like somebody who gets invited to those parties. But that’s what I remember being it being like.
The fact is I was falling in love. With Wellbutrin. I had found my drug. I could get out of bed in the morning. I did less ruminative thinking. I didn’t write and rewrite the same sentence 50 times. Whereas before I would get stuck and blocked ten times a day, now I kept on bulling forward. It was like I’d been water-skiing my whole life, but the boat had been going at half-speed, and I kept sinking down into the water until it burbled up around my knees and eventually I dropped the rope and fell over. Now the boat was going full speed. I was skipping along. I was finally getting somewhere.
For the final test, I went to my psychiatrist and said I wanted to try going off Wellbutrin, to compare my mental states on and off it. Like I did with Serzone. Now for the catch-22. He told me — he might have mentioned this sooner — that you can’t go off Wellbutrin, or if you do you can’t go back on it again, because it doesn’t work as well.
So I can’t compare Wellbutrin-Lev to Lev-Prime. Maybe if I did I’d be horrified. But I’ll never know. I don’t want to risk it. I don’t want to go back to Kansas. I want to stay in Oz. I’m over all that dust-bowl farming shit. I’m going to take these little white pills every morning until I die. Wellbutrin 4 Life.
Now the caveat parade!
One is that I still experience depression. Wellbutrin doesn’t fix that. You feel it all. It just doesn’t paralyze me the way it used to. My therapist gave me a bottle of Xanax to take before public speaking gigs and that sort of thing, as a kind of spot-patch drug, but I haven’t been using it much. (One thing about Xanax, I learned the hard way (the easy way would have been just reading the bottle), is that it doesn’t interact real well with alcohol. And I like interacting with alcohol.)
Another is that people seem to have very idiosyncratic reactions to Wellbutrin. One friend of mine, a supremely talented novelist, loved the high but felt like Wellbutrin had deprived him of something dark and essential — it stole his shadow — and he went off it again. Once I met a famous writer — you’ve heard of him — who, like me, took 300 mg of Wellbutrin daily; six months later I saw him again and asked him how it was going, and he said he’d switched to chewing nicotine gum, and it gave him the same effect.
Another friend of mine had a seizure because his doctor overprescribed the stuff.
And here’s the real head-scratcher. When I evangelized to my brother about Wellbutrin, and how I thought it basically saved my life, he shrugged and said he’d tried it a couple of years ago, and it hadn’t done much for him, and he’d ditched it. My brother and I are identical twins. Go figure.
But the bottom line is, I’m sticking with it. If there’s one thing I’ve learned about depression, it’s that you can have too much of a bad thing.
(Endnotes: if you’re thinking of going on any medication at all, check out the great, albeit horrifically ugly, user review site askapatient.com. Also I’m indebted for the tone of and inspiration for this post to this episode of Penny Arcade TV and to a great essay by Walter Kirn about his own experiences with anti-depressants called “Living the Pharmaceutical Life.”)