From 1995 to 2005 I was on Paxil, a medication that, ostensibly, was to help me in the areas of depression and obsessive compulsive thinking. As I look back on the role that this medication has played in my life for the last 10 years I begin to wonder. Was my dependency on this drug physiological, psychosomatic, or both? I was prescribed Paxil, an SSRI or Selective Serotonin Re-uptake Inhibitor, but with my physical reactions and the growing concern aired in the professional journals and periodicals, questions began to pester me. What was this drug really doing in my system?

Over the last several months of being off Paxil I have spent much time analyzing and piecing together a timeline of events, and my associated mental/emotional states, to try to answer that very question. The more I pieced together, the more I had to broaden what I meant by my original question. The issue became: What role did Paxil play in the roller coaster that my life had become, and was it beneficial or not? The following attempts to lay out, through the clarity of hindsight, the role that the drug has played in my recent life.

In 1995, while on probation in the state of Oregon, I was offered the opportunity to take part in a study sponsored by Oregon Health Sciences University (OHSU) and Washington County Community Corrections. The study was to test the effectiveness of the antidepressant medication Paxil on criminals such as myself. I don’t recall the specifics of the study, but the bottom line was an attempt at reducing recidivism and re-offense among specifically targeted criminals. I was a shoe-in and so began a daily Paxil regimen, weekly mood analysis, and periodic blood tests for the whole of 6 months.

To shed light on my cloudy mental state at the beginning of the study, a bit of further background is germane at this point. I was 24 years old at the beginning of the study. I had begun cutting myself as a teenager. My adolescent rebellion was against the unwanted emotions that a broken home, a dead father, and “abominable” sexual thoughts about other boys my age, brought up in me. The depression and confusion drove me into despondency; the only escape that I found was with a knife.

The pain woke me out of numb despair, but it was the blood; hot and dark, that I needed to silence the compulsion. The chittering voice in my mind, that would wake when I touched the knife to my skin, would go blessedly silent as the redness flowed. It was the messy, but mesmerizing, side effect of the escape that I longed for. In the private moments of despair and numbness I’d seek to feel again. To stop the constant shaming voices I’d use the knives to open myself, and drown out the self-hatred. I could only seem to shock myself out of the black moods by cutting, burning, or scraping. Nothing else seemed to give me the relief I needed. Nothing else silenced the damning thoughts I knew I shouldn’t have.

My self-mutilation continued until the age of 18 when I was convicted of my first felony. That conviction pulled wide the curtain that was hiding a much larger problem, my criminal acting out. Issues of depression and sexual identity scurried, like roaches, for the darkness when criminal proceedings shone upon me. College and community probation followed, with years of intensive in- and out-patient therapy meant to address my criminal thoughts and actions.

I never completed college, but therapy gave me the tools to battle my addiction and acting out. The depression, never directly addressed, continued to build like a pressure cooker without a release valve. Behavioral interventions and stop gap thinking provided me with the tools to maintain my daily life, but the issues of profound despair and deep-seated fear festered within, coming to the forefront in the final year of my 6-year probation. Black moods and a return of invasive and disturbing images accompanied thoughts of self-harm. This resurgence became a concern not only for my family but also for my probation officer. He advocated for my involvement in the OHSU study the community corrections department was already involved in. Based on my conversations with him we decided that I would be an excellent candidate. My addictive and criminal behaviors were being held in check by behavioral controls but the underlying issues had begun to erode the bulwark I’d constructed. The study seemed to be a chance to find relief.

Within weeks of beginning the daily Paxil regimen I was noticeably less gloomy and despondent. My family commented that the overall effect on my personality was that of a beacon illuminating a once murky room. My social interactions began to be more rewarding and effortless where once I only wanted solitude and distance. People saw a new me and were delighted. The changes were widely attributed to the drug and at the end of the 6-month study I eagerly continued taking the Paxil on my own. I did not want to return to the torment and despair that had gripped me for years. I was a convert and regularly sang the praises of SSRIs to those who knew of my past, but within a year, other unanticipated problems began to arise.

