Either My Anxiety Is Less Acute or I’m Better at Managing It—Which May Be the Same Thing

The psychiatrist said that there were plenty of people whose brains did much the same thing mine was doing. He called it ‘anxiety.’

Most of figuring out how to be a person is figuring out how to worry the right amount. Humans have developed the capacity to think beyond our immediate needs, but that came with the capability to think up infinite ways the rest of our lives could go wrong.

Worry too little and the wolves might get you during a careless forage in the woods. Worry too much and you never leave the hut. (Or, then, maybe, you die and are eaten by rats; maybe there were never any wolves!) Fixation on ourselves in the present can be harmful for us in the future; fixation on some version of ourselves in the future can be harmful for what we need in the present. The trick is to strike the balance.

Not that I’d really know. At thirteen years old, I lost that balance. I fell to the side to which I’d been leaning, the side of worrying too much.

As a kid, I’d cocoon myself in bed every night, thinking masked assassins would break into the house and come for me. My blanket armor helped at that age, but it didn’t assuage the quotidian adolescent what-ifs that would keep my brain racing at night. When my mind should have been slowing down to sleep, I began to worry about not being able to slow it down. Soon, I would be too worried about falling asleep to fall asleep at all.

I tried whatever I thought was supposed to help, but they inevitably brought on further agita. Counting sheep turned out to be a mathematical and visual-spatial challenge. Guided meditation on cassette tape unclenched my muscles, but not my thoughts. Even simple deep breathing practices could be a hazard; I remember lying on my back and worrying if my stomach was rising and falling in the correct direction with my breath. I do not recommend forcing your body to expand and contract in the opposite direction of our biology. It felt like breaking.

After each night’s failure to sleep, I’d take my duvet and pillow to the beige couch in the living room. I replaced rest with hours-long infomercials about kitchen gadgets, the same episode of SportsCenter three times in a row, and, finally, the Animal Planet program that showed dawn in different parts of the world. Whatever sleep I achieved wasn’t enough.

My parents concluded that something needed to be done about their sleep-deprived teenager with an expertise in the impressive versatility of the Magic Chop-It. My mother took me to a psychiatrist, the one in the glass office building next to the Dairy Queen in our corner of suburban Denver. He explained that, while I may not worry like most people, there were plenty of people whose brains did much the same thing mine was doing. He called it ‘anxiety.’

Anxiety, I thought, sounded much more grown-up than “worrying.”

The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines “Generalized Anxiety Disorder” according to a number of conditions, centrally (a) “excessive anxiety and worry (apprehensive expectation) . . . about a number of activities” that (b) someone has difficulty controlling, which manifests in (c) symptoms that (d) “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

While everyone experiences some amount of anxious thinking, anxiety disorder is defined by an amount or intensity of that kind of thinking which exceeds someone’s capacity to manage it. Although I used to experience “apprehensive expectation” about all sorts of things for as long as I could remember, only when I couldn’t control it did it become diagnosed.

The psychiatrist gave me a diagnosis and a prescription for a medication to take before bed. Within a few days, I started sleeping again. I saw that psychiatrist a handful more times in my teens. Once, it was to switch to the medication Zoloft (generically known as sertraline); a few other times, it was to check if I felt the medication was still working and to consent to his recommendation to increase the dose to keep up with my growth. It felt needed and helpful at the beginning. I slept easily. I felt like the ground was more even, that there was less to trip up on, that I was better able to catch my balance when I did.

For the next fifteen years of my teenage and young adult life, it continued to be—at least I assume so. Long-term anti-anxiety medication use means never really being sure how that period of your life would have gone without it.

Then, for no clearer reason than when I needed to start, after five thousand doses, I began to feel like I wanted to stop. And so, earlier this year, I decided to stop taking my medication. I smoothly tapered off and I now live without complication—the end.

Clinically, that’s true.

