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Surviving Psych Med ​Changes and/or Withdrawal: an essay & guidebook for creative minds

“I felt like I was deep in a psychedelic trip.”

Here comes your nineteenth nervous breakdown—The Rolling Stones

Dearly beloved, we are gathered here today 2 get through this thing—Prince

Sunday, May 1

Here in Silicon Valley, it’s 750 dollars for an intro session with a psychiatrist. Silicon Valley: the land south of San Francisco of tan foothills, Tesla cars and foie-gras lifestyles, where the beautiful hunt the rich, and the mega-rich hunt the talented, and the talented hunt their billions. It’s an especially foreign place to go into a downward mental spiral. You are going “crazy” alone out here, is how it feels—a lie, as so many suffer from mental illness everywhere in silence.

I am a creative type, broke by Silicon Valley standards at $42,000 a year. Though I have insurance and can afford care—I’m privileged when you think of those suffering from untreated mental illness—I’m a bum compared to most people around me.

I’m an author, editor, and educator. I live in stories. Like all writers, I inhabit narrative lenses and voices sometimes for months or years, depending on if writing short stories or novels. I also have struggled with mental health—I won’t say all my life. But I have enjoyed and celebrated and mythologized my mind and mental health a great deal and I have suffered from it.

One could call my first novel a mythologizing of self, loss, and psychological issues. I’ve been through a few times of real distress with mental health, and I have overcome them, then swept them under the proverbial rug. Turned them into myth. Preferred until present to engage with my moments of mania, anxiety, breakdowns, and illness at a distance, in fictionalized form, shaping them into self-narrative.

Suddenly, it’s not so romantic. I’m having panic attacks, a misfiring mind, depression, spiraling confusion, mania, and fear. I hope, but I can’t be so sure, it is medication-related. Seemingly no one can be sure.

I did cut the dose of my medication in half following doctor’s orders, starting a month ago. I had always thought the drug was more or less noneffective and that I’ve been on it simply because getting off medications is so absolutely debilitating. Maybe I was wrong?

I was diagnosed as having some symptoms of being hypermanic but inconclusively so in my early twenties (yes, a lot of qualifiers), possibly other things in my thirties, none of them all that significant, and now I’m having my fourth mini-nervous breakdown in so many days. Words like anxiety and medication withdrawal or discontinuation syndrome don’t mean anything in the face of the terror, the malfunction, the heightened senses including a newfound intolerance to smells, the feeling like my brain is being rubbed with steel wool, the anger, the grief, the great seeping panic. I’m sure it is from the change in meds. It would be okay if a doctor could confirm this—but they can’t confirm or deny anything.

I had something like a near-breakdown nine years ago. It lasted two years and was a turning point in my life. After my crash I wore horribly bland outfits—sweaters, sweatshirts—and walked around Portland, Oregon, a town full of other people who’d seemingly lost their minds too, walking around in a similar fashion. (This was before Portland was invaded by well-to-do professionals.) A lot of writers and creative types suffer in the mind. This isn’t new information. I went to grad school. I arrived wearing a medicine blanket, holding a puppy, wide-eyed, and carrrazy. I found myself through writing, relationships, and work teaching English courses.

I should tell you these four miniature breakdowns over the past Wednesday, Thursday, Friday, and Saturday (they sound so cute: like miniature muffins)—these four collapsing sinkholes feel familiar.

In literature, there are hosts of characters who are shell-shocked, from Earl of Gloucester in King Lear to Septimus in Mrs. Dalloway to Holden Caulfield and the woman who may or may not be “Jane” in “The Yellow Wallpaper” and in the characters from the recently released collected Lucia Berlin’s stories and all across brave literature.

I cannot believe that the writers who wrote these characters had not experienced and suffered from states of anxiety and mania close to what I have been dealing with currently. But then that is part of how I’ve always apologized to myself for my mental anguish—to say these are the states of mind that writers experience. To blame creativity. I was told this same story as a child with perfect boy-sized dress shirts. I would be fine. I was just creative. They were right, sort of. Sometimes, when things are spiraling, medication is the answer, or in this case, a change in medication is likely the problem.

As a young person I didn’t trust medication, and I didn’t trust society. Maybe I still don’t trust either. I think the medication industry is terribly flawed, that practitioners know next to nothing about the drugs, and that society makes people mentally ill by forcing competition, egotism, racism, sexism, and isolation. Still, what does one do with neurochemical imbalances like severe anxiety?

