Monday, February 06, 2006

the problem of the medicine cabinet

Bouts of mania are one of the many side effects of Paxil use. Cocaine-like in its amoral euphoria, Paxil mania will convince you, wisely or otherwise, of your limitless capabilities and complete insulation from harm. One of these waves hit me in the middle of a long meeting in October 2001, when the warm sunlight slanting in through the window produced in me the sensation that I was utterly invincible. I decided that I no longer needed antidepressants to function, and quit that day.

What followed was weeks of emotional and physical hell, as my body's nervous system tore itself inside-out in a desperate search for serotonin. Conversations turned into shouting matches, small irritations enraged me beyond reason. My emotions ceased making sense. My libido collapsed and inflated at random, like a balloon stretched over a faulty air nozzle.

Worse were the physical symptoms. My muscles were constantly contracting, and when I tried to relax they would fill up with an urge to kick, twitch and stretch. My wife lost sleep from my pedaling legs scrambling the sheets all night. Even now, four and a half years later, a tingling from calf to kneecap still compels my legs to push out whenever I lay down. Doctors call it akathisia. It nearly drove me to a mental state far worse than the numb depression that prompted my Paxil regimen in the first place. *

Forgive me. I'm just trying to explain how I'm not as tough as Zach Braff.

In his debut movie Garden State, Braff plays Andrew Largeman, a struggling actor in his mid-twenties who's been sedated with a cocktail of antidepressants and anti-seizure meds since the age of ten. That's a solid fifteen years of habituated stupor. At the beginning of the film he finds out that his mother's dead and hops a plane from Los Angeles to Newark, putting an entire continent between himself and his orderly but overfull medicine cabinet. And you know what happens? He undergoes a spiritual, emotional and sexual reawakening that reconnects him to his own life. He gets agency. He even gets Natalie Portman in the end, which makes you wonder if the whole film weren't conceived by Braff as a massive and artistically satisfying attempt to make out with her.

How long does it take Andrew Largeman to shake the effects of the drugs and start shaking it with Natalie Portman? Four days. That's all it takes, I guess. A few headaches and you're alive again! Ready to explore life to the fullest! Or if you're Largeman, ready to assume a weird pinched expression and lecture friends and family on what's really important in life.

I honestly don't know why I'm writing about this. I liked Garden State, despite the contrived premise and the creepiness of having a mother's funeral as the spur to emotional and sexual adulthood. I also liked the film despite the last thirty minutes, which appeared to be hemorrhaging script and production problems that a more experienced director might have been able to solve with greater fluency.** It's the drugs that I can't leave alone.

There's a shot early in the movie that we're supposed to put great store behind as a key, one of many, to Largeman's character: a static shot of the character's face, centered neatly in the frame and bisected by the mirrored doors of a medicine cabinet. The image lingers just long enough to let you know that it's saying Something Important, then the cabinet doors are opened to reveal the antiseptic rows of pill bottles, one after the other, set there so carefully against such a pristine white background that you think you're watching THX 1138. First you think, Wow, this guy takes a lot of meds. But if you're not quite under the spell of the film, then you think: Wait a sec, this guy must not be taking his meds because there are so many in the cabinet. Then you think: But what this mini-pharmacy intends to tell us is that he takes lots of meds. Why this orderly orgy of pills?***

Three or four bottles of pills next to a cup with a toothbrush and a razor would have convinced me. One of those weekly prescription dispensers on the sink would have convinced me. But there was no toothbrush or razor to be seen, despite the fact that Andrew Largeman has a full set of teeth set in a cleanshaven face. Something about this omission bothered me at first, but I forgot about it as the clever jokes and the great soundtrack rolled on.

In the last scenes of the film, when the tone changes from deadpan comedy to inspirational tract, the problem of the medicine cabinet came back to me. Hey, I thought, wasn't this guy on massive amounts of meds only days before? Shouldn't he be curled in the fetal position right now, crying and convulsing and kicking his legs repeatedly into the dirt? The charitable view is that the drugs served as a bridge to get the thematic soldiers over to the other bank. I'd say they served as a sofa for some lazy-ass thematic soldiers to snooze on. It was the cinematic equivalent of a plea for more corn chips and another pillow.

When I was younger, I used to hanker for the kind of mental instability that could set me apart and insulate me from the rest of the world. I wanted to escape, and an organic brain disorder seemed like just the thing. And I wanted the zombifying effect of heavy brain drugs (these were the days before SSRIs) to quiet my mind and carry me off from all responsibility. I wrote stories involving young men with high IQs, quirky obsessions, mental problems and apartments even crappier than the one I lived in. One setpiece of exposition involved a medicine cabinet overstuffed with meds. It was intended to be funny and somehow deadly serious at the same time. I thought I had hit a vein of tragicomedy. I had pricked instead an abundant artery of bathos.

Years later, when I was diagnosed with dysthymic disorder - a ready-made excuse to sell meds if ever one existed - I went on a course of Paxil. After a while I realized that the drug was not performing as advertised. Instead of increasing my sense of well-being, Paxil replaced it with a clench-jawed vivacity. I didn't like it, but the drug neatly cauterized my anxieties. Unless I missed a dose, I never had to worry about its effects on my personality.