Like most people who stop using medication for anxiety or depression, and roughly half of those who also took sertraline, I had no adverse reactions to discontinuation. I didn’t suffer from the symptoms or complications of relapse that some people encounter—which is the story that’s in the public spotlight. In addition to the onset of physical symptoms like dizziness, nausea, or fatigue, people attempting to discontinue treatment can face an intensification of the mental health challenges they were trying to address in the first place.

Even though agonizing withdrawal is the dominant narrative, many experts believe that it is not the dominant experience. About 1 in 6 adults in the US have used psychiatric drugs; the research suggests that there are millions of people who have tapered off treatment for anxiety or depression without significant complications. Even with such a high rate of medication, the prevailing public stigma over mental illness and treatment means that few people, in general, speak publicly about their medication. The harrowing stories about coming off of medication are exceptions—and are important public warnings about the complications some people may face.

The other, less eventful experience doesn’t lend itself to storytelling or meaning-making quite as plainly. The plot arc of successful medication and discontinuation seems to consist of things that didn’t happen, rather than things that did. First, I didn’t continue life as a middle-school insomniac. Then, I didn’t have a panic attack every time I moved apartments as an unemployed recent graduate. Later, I didn’t perseverate on the possibility of having contracted a tropical disease after being stung by an unknown bug in Argentina. Finally, I didn’t find myself ever more agitated as I decreased my doses and took them less frequently. I didn’t rush to find the leftover pills and need to start again.

In a clinical timeline of my fifteen years, there would only be a handful of dates to note: when I started medication, when the dosage changed, when I began to taper down, and when I discontinued. The very purpose of using chemical assistance to manage anxiety is to prevent the ordinary from becoming extraordinary. The story should be that there is no story.

The very purpose of using chemical assistance to manage anxiety is to prevent the ordinary from becoming extraordinary. The story should be that there is no story.

But there is one. Over those fifteen years, the story seems to be: I changed from someone who needed medication to function, to someone who thought they no longer did and turned out to be right. Something changed so that, at age twenty-seven, I felt such minimal anxiety about anxiety itself that I wanted to stop using my reliable solution for anxiety. I am extremely proud of that result and, simultaneously, I’m not sure if I deserve any credit.

After so many years of comfortable daily doses, I have craved to know why I could finally make the decision to start tapering off in late 2018. Like when I first started to need medication, nothing dramatic happened to make it necessary for me to take action. Since I had grown up medicated, it also wasn’t a matter of suddenly feeling like myself before drugs: I didn’t know how that felt.

Nor did I choose a typically favorable time for trying to find out. I planned to be fully off of my pills right after leaving my comfortable office job, my apartment, and community and moving to Mexico for an indefinite amount of time. Everything about that plan was riddled with the possibility of old anxieties: moving, money, isolation, the pending unknown next-step, the open time of unstructured days. I just wasn’t that worried about them anymore.

Yes, I’d had time to figure out ways to help myself. I recognized how and when I could use exercise to regulate my brain chemistry; I used office lunch hours to go to the gym when I could. If I sensed anxious thinking growing, my heart and lungs feeling like stretching elastic, a jolt of exercise could release the tension. I remember walking in my neighborhood on a Sunday afternoon in autumn, becoming more certain by the minute that Donald Trump was about to start a nuclear armageddon. I rolled up my chinos and sleeves, ran to the park, and lost the idea in loops on the wet, leaf-painted asphalt. Learning how to take ten or twenty deep breaths have been a more practical and personal solution for those rare spikes of anxious thinking.

But my general, day-to-day feeling shifted, too. I could owe the pharmaceutical company for pills that blunted life’s edges for long enough for me to gain the confidence I could handle them. Perhaps the resilience I gained over time didn’t just come from the pills—or from them at all. Maybe that’s what growing up does: going through high school, college, unemployment, tight and temporary living, moving cities. Both probably helped me persevere through risks real and imagined. My growth led to a fundamentally stable life, one wherein I had the resources and privilege to take a new risk. Months after my last dose, all of it seems possible. But none of it seems provable.