It would seem my body developed a dependency, a need for the chemicals in the formula. Was I addicted to this drug? All the signs of substance abuse seemed to be present. How else would severe withdrawal reactions be explained every time I forgot to take my pills? These reactions included nausea, light-headedness, and a strobe-like effect on my optical nerve so severe that I felt like I was trapped in a Kmart suffering the onslaught of 40,000 poorly balanced fluorescent bulbs. The reminders, as I came to refer to them, would grow in strength and duration beginning within 36 hours of having taken my last dose. At the faintest nudge of the first reminder I would be making plans to get my hands on my next fix. The days between prescription refills or doctor visits were spent in a constant state of nausea and light-headed misery. My medical insurance, once I got some, did not cover the cost of medications. That became a sore point, and as a remedy I began to take smaller doses, splitting pills, and skipping days to make my supply last longer.

One of the other reasons I began to limit my doses was the forewarned side effect of sexual dysfunction. At the time of the study it was not an issue, I had no significant other to be let down by my less than stellar performance. (Not that I was a Casanova to begin with.) As a relationship did blossom my inability to fully participate in the moment became a bone of contention for me. Bad innuendoes and double entendres aside, I was not feeling fulfilled. My partner was very understanding, but I felt inadequate and that was another strike against my esteem.

I cut my dose in hopes of improved intimacy, but depression, condemnation, and self-harm began to occupy my mind more than before. Anti-depressant aided clarity was becoming more cloudy and I gradually returned to my self destructive thoughts and behaviors. By 1999 I had reached a new low. The summer of that year found me locked in the psychiatric wing of a local hospital after a suicidal drug overdose. My significant other had found my note and promptly called 911. (Much to my disapproval at the time.) A couple weeks later I was in jail and facing prison time for the crimes I’d wanted to escape by killing myself. I was at the bottom of my plunge of destruction, hurting many others in the process. I still had an active prescription for Paxil, and so the jail medical staff restarted a daily regimen I’d severely curtailed. Isolated in a suicide prevention cell, wearing an itchy cold smock, and once again on Paxil, I was hounded by deep shame and the crimes I’d committed. I was given a 13-year prison term.

While incarcerated my finances were no longer an issue (and neither was sex), but new problems arose. The emotional drain of prison life saw me requesting increases in my dosage several times in the first year. I’d sit in the cell and stare at the walls that refused to move. My thoughts taunted me with shame while they spun in circles, shouting damning words over and over again: Idiot! Freak! Asshole! Abomination! Idiot! . . . I found escape by using a pair of fingernail clippers to pierce my skin and draw my blood. The pain cleared my head and for a moment the emotions would be silent. I kept cutting myself for a week before a concerned case manager and an understanding Sergeant (both, it seemed, atypical in their empathy) helped me instead of sending me to the Special Management Unit. They provided an available ear when the need to mutilate myself continued and suicidal thoughts haunted me every day.

Circumstances demanded effective intervention (uh…no shit); once again the Paxil was a blessing. Or was it? Between reorders my prescription would sometimes be mislaid, lost, or simply delayed. I would try to order early, keep extra pills, or pester medical staff for my supply. I don’t believe any of the delays were purposeful or spiteful, but when the month closed I would become highly agitated. Anxiety, despair, and the fear of returning to the black moods drove my need for something to keep the demons away.

There were times when the medical staff, urged by budgetary constraints, switched me to another medication that was not as expensive. Each instance was a disaster physically and emotionally. Physiological effects spiked as my body was yanked off one SSRI and shoe-horned into another. The increases in anger and violent thinking were not helpful, especially in prison. (Cell rage? Pill rage?) Pleading with medical staff got me back on Paxil . . . eventually. My side forays onto other psych meds were mentally and emotionally messy. Often the mere suggestion that I was going to be put on a different medication was enough to induce fear, anxiety, and resentment. Due to budgetary constraints, prison mental health had become centered around pills, not people. I no longer had access to the case manager or the one-on-one counselor of my first year. Money was tight and staff were being downsized. Patient care was switched to an HMO medical model and services faltered.

Soon the pill line became crowded, and often it still is the only face-to-face with a medical staffer an inmate has for up to three months at a time. (To speed line movement, questions were highly discouraged.) Prescriptions for generic silver bullets became the most cost effective course in our managed health prison system especially when it gets strangled further if the state runs a budget deficit. Qualified psychiatric staff have repeatedly been reduced (shrunk) until there was only one person doing all the prescriptions and follow-ups. From one angle it is understandable, taxpayers no longer wish to spend money for “feel good” therapies for criminals, especially when the state of health care is so precarious even among working adults. But the unfortunate side effect is that the programs and services that got the axe helped inmates adjust and manage their mental illnesses. That is significant as a large number of inmates entering the correctional system have mental illnesses, and psychiatric hospital services are being shut down across the nation.

