A writer I follow on social media recently asked her audience to share their experiences with Wellbutrin, if any, as she was considering taking it for depression. My Wellbutrin story was too boring to share, as the only negative effect I experienced was its failure to ease my depression. It didn’t elevate my heart rate to dangerous levels the way desipramine had, nor did it make me so groggy that I couldn’t drive, the way carbamazipine had. As medications that failed me unremarkably go, Wellbutrin’s failure was remarkable nonetheless; it was the only antidepressant that didn’t pile its own debilitating side effects on top of my depression’s insistence that I had to die. It simply stood aside and watched me stumble under a weight that grew heavier every day, exerting the same influence on my well-being as nothing at all.
If “nothing at all” sums up my best experience with antidepressants, it also represents the averaged efforts of the psychiatrists who prescribed them. To be fair, my psychiatrists were good, hard-working people who wanted to help. The following anecdotes show how their efforts were hampered by the imperfection of psychiatric medicine and our imperfections as people, including mine.
My first psychiatrist could not have known that desipramine would elevate my heart rate to dangerous levels. The effect of a medication isn’t known until it is tried. I fault him, however, for not warning me that such an effect was possible. I was in the military at the time, doing mandatory mile and a half runs several days a week. If he had to prescribe a medication that could provoke a heart attack when combined with the exertions that accompany military life, the least he could have done was tell me what to watch for. I was “fortunate” that the events leading to my first suicide attempt occurred shortly after I started desipramine. My vitals were checked frequently in the psych ward and the problem was soon discovered. But this experience left a hairline crack in my ability to trust psychiatrists. I was still willing to give antidepressants a try, but every successive medication failure and every bad interaction with a psychiatrist eroded that trust a bit more.
My second psychiatrist possessed an unfortunate flaw that undermined his compassion and decency: the moment he decided which pigeonhole to stuff me into, he stopped listening to me. He got a number of things wrong, and when I tried to explain how his opinion differed from the facts, he wasn’t interested. Ironically, one of the first things he told me when we first met was that he knew it would take time for me to feel comfortable sharing the things that were hurting me. Apparently, he did not want to hear it when those things centered around his dismissal of the facts pertaining to my situation. I blew off an appointment with him one day and never returned. My trust was broken further; effective treatment depends on a solid understanding of the problem, and we could not achieve that if he wasn’t willing to listen.
My third psychiatrist was simply unfortunate. The first thing he did when we met was reach for his phone and tell me that he had to return a call, then withdraw his hand slowly and say, no, I had waited long enough so let’s get started, shall we? His monologue couldn’t have been more staged if David Mamet had been standing in the corner, yelling “cut” as the scene ended. I was in the VA’s voc rehab program at the time, and my participation was contingent on receiving treatment for my issues. So I continued to see that disingenuous jackass because I didn’t believe I had a choice. That changed when I told him that a recent urge to cut had dissipated quickly. He said, “Do you read? That is a pretty advanced word! Since you seem to have a vocabulary, I don’t need to talk down to you.” No kidding, jackass. I’ve only been reading since I was four, “dissipated” is not a particularly advanced word, and other providers in this facility manage to treat their patients with respect whatever their opinions of their intellects may be. Of course, I didn’t believe that I could voice any of this, as I feared I would be punished for doing so. But the cracks in my ability to trust had deepened irrevocably. I never saw him again.
My fourth and final psychiatrist finally drove home how hopeless treatment was. I was far from an ideal patient. My deteriorating trust and growing resentment over having been forced back into treatment made me spiteful and unwilling to share things that might have helped. My final psychiatrist seemed willing to listen, but much of the time, I said nothing. I needed to feel that I had control over my fate, and I asserted this with the only power I believed I had. My silence. My past experiences stewed in that void where a productive conversation should have taken place. Memories of previous interactions that had conditioned me to expect little from the new guy coupled with recollections of previous medications that had done nothing for my depression while impeding me with side effects that ranged from irritating to dangerous. Despite this baggage, I could have made an effort if we were going to sit in his office and take up each other’s time. Much of the time, I didn’t.
Of course, it didn’t help that when I took a chance on telling the new guy what I needed from my medication, he blew me off. I was trying to become a cabinetmaker and Zoloft had made me sluggish, making it difficult to work. Could I please have an antidepressant that didn’t obstruct my goals? I knew he’d blown off my concerns when he described carbamazepine, the medication he had chosen. “You won’t be able to drive or operate machinery while you are on this.” “Great,” I said. “Commuting to my job at the cabinet shop is out.” “Oh, you work in a cabinet shop? What do you do there?” “Operate machinery.” Maybe there wasn’t a medication that would have worked. But his unwillingness to discuss my concerns did little to reverse the trust issues I already had.
Around this time, I became suicidal while experiencing my worst psychotic episode ever. Returning to the psych ward was sobering. My problems were serious, spurring my decision to give carbamazepine a shot. The frustrations began quickly. The levels of the medication in the blood must be monitored, so I reported to the lab before I saw the psychiatrist. He would check his computer, discover that my results weren’t in the system yet, and call the lab. The lab would tell him that carbamazepine panels were done by the night shift and the result would be available the next morning. I would come back the following day and he would say it wasn’t at therapeutic levels so we needed to up the dose, “but not too much because your liver function is worrying me.” Like lithium, carbamazepine is hard on the liver. This was worrisome for me because I learned that this psychiatrist had memory problems. Every time I saw him, he would call the lab when he saw that my results weren’t in, and they told him every time that the night shift does those, call back tomorrow. Was I going to end up needing a liver transplant because he couldn’t keep track of my blood panels?
On top of that, the medication made me so groggy that I often missed work. Many days I couldn’t drive. When I was at work I couldn’t focus. The day I nearly cut my thumb off on a power saw because I couldn’t concentrate on what I was doing was my final day under psychiatric care. I disposed of my remaining pills and never saw that psychiatrist—or any psychiatrist—again. My needs differ so radically from the care that psychiatrists and antidepressants provide that the three lines describing us on a pharmaceutical company’s graph will never meet at a solution.
Despite my assessment that my Wellbutrin story was too boring to share, I shared it with the writer anyway as a prelude to telling the story more fully here. Many times, I have had to justify my decision to go off meds and I hope that this narrative will do that. While I have opted out of taking medication to treat my depression, I do not claim that everyone should abandon their meds or that we should exile psychiatrists from healthcare. I would simply like psychiatrists to do a better job of recognizing the individual character of their patients and to help them find solutions that suit their aspirations as well as their illnesses. As I said in my final message to the writer, “I hope you find a solution that works for you, whether it involves antidepressants or not. Good luck.”
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.