Coping Outside the Box

Antidepressants Don't Kill The Pain, but They Can Be a Huge Relief

Everyone has a moment in time that divides his or her life into "before" and "after." For me that moment was 10 years ago, when I was 34. I had just left New York and moved to Washington -- trading my soul-deadening career and size-0 studio apartment for a 9-to-5 job and a big one-bedroom overlooking Rock Creek Park and the zoo, trading my no-life life for an actual life, not to put too fine a point on it, and feeling really good about it -- when depression struck. Again. The way it had repeatedly since second grade.

It was then that I finally realized that I would never be able to outrun myself; wherever I went, wherever I moved, however stealthily I tried to sneak away, I would always bring myself with me. And at the thought of that -- at the thought of a life sentence with chronic clinical depression as my cellmate and no chance of parole -- I finally knew the jig was up.

Uncle, I cried at long last. Give me the meds.

Describing what depression feels like is a little like trying to describe what chocolate tastes like or what classical music sounds like or what red looks like. But for me, being depressed was like being inside a sealed glass box right in the middle of a big huge party: I could see out and people could see in, but that's about as far as it went.

For most of my life I knew what I was missing out on -- everything -- and even though much of the time I was too depressed to care, every once in a while my heart would leap like a normal person's and I would grasp, in the flash of an instant, that my life was passing me by. Those times my spirit would float up to the ceiling and look down at myself pushing against the glass walls of my box like a frantic mime. But, like every other trapped mime in the history of the world, I could never find my way out.

Caving in after a lifetime of refusing to "take the easy way out" was difficult. I had always been against medication in the treatment of depression -- for myself, not for others. My father had been depressed most of my life, and the Valium he'd taken during my childhood only seemed to make things worse. Even though I knew as an adult that it was stupid to prescribe a depressant to a depressive and that the newer generation of antidepressant drugs was much more effective, giving in to them still seemed somehow like cheating.

After I'd gotten past the initial wave of feeling like a failure -- a failure at traditional psychotherapy, a failure at coping, a failure at life (take your pick!) -- I had other concerns. This was the mid-1990s, and every other week a big article or a big book about antidepressants appeared, reporting on the various side effects of psycho-pharmaceuticals. Given my luck -- which is to say, given my propensity for bad luck, like being born with a ridiculously disproportionate amount of negativity -- I assumed that I would get none of the drugs' positive effects and all of their bad side effects. But even if they just worked a little, maybe the frantic mime inside me would stop pounding pathetically on the glass and start feeling around for an exit door.

Once I'd started taking the drugs, the mime inside me did more than that: It not only found the door and opened it -- it also ditched the white face and black jazz shoes on the way out. Within days, a lifetime of television-screen static and indecision and muteness lifted and was replaced by a focused clarity. Within weeks a new mental energy and ability to concentrate for long periods appeared. Before I knew it, I was able to whip through a week's to-do list in a single morning, make decisions without agonizing analysis-paralysis, and project myself into the future. My sock drawer and closets were organized, and my big black bag weighed half as much, now that several pounds of ATM receipts, shoes and loose tobacco had been removed. And I even finished rewriting the novel I'd been working on for five years.

And that was only after the first three refills.

Like any relationship, my partnership with medication these past 10 years has had its ups and downs. I've tried a few drugs that worked and a few drugs that didn't; I've gone off them a few times and suffered such severe withdrawal symptoms I feel I have some understanding of heroin addiction; and I've gone back on them every time because for me there is no question that I am happier -- or less unhappy, depending on whether I'm in a half-full or half-empty kind of mood -- when I am on medication.

And despite the life-altering effect they've had on me, I accept that antidepressants can go only so far: I still hate going to parties, I still feel fat most of my waking hours, and I still worry that one day the sadness will come back and I won't be able to get out of bed. Just like going through childbirth with an epidural or dental surgery with a local anesthetic, there is still plenty of pain left over even with the drugs.

Which is a good thing. I still like to go back and visit my glass box once in a while, to remember what it used to be like.

Or maybe that's just the medication talking. ·

Laura Zigman is the author of "Animal Husbandry" and "Piece of Work." Comments:health@washpost.com.