I forget her name as soon as she says it to me. Her ID badge is turned around backwards, so I never relearn it. Her frizzy black hair forms a near perfect triangle with the baseline just about at the middle of her neck, and her eyes are either a little too close together or she is somewhat cross-eyed. I can’t tell which, I don’t want to stare, although I probably already am.
She is a fourth year medical student. Not the doctor I am supposed to be seeing. Who had received a call from my therapist earlier in the week in anticipation of this meeting. So I have to rehash it all again. Which I don’t mind terribly; I’m just a little talked-out, a little worn from having to discuss my feelings with someone all over again. It had been my hope that the phone call would have saved me the trouble.
But it doesn’t. So I tell this med student the recent developments; her enthusiasm is equal parts reassuring and creepy. She has upbeat speech patterns and perky “OK!”s as I narrate how I haven’t been cutting, but that I’ve been wanting to. That a few weeks ago, at a wedding, I wanted to slit my throat right there at the dinner table, and just go blanche and slump forward into my food while the music played, everyone bantered, and the colleagues of the bride to my left and right discussed the humor of two of them having the same first and last name, second marriages, and hair extensions.
It was supposed to be a six month check in, just a routine visit. Two months ago, it would have been my hope that this visit would initiate a conversation about me getting off of anti-depressants. My recent mental state, though, made that highly unlikely. We discuss treatment options as the doctor knocks and comes in.
She gives a summary of everything I had just told her. She refers to me in the third person as he takes notes.
He’s thought about slitting his throat and hanging himself; he has a razor that he uses to slash bread that he’s used to cut himself before, but he hasn’t just taken it out and stared at it while having suicidal thoughts. He was recently at a wedding where he thought about slitting his throat. He says that he has suicidal thoughts a few times a week, sometimes daily. He says that this is the third fall in a row where he’s had thoughts of self-harm or has actually self-harmed. He feels overcommitted with a lot of his personal engagements. He says his main reason for wanting to get off of SSRIs is because of the effect it has on his libido.
He scribbles diligently. The pen makes quite a bit of noise as it scratches the paper.
We were just beginning to discuss treatment options when you came in, so perfect timing!
Well, the good news is that there are lots of options, he says.
This is exactly or almost exactly what he said when I first met with him a year ago. His outfit was also similar, if not the same: khakis, white collared shirt with some kind of pattern to it, black jacket vest. Fluffy beard.
Dear Jesus God, I think. It’s been almost a fucken year since I started on these things. I think back to the meeting with my therapist in which we first broached the subject. Me on the couch, with my girlfriend at the time, telling my therapist that I had texted her after some argument saying that, to paraphrase, this shit made me want to die. And that she couldn’t handle that.
I think about my girlfriend getting up to go (was she a little teary, a bit sniffly? I can’t remember), telling me she’d see me later that afternoon, thanking my therapist for letting her sit in on the first twenty minutes of the session. I think about how I felt like shit.
I think we need to discuss the possibility of getting you on anti-depressants, my therapist said, seconds after the door closed behind my girlfriend.
I must have looked a little shell-shocked. She hadn’t used the word before. Technically, she still hadn’t; rather, she had suggested a solution to it.
So this is depression, I said, or asked, or something like that. I told her something to the effect that this was the first time we had actually put a label on what I might have.
Your is an anxious depression, she responded. The ownership of it all: my depression. My anxiety. My self-mutilation. My current mental state.
She zoomed out for a second, mentioned that the label doesn’t carry the stigma I think it carries, that one-third of Americans are diagnosed with depression. If that were true, that would mean that there are more depressed Americans than there are total French citizens in the world.
I couldn’t be certain if knowing that I was among a third of all Americans made me feel any better at the moment. This banality of depression juxtaposed with the possessive: societal, personal, the fucken brain and all of its dysfunctional glory. A shared mania 100 million strong.
I told her that I had to think about it, that I would do some homework, do some reflecting. As she closed the door behind me and I was excreted from her office back into daylight, into reality, where the neat categories and parts of me that we dissected were all at war.
I didn’t let on that I was leaning towards saying yes on the spot, that I would welcome any fucken remedy to stop the cutting, stop the thoughts of chucking myself off the bridge, stop the daily conversations in which I raged at my girlfriend for not understanding, for not getting how fucked up it was in my head. After all, how could she, why would she? She was far too well-adjusted, far too optimistic about life in general.
I took two weeks to deliberate. I asked a friend who I knew had taken anti-depressants.
Things just roll off you more easily, he said to me over the phone. It sounded appealing.
The steps: as boring as they were simple. Tell my therapist that I’m on board. Call my primary care physician. Tell him all about it. Get drugs.
This is too fucken easy, I thought, walking away with the prescription in my hand.
It was that first meeting, just under a year ago now, when he first said, Well, the good news is that there are lots of options.
C PODY. Code I recognized from my days working in a pharmacy. Take one capsule by mouth once daily. So I took my first capsule, two shades of blue on the morning of my 27th birthday, on my way out the door to drive to a funeral four hours south.
And now, I am back at his practice, in an examination room, with a fourth year medical student referring to me in the third person.
Lots of options. As though I were choosing breakfast cereals at the supermarket.
Really, though, there don’t seem to be that many. As far as I can tell, my options are:
- Increase my dosage.
- Keep my dosage the same.
- Try a different SSRI.
- Change the class of medication so that it isn’t affecting my serotonin levels.
- Combine an SSRI with a different class of medication.
Those options become even fewer as the three of us discuss what is actually the safest, the most logical solution. My own vote is to get off of SSRIs so that I can have the functional sex drive of a late-20-something who’s trying to date and not have to explain with each new partner why, in fact, I haven’t orgasmed despite a half hour or more of vigorous humping, blow jobs, and self stimulation.
Babe, my legs aren’t meant to stay open that long, one said.
Your hip bone is digging into me, sweetheart, said another.
My mouth is numb now, said another.
The wisest decision, it seems, is to increase my dosage back to twenty milligrams of fluoxetine, back to what I was taking when I first had a lot of options. I am to touch base with my doctor in a month, to discuss switching off of this class of anti-depressants, in the hopes of getting on something that won’t affect my libido.
My libido. My depression. My anxiety. My desire to self harm. My desire to maintain a goddamned erection. A third of all Americans have what I have. 50 million men. A little more than 50 million women. I wonder what their struggle is like. I wonder if they find themselves with fewer urges to self harm, but dampened desires.
I practically apologize to the medical student for putting such a heavy emphasis on the sex drive.
I know that shouldn’t be such a huge driver of my decision, I say.
It’s part of your mental health, she responds.
Mind and body are one. One of the most basic tenants of my martial training. So of course it should be a fucken driver.
But we agree, or I agree with them, that we should wait until I restabilize to change the class of medication. I reflect that earlier this week, I was ready to call it quits, ready, as I told her, to get in the tub and cut myself open. Like a goddamned fish, I don’t tell her.
They say some clinical things to one another. We up the dosage.
Let’s see how you’re doing in a month. If things get worse, definitely call me, because we don’t want that, he says.
They show me out, pointing me down the hall. I schedule an appointment for a month. The piece of copy-proof prescription paper in my hand.
Fluoxetine 20 mg. CPODY.
Take one capsule by mouth daily.
Like that’s supposed to solve it all, I think.
But then I think: I fucken hate to admit that this actually makes things better.
Things just roll off you more easily.
I sure as shit hope so.