In dealing with anxiety and medication, I have reached out for writers and mentors, such as D.A. Powell, Lidia Yuknavitch, Gordon Lish, Susan Steinberg, even showing up at one of these writer’s doors (by invitation) one evening. These writers project a mythos of healing. Their work says to the world, “Yes, we go on in spite of the troubles and we heal. Our stories are stories of braveness and healing. We got this.” But I don’t got this! I’m trying to affect a calm tone. I’m losing my shit.

I want to do the same, to find and project sound bytes of wholeness through my work, to produce writing that is more healing than troubling, more healing than manic, more healing than wounded, more mature in general. But I am still writing through my crisis. I’m still writing toward a wholeness I don’t have. What I’m writing toward and from is a history of abuse, mental health challenges, privilege, grief, and mischief.

My first book was a narrative vortex of all the above in picaresque form, but now I feel something else. I feel a need to get very honest, to come down into my hurt self, and to write the truth of it—to heal toward someday writing work that has answers from having made it to the other side—that one could even base a Ted Talk on, that one can summarize in an elevator pitch. But right now I have to be honest. I’m in uncomfortable territory. And I hate most Ted Talks.

I am writing this on Sunday. Prince died a week before, or two weeks, or nine days ago. I looked it up. I am not being coy. I am having a hard time keeping things straight. I looked up when Prince left.

I went back on the full dose per doctor’s orders on Wednesday, April 27, three days before writing this—not enough time for my pharmaceutically manufactured anti-anxiety drug to kick in. It takes two to three weeks.

So to treat these panic wells I am having, these depths of panic, these floorless free falls into the wells of fear, I am to take Valium. I was going to take a Valium now as I write this.

Every time I take a pill I fret about whether I took the pill. Sometimes I take it in the mirror, telling myself, You are taking a Valium. You are now taking a Desipramine. Med changes are like this. Who was this bearded man in the mirror of a log cabin up in the Santa Cruz mountains?

I want to know how I got here. I need to think backwards, to excavate.

Saturday April 30

I woke up in a Marriott Hotel on the bay by San Francisco Airport, right across the street from the protest of the RNC—where Donald Trump (my brain was just saying Dick Cheney) was being protested and where protesters were trying to flip cop cars, cut Donald Trump’s path, where he had to flee into a ditch and escape along an alternate route. I woke up at the Marriott and caught an Uber to long-term parking, where I had left my truck on Friday evening, and then I drove to San Francisco.

When driving, I feared I should not be driving, feeling like I was going to be ripped out of the seat, pulled from the scene. Saturday morning, turning into Saturday afternoon, a perfect sunny spring day rolling into summer, the people and the beach and San Francisco were so beautiful, so truly manic. I was back, like I was in my twenties. Happy. Only this manic state was caused by med changes. And I loved the passersby and they loved me again, and we all did double takes off one another, flirted and talked and smiled, like we were seeing one another, for real, again, after so many years, and I could talk to people again and be one with them, only I was firing at too many RPMs.

Then the terrifying sea. At the ocean at Ocean Beach, I felt the waves were truly sublime, like an endless green foaming painting larger than the mind that could come after me, or a drowning. I feared constantly that I would leave myself and not be able to keep myself in reality. That I would die or go fully mad. I hugged the dunes, my body far across the sand from the sea.

These were only fears, pure anxiety, I would tell myself, practicing some hodgepodge Buddhist meditation shit of naming the sensation.

I’ve been on a low dose of Desipramine for nine years. It is a very mild drug. It’s not supposed to do much, but it did help me nine years ago when dealing with anxiety, after one day in a high-rise hotel room in New York City I feared I would someday throw myself out of a window—fear of fear and of self harm. The window didn’t even open. I’ve never harmed myself.

(Let’s Get Honest)

To be honest: Spinning in cycles of panic again, melting down, there is something else below the terror, or above—above it, really—that feels like elation. Like being under the influence of a drug coming on. Although, in this case, I do not want the drug to come on. Here it comes.

Right beside and inside you is engrossing elation, drama, mania, love, emotion for others, great intoxication with the fullness of life that days and months ago were not present—and panic, depression, confusion, failure. I newly understand why painters have cut their ears off, why people leave this world by suicide, why bodies are in mental institutions. (I’ve recently been on two dates with people who suffer with mental health—one with a YouTube vlogger with severe anxiety who has started taking Zoloft. The other with a woman who suffers alone through multiple issues. The date ended in the ER with her crying after being taken by a social worker into a hold for risk of self harm; I held her hand and stroked her arm and tried to assure her I understood and that things would get better. I would be there with her.) I newly feel more genderless, more distant from self, less in the rat race, less fixed to any self, and yet trapped by my circumstances and stories, all of them hopelessly crashing. Not liking any of my old selves or self-stories. Most days, on the usual dose of the drug, I don’t feel anything like any of this. This is too much feeling. This is elative and trapped and dangerous.

