But the Emperor’s New Clothes Keep Me Warm

I just noticed that I’ve been taking Lexapro for a year. I would have guessed it was half that. (Where does the time go? Last night, I also realized that as of this past September, I’ve been living with my wife for a third of my life.) A couple of weeks ago, I checked in with my psychopharmacologist after cutting my dosage in half back in December. I definitely notice the difference. When I was taking 10 mg (which is still a pretty small dose), nothing bothered me. I felt a sort of steady background sense of peace and even elation. And I’ve only become more aware of that as that sense has receded with the reduction in dose. I’ve been trying to reconcile this with the recent findings that antidepressants are generally ineffective.

I wonder (though not enough to actually read the studies) how the effectiveness of antidepressants might be measured. I can’t imagine how anyone else following me over the last year might have reliably assessed how the changes in dose affected me. It’s not like I’ve become more effective or easier to get along with. I’m not even sure such an assessor would have been able to make much of my attempts to convey how I feel. But that doesn’t make the effects of the medication, subjective though they may be, any less real, and it won’t stop me from trying to convey how I feel anyway.

I don’t know what the narrative in anyone else’s head sounds like, but mine has always been stern, sharp, worried, and relentless. I took up meditation hoping to find some respite from it, only to discover that mindfulness practice brought it into sharper focus. But having it in sharper focus has made the change in its tone over the last year much clearer. And on 10 mg of Lexapro, it was supportive where it had been stern; insightful where it had been sharp; calm where it had been worried; and reassuring where it had been relentless. With the decreased dosage, it has shifted back toward what I had come to believe was normal. I find myself feeling more threatened and vulnerable, and so defensiveness seems to motivate more of my behavior, but not so much so that anyone else seems to notice. I guess it’s not that I’m acting differently, but though I’m still doing the same thing, I’m doing it while wearing the slightly itchy underwear of my background anxiety.

When I visited the psychopharmacologist, our discussion of whether I should stay on the reduced dose of Lexapro or go back to the higher (but still fairly low) dose–a discussion greatly simplified by the lack of side effects, which had been an issue with Celexa–centered on the issue of subjective experience versus objective behavior. She recognized the subjective difference in my experience as real, but suggested that if this change didn’t translate into a difference in behavior and didn’t affect my ability to function, then I should consider staying at this dosage for the time being. I had gone into the appointment thinking that I’d return to the higher dosage, because why suffer if I don’t have to? But I came around to her way of thinking, in part because she told me that what I feel now (manageable irritation), not what I felt on the higher dosage (bliss), is normal. But also, if I simply never suffer, then I suspect the emotional “muscles” used in managing suffering would atrophy, and I’d end up the psychological equivalent of the former earthlings in WALL-E. So now I find myself on the other side of this insight:

Being willing to face the unavoidable pains of life is often a sign of courage and wisdom. Nonetheless, being unwilling to use effective therapies to relieve unnecessary pains may be a sign of misunderstanding, and of a spiritual superego run amuck.

Where a year ago I had to recognize that my pains were perhaps unnecessary and could be more compassionately addressed, now I have to recognize again that some pain is unavoidable and find a little courage and wisdom to work with. But I do so with a sense of hope. First, I know that the medication is always available, that it’s effective, and that I don’t suffer side effects taking it. This offers the non-negligible comfort that whatever’s bothering me can be stopped if I need it to be. But also, having been through this experience in the context of a mindfulness practice, I’ve been able to see clearly that the quality of the narrative in my head, and so of the most intimate layer of all that I experience, is changeable. My very self, as I experience it, doesn’t have an inherent texture. That’s the considerable upside of impermanence.

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