This is an important issue because a large percentage of all inmates currently incarcerated will be getting out, along with their mental imbalances. Wouldn’t it be better if issues of physiological imbalance and mental illness were addressed inside prison as opposed to when maladjusted ex-felons are on weaker supervision within the community? The uncomfortable reality is that when medical insurance for those not in prison is a luxury commodity, prisoners won’t be the exception.

In my own case the unpleasant reminders worked to insure that I didn’t want to stop taking the pills for very long. When I finally did determine to come off the drug I discovered further unpleasantness. Several factors came into play that led me to decide to stop taking Paxil.

I recall sitting in chapel and listening to a volunteer discuss the “Good News” of the gospel when the call came over the intercom for med-line. The volunteer stopped what he was saying and began to rail against the demonic possession of those on medication. He berated everyone that got up to go get their medications with nothing short of hellfire and brimstone. His condemnation wasn’t a lone voice among the chapel volunteers or the inmates that listened to them. Anger and misunderstanding spread heated words denouncing the evils of medications to “alter the brain” by claiming the soul. I had heard such demagoguery from militant and offbeat sects but this was a conservative Christian fuming against Satanic medications.

I felt ashamed and guilty when I heard his words (as is often the point of hellfire and brimstone preaching, “turn or burn!”), yet I believed that the Paxil was doing me some good. I thought that if the Paxil was helping me battle the thoughts of suicide and depression that it was a good thing. The church always told me that suicide was the fastest way to hell, and depression was of the devil. But was I wrong to have faith in this drug? Was I going to hell for something else I was doing wrong? I knew I was condemned for committing the heinous crimes that I did and for thinking the heretical thoughts that I thought, but was I also condemned because of the medication I was taking? I thought that if the volunteer got to know me he would agree that it was a good thing that I was on the medication. But, then again, he didn’t seem all that understanding to begin with, things were right or wrong, there were no grey areas, no mitigating circumstances.

My anger kept me away from chapel services for awhile and made me feel less worthy of any forgiveness or peace. I began to wonder if maybe there was a miraculous healing that would overtake me if I “just believed” and let God do it all. I knew that my “belief” wasn’t strong enough and that stopping the meds would probably be detrimental, but maybe he was right. This profound confusion and shame began to boil over and affect my daily sanity. I decided that I didn’t want to be on the medication anymore, so that the next big depression would be the last one. I figured that if I was not on the Paxil I would more likely follow through on my suicidal thoughts. There was nothing worth living for if the church (meant to be all-inclusive and forgiving, or so I thought) was condemning me for another demonic stronghold in my life. Desperation grew into resolve.

As the days passed without taking my full dose, I began to wonder; “What all that I had gone through, why did I want to come off a drug that had done me so much good?” Stubbornness, anger, and curiosity kept me decreasing my dosage, weathering reminders for several months. I wondered what waited for me on the other side? I discovered it was not the anger and depression that I was expecting, but full body shakes, muscle tremors, and disorientation. I’d walk around in a constant fog of light nausea and trembling for no apparent reason. But how could nausea and disorientation be light? Though the intensity was not debilitating, the light nausea was as infuriating, if not more so, than stomach-pumping, cookie-tossing, planet-spinning nausea. With the light annoyance I was constantly tricked into thinking that I could function on a consistent basis, but after a few minutes the world would tilt and spin the wrong way. It was the reminder from GlaxoWelclineZenstro, or whoever they are. I began to suspect that the R & D departments purposefully worked those little reminders into their formulas; otherwise they wouldn’t be the multi-billion dollar revenue streams they are. Or maybe our fast-food, fast-fix culture is to blame. (Anyone up for Cialis?)

During this time of stubborn angry resolve I read an article in The New York Review of Books questioning the effectiveness of the leading SSRIs. One of the most telling questions for the resident doctor-cum-bigpharm lackey was whether or not Vincent Van Gogh would have been as much of a genius had he been on Prozac. Sure he may not have cut off his ear, and his personal life would have been more fulfilling, one would think, but what about the paintings? Would they have exhibited the same force and intensity as they do now? Or would he have been painting cutesy precursors to Thomas Kincaid? (Now that would have been a tragedy).

Then I began to wonder; what have I suppressed by taking this drug? Have I been cheating myself out of my own artistic responses and temperament by tamping down the depression all these years? But who am I to question the wisdom I was given all those years I met with clinical experts and other “interested individuals”? They had no problems telling me what I should think, feel, and do. Yet the issue is a good one: who but myself has the need to ask these questions and live with the answers? I began to delve into the subject.

