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The Man Who Pushed No Pills



Here is the truth: I took meds. Not much of an admission these days. Shrimp wander unafraid into the light and are getting eaten for all the Prozac in the water. Vitamin Z is a popular choice.

I’ve written about this before–look back in the archives for the pictures of the artfully off-center pill bottles with the RX numbers obscured. Among them was citalopram (or Celexa, if you pay retail). I have not written about it before.

As a general-purpose anodyne for the feeble-nerved, my doc explained, it’s beyond compare. She uses it with kids. The most stereotypical psych med side effects–weight gain and a blown clutch on your wang–are minimal, often nonexistent. My therapist wanted me to talk to my doc about it. We talked about it. She wrote the paper. A bottle of orange oblong tablets cost as much as a king-sized candy bar.

From October of 2010 through August of 2012 the little orange pills–snapped in half–were my bedtime ritual. They were with me in my friend’s attic, the flight to Hawaii that made me think of a very green Texas, months on a friend’s futon, the hollow eerie time of a brand new place. Those first October 2010 weeks I remember a giddy mania turning the world to animist magic: birds all but spoke, I heard plants grow, cars actively smiled at me. I floated through a week of the world’s miracle, and then I could hardly stay awake for two weeks. Then I remember the divorce, mainly. Three hour phone calls of panic and guilt with distant friends.

I returned to the therapist in the fall of 2011. She pulled no punches; in my case, strong assertions I am not the failure I presume. The rhododendrons outside her office went from green to winter dull and back to spring shoots again. Spring 2012: she declares there’s no reason for me to see her any more. One sunny Saturday I ride my bike to see my friend sing, and I can hardly understand the happy perfume suffused in the setting sun.

I decide to cut out the citalopram. I make tiny adjustments down over weeks using liquid suspension, a big brown bottle like kid bad-cold cough syrup. I eyedropper out a syrupy orange milliliter at a time. By August 2012 I am done.

September 1 the world inverts. My cat is suddenly, extremely ill, then better, then ill, then gone. A woman I’d grown close to and who showed every sign of wanting more pulls the plug. Vet bills and grief panic me to sign up for unemployment and look for work, astonishingly fruitless. September 2012 was meant to be the start of my writing life. Instead it was a collapse into the grey glass abyss I know too well. I haven’t realized where I’ve been.

January brings a job and a torrent of anxiety, an avalanche of divorce guilt I thought was resolved. I work on the book, meeting initial generous goals, then bogging down in actual writing. It’s May and I have a fractured first chapter, maybe half of the second.

Sometimes I have felt invigorated, imbued with the sense of discovery and creative joy. Most of the time it’s too slow, another job to fear. I am sensitized to the slither of every hour.

I talk to the therapist and the doctor. Both show concern: you have a history, you have these other issues, and so on. I wonder in retrospect why they didn’t sense my making the schizophrenic’s mistake of not needing chemical help. I decide to go back on.

April 11 I take my first half dose. Close to the weekend if anything untoward. I don’t notice much–some stomach upset, a little more dizzy, but both pass. I don’t realize until later I was experiencing gentler mania, walking Alki, my mind running over with images and good ideas, sun and clouds everywhere lit with sun.

April 19 is a Friday, the first night at my old full dose.

By Monday or Tuesday the anxiety has come. This anxiety is not like Monkey, not the ceaseless doubting chatter of the Hawaiian mountainsides. It has no voice and wants nothing; it has no locus and cannot be seen. It shines out of me in a froth of shards. It is a power.

It is worst in the morning, or at night. I call friends interminably knowing there is nothing they can do and unsure of what I want from them. I spend a weekend in a friend’s guest room, wrapped in a blanket with the dog on the bed, talking and talking. One Thursday night I called this friend again, her exhausted from work, me lying on the floor next to the bathroom, the vibration especially bad. I ask her if I’ve been worse. She says I’ve been crazy. Her wish for me is just to have some peace.

Consulting the web is always dicey, but it turns the light on. Exacerbated symptoms are common when starting these sorts of medications, say authorities and nameless forum posters alike. The first two weeks were hell are comforting shared misery. Four weeks, six weeks, eight weeks. I notice I am clenching my fists. I have thoughts about ending up as the men I see hanging around the bus stations, airing out their shoes, sleeping on duffel bags.



Last Monday I am at Pharmaca in West Seattle, a health supplements store with the twist of also housing a regular pharmacy. I need to replenish some items and ask one of the resident naturopaths about the overpowering anxiety. A tall kid with a blank face who looks like he played basketball  points at little bottles with neat price labels. “Yeah, and there’s this. And, uh, this. It’s calming.” There are many, many bottles. I voice doubts. “Well, you want a pharmacist consult?”

The little window is set in a curving glass wall, the shelves of medicines too strong for mortals curving with it in pleasant faux wood. High in the back is another level where a man in a white coat works behind a railing, his furious pace transferring slips of paper from square plastic trays. Consult, someone calls. Be right there. The man descends the stairs and comes to the window.

He is a kind man, quick, Asian accent a little thick but understandable. I relate my problem: the objective dates, times, dosages, combinations; the subjective need for a way out. He listens, nods, asks questions proving his active listening and commitment to a unique response. The Ambien I’ve been reliant on since November and stopped somewhat abruptly: you’re over it, you weren’t on it long enough to cause a problem. Something else longer acting, short-term to help get over it: very small, no problem unless you take it for years. The big issue–the citalopram anxiety–he is quick as he is careful. It’s not so much the symptoms get worse, but that it hasn’t started to work. You felt mania, but it didn’t last, right? He uses his hands to emphasize a mechanism of action that appears to be one thing but is something else. (I wish I remembered this better.) He seems to be saying it’s  working but I’m not done with the transition. I’ve heard of medications not working again after stopping them the first time. He pinches his face at such old wives tales: No, it will work the same. You are adjusting.

We keep talking. I don’t question if he has something else to do; he seems fine sitting slouched on a hidden chair against a register in a white space of controlled clutter, his eyes focused directly on mine. I realize now he talks and listens like the physician we all want: the doctor we grew up watching on doctor shows.

So what is happening in your life? What is going on, why the change? I tell him since September: loss, guilt, fear, loneliness, frustration with the book that is something more like pursuit. We are too reliant on pills. I mean, atavan, valium, xanax–all those things would help now, so I could suggest that. But think about why you would take those–why, what for? What do you do for fun?

He took a skydiving trip recently. His arms shoot out, his face alive with the thrill of it. You have to find that, man. What is it that makes you like that–really alive? With that, balance. When you have that, it will all fall together. The book will be there, you will see. You need to live your life and feel free in your life. 

Twenty, thirty minutes we talk. Time is a totality, every moment held, let go. At the end, he reaches out his blue-gloved hand and shakes mine.

Every so often a Monday evening is as extraordinary as it is plain, a parting of invisible seas invisible to everyone else. Every so often we get exactly what we need.


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