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Lexapro, Xanax, Anxiety or A Good Therapist

Posted Feb 20 2012 12:00am
Escitalopram 10mg Tablets (Lexapro brand)

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I resisted mightily, having never taken anything but an antibiotic before in my life, but he reasoned that, since America invested so much money developing these drugs, we should take advantage of them. Fine, I said, terrified by the fact that he might die.

 

Five years later, he did. We were still both on the antidepressants, and after he died, in my grief I went back to Dr. Carl Hammerschlag, a psychiatrist I knew well, and he changed me from Zoloft to , a newer med with fewer side effects and better anxiety control. I should say here that Carl is a  healer in the Native  American tradition and a Yale-trained physician, not a thoughtless drug- dispenser.  He knows me, and he’s nobody’s fool. He knows what I can do to myself. He has seen me through three businesses and two husbands.

 

As an entrepreneur, depression was never my problem, but anxiety always affected my life. I had so much responsibility: for clients, for employees, for children, foster children, dogs, houses. How was I ever going to do it all? Every once in a while, my anxiety manifested as some physical symptom– hyperventilation, acid reflux that would send me off for a battery of tests,  and I’d be reassured and then feel fine! That’s called  ”generalized anxiety disorder.” it is common in women, and I think it was called hysteria in the Victorian era. Carl, the shrink, walked me through it all, lighting sage as I walked into his office and treating me with a sense of irony as well as his monumental clinical experience.  I was the of Phoenix. And then I “got well” and stopped seeing him.

Fast forward fifteen years.  I have learned a lot about putting chemicals into my body, and no longer eat processed food at all.  I feel very healthy. So I decide to go off the SSRI ( the reuptake inhibitor) Lexapro because I am a happy optimistic person and clearly I don’t  need it.

Sure.

Having read a lot about these drugs in the intervening years, I first go to a clinical nutritionist who is also a pharmacist, and get a bunch of specially blended enzymes and vitamins. Then I carefully titrate off the drugs, feeling fine all the way. Ahhh, I have done it. A daughter warns me not to go off them, but I don’t listen.

Two months later, I awake in the middle of the night wondering if I am dying,  heart pounding and stomach churning.  I calm myself down, but can’t go back to sleep, and for the next week, I wake up three hours after going to sleep and lay awake all night. I wind up tighter and tighter, secretly thinking I am dying, and running off to the doctor for tests. My digestion speeds up inappropriately.

Although I have normal tests,  I am not normal in my head. I think my life is over, no one wants me, I will starve, and on and on. The anxious mind plays terrible tricks. But I have studied enough mindful meditation and yoga to observe myself even while all this is happening. I  know I am freaking out, losing my equilibrium, so I reach out: to friends, to my yoga community, to nightly podcasts on Zen.  I refuse to go to the emergency room, because I know all these physical symptoms ( the racing pulse, the queasiness, the sleeplessness) are part of me by now. But I want relief. I feel like I am dying. Or maybe I’d rather be dying.

So I go back to my old friend Carl. “yeah,” he says,” you never come here until you are three sheets to the wind.”  I tell my story of going off the Lexapro, and we discuss whether, indeed, these drugs destroy the body’s ability to produce its own Seratonin over time, and thus produce something like insulin dependence.  The patients all write about this on online message boards, but there have been no clinical trials that I can find. And seratonin is made in the gut, so it’s presence or absence affects the digestion.

Carl doesn’t care about clinical trials. He wants to help. He prescribes Lexapro again, but the first week I am on it, I am still very anxious. When I come back the next week, he adds .

Not a fan of Xanax, I lead him into a long discussion about whether it’s a good idea to be on those benzos, because I know they are addicting. He tells me I never will be addicted, so I accept a very small dose and enjoy the first week of uninterrupted sleep in a month.

But just as I am feeling like myself again, I see on Twitter that Whitney Houston has died. And later, I find out she took Xanax.

That’s enough for me; I opt for insomnia and titrate (the magic word), off the Xanax.

The Lexapro has kicked in, and I feel like “myself” again. But I haven’t forgotten why I went on and off , and how I felt. So I  am appealing  for clinical trials or longitudinal studies about the long term effects of these drugs and whether, indeed, they actually do shut down the body’s ability to make its own seratonin, or if I never was able to make it or use it correctly in the first place.

A recent 60 Minutes episode insisted that anti-depressants have no more effect than placebos. Dr. Irving Kirsch, the researcher on the segment, concluded that it’s not the chemicals in the anti-depressants that make people better, but the placebo effect. For the vast majority of people, Kirsch says, the chemicals in the drugs do not make any difference.

Kirsch also said that the therapist who prescribes the pills contributes to the placebo. Mine certainly did, because the first one was my husband, the second a psychiatrist I really trust. The segment even questioned whether depression has anything to do with seratonin levels in the blood.!  It is about time we studied these heavily prescribed drugs, especially in this era when they’re routinely given to kids and to people on the advice of a  primary care doctor untrained in psychiatry. I’ll be the first volunteer.

 

 

 

 

 

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