It is known that works of recognized genius often come from minds that exhibit classic symptoms of mental illness or instability. So, if someone transported Paxil or Prozac back in time, would Western Civilization still have its volume of classic works of literature and art? Would Dante have spent so much time journeying through hell, and writing about it, if he hadn’t been despondent while pining for sweet Beatrice? Would Blake’s descriptions of the Fall of Lucifer have been as evocative had his muse been drugged into submission? Would Hemingway still be alive and writing such incredible works of genius? What would A Catcher in the Rye sound like if J.D. Salinger had been on Prozac? (More like Chicken Soup for the Prisoner’s Soul?)

These questions could be more broadly applied to all the dark periods of Western History. Maybe Hitler could have worked out his inner demons if he’d had the chance to take a few hundred milligrams of some generic anti-depressant. Maybe the Catholic Church could have avoided all the messiness of the witch burnings if their parishioners had a pill to allow them to mellow out instead of acting on their inner heresies. Will historians look back on our times and refer to them as the century that took their faith away from science or a higher power and placed it into the hands of drug companies and their broad spectrum marketing techniques? Why endure anything when a drug can be manufactured to dull, enhance, eliminate, or rejuvenate whatever you’ve been convinced is “bad” about you?

Am I merely being a pompous egomaniac by suggesting I could ever produce a work of literature or art that would become a classic? (I am a repeat felon after all, who am I kidding?) Would I have been closer to this chaotic “genius” without this drug coursing through my system? Maybe, but then I would surely have been successful in one of my suicide attempts. The medication numbed me for a time, but I guess that was the point.

When I was a teenager I wasn’t prepared to deal with the emotional quagmire that lay before me like a quicksand minefield. I was too tied up in other people’s views of who I should be. Other people condemned me because I was not like the saints of old. They wanted to shape me into their idea of what a good moral person should be. Their inability to consider that maybe they didn’t know what they were talking about never entered their minds. They were right; everyone at church, at youth group, and at summer camp thought the same way. Everyone in my world, limited as it was, told me who I was supposed to be. How could they all be wrong? My mind and emotions were at war. A war I could not win without help. In the psychiatric field I believe that this is called a cognitive dissonance. Ten years later I was introduced to Paxil. The drug helped solve none of the key issues, it merely put them on hold.

But did I need the drug for ten years? Or would a much shorter time period have been appropriate, maybe the original six-month trial period? A drug that was meant to be a stop-gap emergency measure had become a lifestyle. It had become a habit. Did the Band-Aid become the putative cure? My body consumed the substance daily, building a dependency.

An October 2005 article in The Atlantic Monthly, entitled “Lincoln’s Great Depression” by Joshua Wolf Shenk (adapted from his book entitled Lincoln’s Melancholy: How Depression Challenged a President and Fueled his Greatness), examined and found a man who was tormented by melancholy, to the edge of suicide. The author’s argument is that Lincoln’s struggle from within his depression focused his statecraft in ways that were essential to addressing the specific challenges of both the war of secession and the contentious debate on slavery. But, as the author explains, all of that arose from Lincoln’s approach to living with his depression. He did attempt medical remedies that we can now conclusively say did not help, and in fact may have harmed. He tried tablets of mercury, cocaine, and infusions designed to induce violent diarrhea, to name a few. Today we see all these remedies as “snake oil” in the battle against depression, but the medical establishment of the day trumpeted their efficacy, much as the current TV commercials do for every conceivable malady anyone with disposable income could have.

Lincoln worked with his depression and is now, inarguably, considered one of this nation’s best presidents. He didn’t overcome, rise above, or surmount his melancholy. He never gave a glowing testimonial about how he found God or a drug that miraculously saved him from the clutches of the demon depression. No, he had a different approach. The author tells us that Lincoln requested a copy of the eulogy given at the funeral of his 11-year old son, Willie. Shenk says, “He [Lincoln] would hold to this idea as if it were a life raft.” The idea is that “ . . . with confidence in God, ‘our sorrows will be sanctified and made a blessing to our souls, and by and by we shall have occasion to say with blended gratitude and rejoicing’ it is good for us that we have been afflicted.” His depression was not a demon to exorcise; it was a fact of everyday life necessary to live with.

