WillSpirit!

Apologies to the many talented, ethical psychotherapists in the world. My last post demonstrated my bitterness about some bad experiences I’ve had with counselors, but I painted with too broad a brush. I do think clients need to use caution in choosing a therapist. And they should always make their own decisions without feeling pressured by any professional. That said, there have been times when going to see a therapist has helped me weather rough periods better than I would have alone. Many of us missed out on large families and large circles of friends. We are often isolated, and a therapist can be a beacon in the midst of loneliness.

On the other hand, I believe starting medication for my mood issues was a mistake. I would never have begun psychiatric drugs if without unshakable faith in my therapist at the time. Yet my life now seems to revolve around pills. I take six different medications for various aspects of my mental health. A year ago I was on seven. Currently I am in a pitched battle aimed at trying to reduce my medication load. The war is not going well.

Case in point: I have been on SSRIs (selective serotonin reuptake inhibitors) for almost fifteen years. Currently I take duloxetine (Cymbalta) which increases synaptic norepinephrine in addition to serotonin. I have been working hard to reduce my dose of this drug. A year ago I took 120 mg each day. About six weeks ago I took my latest step down, and limited myself to 20 mg per day.

It has been a rough six weeks. I find myself saying things like, “if someone told me I only had five minutes to live, I’d be upset: I wouldn’t be able to say goodbye to my wife and dogs. But if they gave me an hour, I’d be fine with it.” Or words to that effect. Not a very positive outlook, is it? For the most part, I haven’t been bothered by the melancholy, since one of my projects this year has been to learn to tolerate adverse moods more. After six weeks of feeling like life is nothing but a chore, however, I broke down and went back up to 40 mg. I just got tired of the dreariness, and it did not seem to be going away. So today I increased the dose. No doubt my mood will improve, but I hate to retreat in this way. I feel trapped by my body’s habituation (addiction?) to these medications.

My psychiatrist says she could switch me to fluoxetine (Prozac); it has a longer half-life and comes in smaller dosage forms. So it would make for an easier taper. The problem is, I’d be left anorgasmic. Ever since I started SSRIs my sexual sensations have been diminished. Cymbalta at least wears off quickly, so I can stop it 48 hours before sex and things feel mostly normal. If I go back to Prozac, I won’t have that option. So I hesitate to travel that route. I don’t want to give up something that brings me joy, at least not when I my life already feels so ‘blah’.

Like I said, a well-meaning therapist convinced me to start psychiatric medications back in 1995, after I had spent the previous 20 years refusing them on the grounds that they had not helped my mother. (She died in a mental hospital in 1964, after years of psychiatric medication and shock therapy.) Since I had benefitted a lot from this therapist’s help, I took her advice. I did well on Prozac (and lithium) for several months, but then became depressed again. So the dosage was increased. Later, more drugs were added. Then yet more again to deal with side effects. That has been the story of my life ever since: transient improvement, followed by increased need for drugs. It is hard not to conclude I’d be better off without any of it. Not to mention that I’d have a more normal sex life.

So even though I extend apologies to all the hard-working therapists out there, I still end on the same note as last time: I wish I had exercised more caution, kept my own counsel, and pursued less therapy.