Every three months or so, I see my psychiatrist for a few minutes on zoom (or Doxy, actually, a platform specifically for medical appointments), because he decided not to go back to in-person visits after Covid. He asks me how I’m doing with my antidepressant medications, and I say “fine,” and he takes notes and refills my prescriptions and makes a new appointment for three months in the future, and then we’re done. Of course, there have been times when I didn’t say I was fine, and he raised the dose of one or the other of my medications, which led to a one month follow up instead of a three month follow up, but for the most part, everything has been stable for quite a while. To fill out the four- or five-minute appointment, we tend to chat about my teaching, or my other doctors and the new medications they’ve added to my regimen, but for the most part, he asks me if I think I need to raise the dose of my meds, and I say no, and we wish each other well. But at my latest appointment, when I said a variation of my usual “I’m fine,” he said, “but what does that mean?” and I didn’t know how to answer.
In the end, I must have said something reassuring, because he kept everything the same and we made the usual appointment for three months in the future, but when I closed my laptop, I wasn’t sure if “I’m fine,” was really the truth, or just something I’ve gotten used to saying. I don’t remember if I was more willing to go into details back when I actually had to leave the house for those five-minute session every three months, but there’s definitely something about the virtual appointments that encourages me to keep it simple.
The fact is, I don’t really know if I’m on enough anti-depressant medication, or the right medication. I have no idea if this is the best my mental health can be, or if there are medications or other treatments that could make things better. The few times I’ve been willing to risk changing my medication were when I was feeling so awful that I wasn’t sure I’d be able to function otherwise.
Antidepressant medications are a mystery, and not just to me. Doctors still don’t really understand why they work, or why one medication works for one person and not for another. It’s a lot of trial and error and guesswork, and a little too much Russian roulette for my liking. When I was first trying medications, years ago, the doctors would try a few from each family of drugs, and I had to spend weeks, and even months, dealing with weird side effects while waiting to see if something positive would happen. There was one medication that the psychiatrist (a different one) insisted on trying even though it was meant for bipolar disorder, which I don’t have, and within 24 hours I felt like I was going to jump out of a window, or at least scream until my head exploded, and I refused to take another dose. The doctor didn’t seem to think my reaction to the meds was all that bad, and he wanted me to stick with it for a least a few more weeks to see what would happen, but I felt strongly that I shouldn’t be taking a medication that made me want to kill myself and he reluctantly moved on to another class of drugs.
Psychiatrists, and other doctors who prescribe these medications, also tend to be unusually terrible at diagnosis, because there is almost no consistency in how different doctors interpret the words of the DSM (Diagnostic and Statistical Manual of Mental Disorders), and the words used in the DSM are generally unrelated to the way patients actually experience and describe their own symptoms. Sometimes it feels like the doctors are waiting for certain magic words to be said, and don’t know what to make of the metaphors, sentence fragments, and shrugs that real people use to describe how they feel.
To be fair, medical doctors are just as terrible at diagnosis when they don’t have hard and fast results (from blood tests or scans) to determine what’s going on inside. The pain medication I’ve been on for maybe fifteen years now (after trying a lot of different drugs meant for any number of different diagnoses) has only ever reduced the pain by half, and usually less than that; and the same is true of the psych meds: if they reduce my symptoms by half, that’s a good day.
In an ideal world, I would sit down with each of my doctors and describe in detail how I feel (what hurts, how it hurts, what I’m struggling with, and what I’ve tried) and be answered with curiosity, understanding, respect and investigative questions to help me pinpoint and articulate my symptoms as clearly as possible. But, to be honest, that has never, ever happened. I have certainly attempted it, with dozens of doctors, but they tend not to hear what I’m saying over the noise of their own assumptions, and it ends up being easier to keep things short.
I’ve been on my current anti-depressant medications for more than ten years now, and while they have caused weight gain and nervous system disruptions and a bunch of other side effects, they allow me to function most days, and they give me the leeway to do the therapy work that helps me move forward. And for me, to be able to say on an average day that I am fine, that I am not in a panic spiral or falling into depression or obsessing over this or that awful thing coming up in my life, is huge. It allows me to live my life each day and accomplish some of the things that matter to me, and experience joy, and even do the laundry. It may not be miraculous, but, at the very least, it qualifies as fine.
If you haven’t had a chance yet, please check out my novel, Yeshiva Girl, on Amazon. And if you feel called to write a review of the book, on Amazon, or anywhere else, I’d be honored.
Yeshiva Girl is about a Jewish teenager on Long Island, named Isabel, though her father calls her Jezebel. Her father has been accused of inappropriate sexual behavior with one of his students, which he denies, but Izzy implicitly believes it’s true. As a result of his problems, her father sends her to a co-ed Orthodox yeshiva for tenth grade, out of the blue, and Izzy and her mother can’t figure out how to prevent it. At Yeshiva, though, Izzy finds that religious people are much more complicated than she had expected. Some, like her father, may use religion as a place to hide, but others search for and find comfort, and community, and even enlightenment. The question is, what will Izzy find?
rachelmankowitz 