Due to my state of mind and incarceration, I was forced to deal with the underlying causes of my depression. Forced because I didn’t wish to visit the Special Management Unit that the state had set aside for inmates who did not get along with either their cellmates or their own realities. I chose to tackle the issues before they tackled me. So, having chosen to deal with the issues that were aggravating the depression, was it necessary to continue with the medication? What is meant by necessary? Was it the medication in my system that allowed me the time to focus on the issues? I guess an answer lies in the state of my emotions after withdrawal.

Even after several months off Paxil the ground was still spinning the wrong way. Could it be that the physiology of my body was (maybe still is) so out of balance that this SSRI corrected it? Could it be that this was meant to be a long term, lifestyle medication? Or did this drug merely create its own neural pathways in my brain, shortcutting around previous avenues of depression, compulsive thinking, and anti-social tendencies? The state of the scientific evidence, or lack thereof, has me thinking Paxil is no insulin, no long term wonder drug. The British Medical establishment recently banned SSRIs from use by any adolescent. There were too many instances of increased suicidal behaviors and pronounced rage. The cure turned out to be worse than the disease. Americans have recently seen several legal defenses and lawsuits whose arguments have included the gross ineffectiveness of the anti-depressant the defendant, or plaintiff, had been prescribed. The more I read, the more I wonder who was supposed to be hit by this magic bullet. Was it to kill the depression or the sufferer?

As the time grew between stopping the medication and the present, the emotional and physical states that I encountered didn’t feel extreme. Extreme meaning a profound and lasting black depression, increased anger to the point of uncontrollable rage, thoughts of self-mutilation, or increased desire to be alone. Although I have noticed some increase in those areas, I wonder if their increase is a side effect of withdrawal or just because the chemicals are no longer coursing through my system. The most significant area of change is my discomfort with social interactions. I find I am more comfortable spending time alone. My anxiety around crowds and social gatherings has increased. This makes sense as one of the side issues that Paxil was marketed for was Social Anxiety Disorder. But if this is the only area of significant change and if the depths of the black depression don’t return, then the withdrawal will quickly become a moot point. If the depression does return do I cheat out of it again? Yet, is that cheating? Will it become apparent, at that time, that the medication was no longer beneficial?

As the months passed it seemed that the only reason I was staying on Paxil was my combined fear of withdrawal and a return to my self-destructive behaviors. Given the intensity I remembered, am I foolish to attempt this? Should I have sought more professional help? Yet could anyone else have faced these issues, worked towards understanding, and settled the cognitive dissonance? By doing this on my own am I cheated or saved from myself? Is my decision beneficial when it comes to the possibility that I will commit more crimes? (Or would depression and suicide have solved the conundrum faced by communities when ex-felons finish their time and are released?) How can I assess the last decade clearly enough to know my course is the right one? Or is there a deeper, more pernicious motivation at work in my actions? By being un-medicated do I ensure that my next depression will be the last . . . ever? (Kind of like canceling the flood insurance as the next hurricane comes barreling in for the coast.)

I suspect that a very talented and long-suffering psychiatrist could have helped, but maybe I haven’t been ready. Prison and its effect on my psychological state could not very easily have been replicated on the outside. It is a unique and demanding environment. (From what I hear, military combat comes closest. And that is from veterans who are felons.) The reality of my crimes, my upbringing, and my outlook on issues of personal importance were forced on me by the immediate reality that is daily prison life. If I am going to remain sane and have any hope of a future I have to face whom I have become and who I want to be.

I am free of Paxil for the first time in ten years. As I look back on the role that the drug played throughout those years I see much to be alarmed at and thankful for. The Paxil was a crutch in every sense of the word. A crutch aids when the injury is fresh, but too easily can become a dependence that prevents complete healing. Paxil was beneficial when my mental and emotional life was in turmoil, but it became a hindrance when I was stable. I came off the drug for some of the wrong reasons and found that the result was exactly what I needed. Now the reality I face is my own life, unaided or suppressed by a chemical inhibitor. The tendencies towards depression and obsessive compulsive thinking remain, but my reaction to them is not the same. I am a different person than I was ten or twenty years ago. The masochistic teenager and the self-destructive twenty-year old are behind me. Although the future is less than rosy to look at, the present is much, much clearer. And the present is where I have to live.

“Whatever greatness Lincoln achieved cannot be explained as a triumph over personal suffering. Rather, it must be accounted an outgrowth of the same system that produced that suffering.” –Joshua Wolf Shenk