At night these days I sit at my desk not writing, feeling sad. I live in a 500-square-foot cabin in the Santa Cruz Mountains, surrounded by giant redwood trees. It is the land of birds, woodpeckers, grackles, robins, owls, doves, and jays; mountain lions, hawks, and deer. It’s like waking up outside Yosemite. It looks like it is for the leader of a Boy Scout troop. It feels good to be writing. It feels good to be there. Both feel far away from the breakdown. It is in relationship to others we know ourselves. Neither the page nor the wilderness tell me who I am while in this state of chemical flux. But they help me feel calm.

I was supposed to be in Texas at Southern Methodist University getting an honor for my writing—at a black-tie gala at the prestigious Presbyterian University in Dallas. Schmoozing. Posting a black-tie selfie to social media. Instead I was back home, sitting in this fear bath, wondering how much longer, how many more days this might last, and having no answers, knowing I was lost. I wished someone would come get me. Take me to a hospital. Sedate me.

There’s someone in my family who has had debilitating anxiety and depression. Another had a short time when she feared she couldn’t stop biting into her own tongue. This is a strong woman who raised five kids, codirected a terrifically and unusually successful company long before women were often in positions of power, survived the Depression with no father, sewed blue jeans to help her family support itself, and has a mind sharper, faster, and of greater wit than all but a fraction of a percent of people I’ve ever known. With medication, both of these matriarchs are fine.

When I went to one of my mentors for help this past week, she spoke of fears she had to conquer that medications would make her not as good as a writer. She seemed to have some inner turmoil about taking medication to help with her mental health. We all do, I think. She also mentioned that she seeks and practices alternative treatments and healing.

The truth is I feel more like myself now in this breakdown in some ways than I do in my usual routine of working, feeling frustrated, feeling unimportant, feeling sometimes marginally important, feeling un-alive to my urgent need for others and kindness. To human need. To my needs. Maybe what I’m saying is part of this unraveling is coming to terms with who I am, who I need to be, and how life isn’t working for me teaching, living the life of an academic alone in Silicon Valley. Maybe who I am is more sensitive than the role I’ve been playing.

Am I crashing because I’m not living right? Was the writer correct to be suspicious of the approach of just taking a drug? Usually I am feeling masculine, aggressive, or rather assertive, or, rather economically surviving in a world of hustle. Nose to the grindstone. Really, it isn’t that I feel so masculine but that I perform masculinity in the face of a masculine system of severity of hustle and numbness. Rush. Work. Game face. Apply for jobs. Lead the classroom. Deal with others. Write. Maybe it’s not masculine, but it is aggressive. A story I have been told is that being masculine and being aggressive are similar—at present I want none of it.

So much of it is living without a healed self, without a celebrated empowered identity or persona as an author or person sharing how they healed. I agonize that I am not a packageable brand of salvation I can sell, a story line of resurrection and overcoming of challenges. A Ted Talk. No, I’m still trying to crystalize meaning. I’m still wild. I’m still healing this sometimes hard-to-handle self. And so are the authors I’ve mentioned, many of them, and yet they have their story sorted. I don’t need that to be resolved today. I need my medication to straighten out. But in this state, everything swirls together into madness.

I guess what I mean about the hustle, about how I feel in this familiar-feeling terrain of breaking down, is I’m feeling less “masculine” and feeling less numb and I feel special. I mean I feel differently abled, or just different, and by that I mean not cut out for the hustle. Outside of the world. Many of us don’t feel cut out for this hustle. This world is hard to handle and asks us to be bulletproof. Right now I’m not. I can’t have a conversation. We aren’t bulletproof and this society is in chaos. Mental health and mental illness are key issues now more than ever.

Sitting here is right now, and right now is right now, and every moment the curtain between all the different times of my life and versions of myself is as thin as a piece of blank white paper; I could rend it down the middle and be in those other times. Like I’m going to fall out of time. Like I’m going to stop existing or stop knowing the difference between the times I am in and have been in. Take the Valium. Be fine. Tell yourself, You are taking a Valium. It’s a fine balance and I’m only a small dose from fine.

These feelings I am having are debilitating, strange, cruel—pregnant with feels and meaning and possibly entirely neurochemical. Over these past four days every moment feels like a minute, and every few minutes feels like an hour, and every few hours (which I dare not count) feel like a day, and each day feels like a year. I’m in meds withdrawal, I tell myself.

The doctors aren’t sure. They say withdrawal would end after the drug was taken back into the system. Though it takes time for the drug to build up to the sufficient levels where it is working properly. Wait. Wait. Wait. That’s the instruction. Wait. They think things but don’t know. This is not a perfect science. This is far from science.