What I wanted most from the drug was forgiveness for past failures, for everything that I had not accomplished thus far. I thought that absolution would launder my soul and make it more palatable. Like sheets that invite untroubled sleep by their cleanliness, so would my fresh new consciousness allow me to act without the instinctive tug of conscience.

This was a lot to hope from a hastily-marketed brain drug. At some point I realized that it had done nothing much more than smooth out my temper and prevent me from feeling bad about anything - which isn't nearly as nice as it sounds. Worst of all, it blocked out feelings of disgust and boredom, which are invaluable weapons in the fight for the good life. After I went off my meds I knew that I would never write another story about a young man popping antidepressants or antipsychotics. Illegal drugs make great metaphors. Legal drugs are just depressing.

*Doctors caution people against cold-turkey withdrawal from antidepressants, but I've seen people go through the same symptoms when they wean themselves slowly off the drugs. Besides, by that point I had no reason to trust my doctor, who had prescribed drugs for me within ten minutes of my first appointment and moved to another city without notifying me.

**Producing a show has left me with an overly keen sensitivity to failure and wastage in movies. Sometimes I'll sit in a theatre and picture the unused ribbons of film trailing into oblivion.

***In order to make sure that I wasn't just making this shit up, I phoned Schmutzie to verify that I'd really seen a medicine cabinet full of pill bottles. She concurred and then went on to describe all the bottles of slightly irregular dimensions in the shot and where they were placed. It's nice to have extra memories when you need one.


schmutzie said...

Any time, dear, any time. And I kind of like your restless legs.

blackbird said...

Yet more evidence to support my decision to NOT put Oldest on Paxil.

Re **
K cannot watch without being sensitive to aspect ratio problems.

palinode said...

Paxil also makes you put on weight. Doctors will tell you otherwise, that it's a rare side effect, but a pharmacist I know told me that it's called "the fat drug" by her peers.

ZaZa said...

My mom was on Paxil for a few months - completely deranged. It does really bad things to older people. She was in the hospital in Vallejo, CA, with a broken hip and thought she was on a tour of Paris! It completely wiped her short term memory, too, and exacerbated her mild dementia. I don't know if I've ever heard anyone have a good Paxil story.

Oh, she went from 225 down to about 140 in about six months because she was too wacked out from the Paxil to remember to eat. So, if the side effects are bad enough, you don't have to worry about gaining weight. Great med.

mathew said...

i was on paxil a few years ago and i too quit cold turkey. my reason for quitting wasn't that i felt i no longer needed the drug, or that it wasn't working, rather that i couldn't afford to take it.

i had no withdrawl symptoms, though the depression of course came back (and is still in place, some 3-4 years later). that dysthymia sounds like me, but i've been depressed since before puberty so who's to say? maybe that's just who i am.

(and i lost weight on paxil, but immediately, and steadily, put it back on. you'd think i was paid to say these things - i wish it were so, then i might be able to afford meds.)

Anonymous Midwest Girl said...

What I wanted most from the drug was forgiveness for past failures, for everything that I had not accomplished thus far. I thought that absolution would launder my soul and make it more palatable. Like sheets that invite untroubled sleep by their cleanliness, so would my fresh new consciousness allow me to act without the instinctive tug of conscience.

This is really just too beautiful, too poetic, too well-said, too honest to let it go without letting you know that. Amazing.

Deron said...

Interestingly, I was fine on Paxil, though it seemed to take away all my creativity. I too stopped cold turkey one day, mostly because I felt it was no longer necessary, but partly because I was no longer interested in taking it. I had no side effects. Since then I've also stopped taking Fluoxatine cold turkey (twice), and again had no ill effects.

It's interesting that you mention the restless leg: my leg became increasingly restless as the drugs began to have their strongest effects on me, but then returned to normal as things normalized. Only my left leg, too. Apparently I'd done something to piss it off at some point in the past, and it felt that was the opportune time to effect an escape. Poor thing never did get very far.

roo said...

Dammit, now I know how "Garden State" ends. I never would have guessed Zach Braff got the girl.

My sister has been relentless in her desire to see me put on antidepressants-- she really has faith in the magic pill. I've always had reservations, but hearing your account of your experiences with Paxil confirms them.

Nora said...

A good friend of mine tried to kill herself while coming off Paxil. apparently it's a "known side effect." Luckily she's fine.

My live-in-man-friend-who-is-not-my husband has the restless legs too. Which led to the following not-uite-up-to Palinode&Schmutzie conversation:

LIMFWINMH: Time to wake up! Coffee coffee!

Me: mmph. Your reckless legs kep me up all night

LIMFWINMH: reckless legs?

Me: (giggling) they was runnin' all over town.

Belinda said...

Well, I'm glad somebody said it. All I've heard is praise for this movie, and it pissed me off for many of the very reasons you cite.

My husband has bipolar disorder (which, given the meds Braff's character is taking in the film, one would assume he had or was suspected of having by the nutso father), and works hard, and successfully, at maintaining stability through medication and insight into his moods.

Just about every mood stabilizer is an anti-seizure medication (even lithium), and there are some of them which, if you stopped taking them abruptly, you'd have seizures.

Oh, all right, I'm done, that movie just drove me nuts. Thanks for giving me a space to foam at the mouth like a rabid dog.

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