*

In my second one-month sublet in Mexico City, I pinched a final half-pill out of the bottle. It was one week before my twenty-eighth birthday. I hadn’t felt any increased anxiety as I decreased doses every few weeks; I didn’t feel more anxiety or experience other unusual symptoms as the drug fully left my system. As days passed since that last pill, I didn’t feel as if, suddenly, I was someone new.

I’m glad I avoided the serious swings that some people experience as they quit medication. But I also had hoped for a more significant shift, rather than feeling pretty much the same. There was no triumphant blossoming, no sudden technicolor reveal of the life I’d been missing, no “new me” that emerged from under cover. Just as I can’t attribute specific improvements to specific reasons before I quit, there’s no easy way to pick apart the causes of the ways I’m different now. Just as I couldn’t sense any significant change, neither could my friends. The vast majority of them, even my closest, never knew I was medicated. And the ones that did know didn’t learn I’d stopped until I decided to tell them months later (or, hi, are hearing about it right now).

I can feel one change: I’m happy to say I feel more able to cry now—a change from ‘not at all’ to ‘very rarely.’ That might be because I’m no longer subject to “emotional blunting” that can be a side-effect of sertraline. In the months after quitting, I can count a handful of times that I’ve shed a few tears. The first was at the end of a Spanish rom-com, when a corporate-executive with amnesia found redemption in joining an older-ladies’ hip-hop dance team.

I don’t think my catharsis was due to the profundity of the source material. But I also can’t say I’d opened up solely because the medication wasn’t there to seal me off. I could be more emotionally vulnerable now because I had also been spending significant time trying to understand my social conditioning, taking part in a masculinity discussion group with other men seeking to become more emotionally vulnerable. Everything else in my life hadn’t remained constant to test just the effect of this treatment.

Despite my desires for order in disorder, to extract fact from hypothesis, this transition has proved to be a reckoning with the concepts themselves. I wasn’t experiencing a failure of perception, but an inadequacy of category. I was supposed to start looking at uncertainty and accept it. It has meant relinquishing the idea that I am solidity surrounded by flux. In myself, I couldn’t find clearly defined stages of being and no versions to compare. Just like there is no control group for myself—no never-medicated other me in a parallel universe—there is no former-me or new-me, either.

It’s like the sorites paradox, otherwise known as the paradox of the heap. When you take a grain of sand from a heap, that heap of sand doesn’t immediately stop being a heap; it is still a heap when you take away another, and another. But take away enough grains and you’re left with just one grain of sand—no heap at all. At what point, the paradox poses, does the heap become a non-heap? At what point did I stop being an anxious person and become a non-anxious person? One conclusion is that I might be better off simply contemplating the shifting grains of sand.

There was no before, during, and after my anxiety. I had anxieties before I started, during all those years, and even now, I have and will have anxieties. I froze when I had to decide whether to throw away my leftover pills, wondering what type of crisis could make me want them again. I started to feel that suction in my chest on a recent visit home and my mother was late coming home from the grocery store. Concern about spending and saving enough money sometimes build into a smog that sets down around my head.

The difference is that, for now, in a period of my life without medication, my anxieties either feel less acute or I feel more capable of managing them—which may be the same thing.

It would be convenient if a process of becoming less anxious followed a tight narrative, if disengaging from medication offered manifest conclusions about how our mental health works. It would certainly make the decision to stop anxiety medication a little less anxiety-provoking. But, for me, a tight and conventional narrative wouldn’t be true. I had a simple answer to my childhood fears, and then I didn’t. I had a need for medication for so many years, and then I didn’t. I chose the least likely time to stop, but it was fine. After fifteen years, I didn’t suddenly find a new truth to divining the possibilities of the future. I found even my past and present to be a product of hypotheticals, a composition of uncertainties. I found out I can live with that, at least for now.