Friday April 29

I woke up at 4 p.m. for a 6:50 flight. I was at my Boy Scout cabin. The commute was two hours with traffic. I checked in online. I went to the airport. I parked. I got on the airport bus.

By that point I was having a rapid panic. Ground-shaking, ground-leaving panic. Should I get on the plane or shouldn’t I? I get anxious when I fly in the best of times. I don’t remember what I was thinking, just that I was terrified; it was happening again. Mini-muffin breakdown number three. That there was too much stimuli. That my brain cells smelled like something was being deep fried. That I couldn’t stand the smells, the thinking, the people, and the long-term parking bus driver not telling me where to go like I had asked him to. That I was feeling (I just took a second 2.5mg of Valium) something akin to all synapses firing at once, all my nerves fried, every smell too intense, panic and elation firing, more panic, almost all panic, and that I couldn’t get myself to come down. Depersonalization was occurring. I didn’t feel like myself. Also, I didn’t feel like I could manipulate or work reality. Yet reality felt more real, truer perhaps. I wasn’t me and this wasn’t the airport. I was in a bubble.

In this bubble, I couldn’t match my insides with my outside environment; I was texting my doctor (my grandparents are well-to-do; they pay for a boutique doctor for me) things I felt I should not have been texting, things that said SOS, things that said 911, things I feared could land me in the place that I have managed to avoid even when I spent almost a year in the fetal position every night, every hour of every day in a time that wouldn’t move forward the way time should move, in a place psychologically and perceptually where people were sort of terrifying.

In the years after the breakdown I entered and graduated from an MFA program, while teaching classes and writing and being at the top of my class and scoring almost 5/5 on all my student-teacher evaluations, until I was close enough to whole to fall in love, to study with Gordon Lish and become friends with him, to co-edit a top independent literary journal, to write my first novel and have it win a major award, and to land a tenure-track job. These were sources of pride; with these events and stepping stones (sounds like a rehab) I felt I was on a track to success (now seem like nothing). Even with rampant anxiety and other mental health challenges.

This year I have had to choose between staying in that tenure-track position and leaving. I have been working hard on a new book that is bending my mind. I have been lonelier than ever before in my Boy Scout cabin. I’ve been wrestling with the success of people in Silicon Valley, and still searching for my place.

Part of the magic help, the salvation of that time, a small part of surviving those years between the breakdown and now, was this drug made by the generic pharmaceutical giant Sandoz: Desipramine. It’s a tricyclic drug for anxiety and depression. This was what I currently didn’t have enough of built up in my system.

The airport bus had passed my terminal without my understanding and was two terminals further on its track. The driver was speaking to me, pulled over, saying, “What do you want to do, buddy?”

It took me some time to realize he was speaking to me. I didn’t feel like anybody’s buddy. I couldn’t recall where I was. I mean I knew I was in SFO, but really I was in that bubble.

“Take me back to my truck, please. Long-term parking.” I sounded panicked, childlike, helpless but needing help. Non-gendered. Pure. Afraid. Human.

“Are you sure,” he said. He was telling me something about a tram I could take. Apparently it’s a big faux pas to go to the airport and not get off the airport bus.

“No. No. Long-term. To my truck.” It was so ridiculous. Time didn’t move. I said it this time with surety, though, and a hint of something like aggression. Not aggression, but you know, compunction or composure. Was I in control of all or any of this? I had to speak with authority, which felt like what I didn’t want. I did not want to be like people who knew what they were doing. Functioning while I was out of control. How many people do we see like this every day without seeing them?

By the time I got back to the long-term parking lot of SFO Friday evening, looking at the giant red letters for united airlines on the building across South Airport Boulevard, having not taken the flight, I couldn’t find my truck; I couldn’t find the stop where I had gotten on the bus, where I had gotten off the bus, and it was like someone was turning the world beneath me like a top and rearranging everything. I was panicking. My mouth was so dry. I felt like I was deep in a psychedelic trip, or like what happens when someone ingests cannabis and isn’t used to it and maybe isn’t right in the head and the world fragments, breaks into second-by-second frames, and won’t make any sense. Like the splintering of an entire tree trunk.

I am a sober person who doesn’t do illegal drugs or drink. I could write a whole other essay on the debate in recovery around using drugs like Valium and pharmaceutical medications, but I won’t. This feeling, of panic, of being on the edge of losing it, of not being able to tolerate the intensity, is somehow the state where I can feel just how incredible life is, how real, how intense and desperate and connected we all are. Manic: I think I maybe have been chasing this feeling. It’s like the reason people took psychedelics, smoked cannabis, or at least the reason people did it the first time. To fell down that mighty tree or edifice of normalcy and to experience the mystery of muchness. Sensation! But now I don’t want that. Too late.

