The Promise of a Pill




I’M TIRED, ANXIOUS, AND EDGY TODAY. Yesterday I increased the dose of an anti-depressant prescribed while I was in the hospital. At the time, I was already being treated with a mood stabilizer but this medication alone failed to ameliorate the deep depressive valleys that have been the worst part of my bipolar 2 disorder. Feeling encouraged by an improved mood, I asked my psychiatrist to significantly increase the dose of my anti-depressant, hoping it would catapult me, or rather my mood, as high as possible. This has been one of my self-defeating patterns, although I believe others struggling with depression may share this flaw with me. When something seems to work I want more of it, and as quickly as possible; a sort of desperate sprint toward mental health. However, as I am repeatedly taught, the journey out of depression is not a sprint. It is the Boston Marathon, Tour de France, Scaling of Everest, Atlantic swim, and Indie 500 all rolled into one. There are times when I’m on the fast track to the checkered flag of happiness. Other times when I’m in the middle of a dark and windblown sea, attempting to swim, exhausted, and simply treading water. There are times when the world could not appear more beautiful and my senses are supremely alive as the impressionistic scenery of life whizzes by (actually, this one may be hypo-mania, which, for me, is generally a precursor to depression). And there are times when I stand triumphantly at a summit, but dare not look down, fearing the vertigo that precedes a fall into darkness.

The marathon, however, for all its slowness and lack of obvious excitement, is probably the most accurate metaphor. Running a marathon is a slow and steady process. If you push too hard, you’ll never make the finish line, but going too slow actually makes the race more grueling. There is an optimal pace.  It is, however, absolutely subjective. Setting your pace requires accepting your limitations while realistically challenging them. When the pain becomes too much, it is the encouragement and guidance of your supporters and fellow runners that keeps you, however slowly, moving forward. And when you’re scaling an unforgiving hill, and one stride feels like the marathon itself, focusing on the ground right in front of you makes the challenge manageable. A marathon may consist of thirty thousand steps, but the present step is the only one that matters.

Refusing my desire to “sprint,” my psychiatrist, kind as a saint yet with the discipline of a catholic-school nun when it comes to doling out medication, saved me from myself. Instead of the 50 milligrams I requested, he increased my dose by a paltry 25 milligrams. And god bless this man!  As this small increase has put me on the verge of a panic attack for the past two days. I know my body chemistry will adjust over the next few days, but I shudder at the thought of getting my way on my original medication request. Double the dose and I surely would have been riding the quadruple espresso anxiety train to the emergency room. Lesson learned…trust your psychiatrist.

I’ve come to view managing my depression as a story of adventure with many heroes. When I rely on and trust these heroes, which include my psychiatrist, therapist, family, close friends, and my healthy self, the forces of darkness and depression are seldom victorious.

Mercifully, I have been taught, yet again, that while the gradual monotony of the slow and steady path out of depression may not “win” the race, slow and steady steps in the company of those who understand the pain allow us to get up after a fall and laugh a bit along the way.

Trust the process. Stay the course. Keep the faith.



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