I called my mother from the long-term lot. She was going to call 911. Oh no! I heard myself cry out that I didn’t want to go to the mental institution. I didn’t quite believe myself. I heard my voice again, more like a whimper, saying something. Then I found my truck, after ten minutes maybe of this call, or less, I don’t know, this silly drama, this strange feeling of being high above myself watching myself, like as a kid, like in school, like roaming the slick halls. It was not feigned. This wasn’t pretend theater. But it felt like it was. I was watching myself from above. In the end, having found my truck, which meant everything, somehow, I took an Uber to the hotel where I’d rented a room: a thirty-five-year-old man who has written novels and stories where he plays bold and free-spirited, intrepid. Again I think about privilege, about the people just like me locked out of the world of privilege. I had a $12 burger. I went to my room. I was on my Valium. I felt better. I realized I didn’t have my medication, the Desipramine, which I had packed, I had triple-checked the label while packing, and which I had been cutting in half for a month, under the care of the new psychiatrist, and now was back on the full dose for the first days back on whole pills; I didn’t have it. I needed it!

I panicked. I called an Uber, or rather used the app and the driver took me to my log cabin and we got my meds at 1:30 a.m. and then we drove back to the hotel. My truck was still at SFO. It was a hundred-dollar pill. I loved my Uber driver. We listened to Hawaiian music and Top 40. He was Filipino. The night swirled and there was a glittering edge of fear to everything. We had a great time. Chewed gum. Talked. We both were privileged compared to the ill that have no access to care.

Wednesday, April 27

It was in a psychiatrist session when I had the first of the mini-breakdowns. It didn’t feel mini. It felt like my entire being was being spun around. I had begun working with this man because I wanted to get off the med, which makes people tired, and I had been having fatigue. I was in a session with him and every story of my life was crashing into every other story. I don’t know how else to tell it. All the stories I lived on and used to operate were crashing. My brain was so fast. I had been becoming increasingly negative over the month while cutting my dosage in half, but didn’t think of the correlation. It never occurred to me.

Mental health is funny like that. You might say, how ludicrous, how foolish, but mental health is like the proverbial frog in the boiling water. The frog could jump out of the water from the pot any time before the water reaches a certain temperature, but it’s so gradual, the heating up, you forget to jump. Then it’s too late.

My shrink is an old man, very tall, large, wears totems and trinkets. His entire toilette sits out behind him on the counter behind him. His office I’m sure doubles as sleeping quarters when he is in Los Altos, where he commutes for one day of work per week from Grass Valley, a hippie cannabis-growing alternative community.

He didn’t seem interested in my crashing. He gave me a prescription to add to the stack: Neurontin. He told me I might want to decide to get back on my medication at full strength. (It was left up to me!) Every doctor and shrink I have talked to since say it is insane to cut Desipramine in half as a starting point to weaning off the drug. Not insane—dangerous. Extremely dangerous. I smelled burning plastic that wasn’t there. I wept. I felt panic. Every day lasted and lasted for what felt like weeks.

Epilogue

It’s been months since I wrote this diary and I’m back to health. The trip is over. Maybe 10% of the anxiety remains. Just like that! The drug slowly brings the world back to focus.

Actually, I won’t say the trip is over. It’s better. Life. I have a lot of sorting out to do. Always. I will find my way by might, by star, by day, by drug, by hype, by strength. I won’t go on without medication if I need it. And I will try to celebrate the strange way I experience the world. It may be scary at times, feel surreal at times, but it is beautiful, and it needs to be given language and allowed to speak in the world.

This is an essay about going through an anti-anxiety and anti-depressant medication withdrawal. It is a guidebook for going through neurochemical changes in a world where drug companies make drugs that practitioners don’t really understand how to wean patients from taking. It’s about the twin-headed hydra: needing meds genetically and needing meds because I was on meds. About the severity of withdrawal.

I fear being judged for writing about this. People have told me I should worry about being hirable, after sharing this essay. But I wonder about others who are done similar disservices, the ones who have no good care. No support networks. No history of overcoming mental health scares. This essay is for them. A student of mine came to me at the end of the semester and asked me about the aliens watching him as he writes, the voices that are listening to his writing. I talked to him about seeing a psychiatrist. I think of the ones who may die if they feel there is no relief to come. And the ones who could become violent.

I tell myself there is relief. I tell myself I have a right to myself and my mind and my heart. I tell myself, and you, I am working it out in writing.