Tuesday, November 09, 2004


I know HIPAA places all kinds of restrictions on what doctors can say about their experiences with their patients. I think patients can still say whatever they want about their experiences with their doctors, though. It's interesting that health care is such a private matter (I'm not saying it shouldn't be, I just think it's interesting that it is). Whenever we admit that we went to or are going to see a doctor it's always in hushed, vague tones, as if we are embarrassed about even having to set foot in the door of one, no matter how minor the issue. Is this because it's just not something others care about or are we afraid of admitting we have weaknesses, that we need help? Certainly as a twentysomething there's a tendency to feel pretty immortal at times.

Anyway, being new in this town and one to put these things off I hadn't yet located a medical provider when my paroxetine (Paxil generic) ran out on Saturday. As this drug is supposed to have some pretty nasty withdrawal symptoms, I was concerned about letting it lapse for too long and got the first available appointment from Student Health. (Coincidentally, the only available time was during discussion section, so in going to this appointment I was leaving a discussion about membrane transporters to go shut down one of my own membrane transporters.) The NP I saw was nice and obliging, and gave me a fresh prescription with a minimum of rehashing of my troubles. She asked routine questions about how I was adjusting to life here, and I tried to convey the truth, which is that I've been more satisfied with the way things have been going since I've been in SF than I have been in a long time. She described the talk therapy programs here at UCSF, and when I did that thing I do where I stumble and stutter rather than simply saying "I'm not interested," she ended my hemming and hawing by saying "You just want your Paxil."

This was the truth, but hearing it put this way was a little funny. It really is something that I want rather than something I need, as I could certainly live without it and have lived without it. It's just something I'm afraid to go off of at this point because I know how bad it can get. Rather than being a necessity, for some of us SSRIs end up a lifestyle choice. Some think there's a certain moral high ground in not taking them, as one should be able to deal with one's own problems without the aid of exogenous psychoactive chemicals. You could probably argue that there's a practical high ground to this as well, as learning to deal with one class of difficulties may enhance your ability to deal with other problems. I used to feel this way but at this point I just don't care about any high ground I may be losing by continuing to block SERT. Choice A is a wider range of moods and the risk of being incapacitated by a significant depressive episode. Choice B is emotional equanimity and dependence on a drug. It seems so much safer to stay on the drug.

After all, would I be where I am today without my meds? Would I have been confident enough to pursue the opportunities I am today glad that I pursued? Would I have cared enough and been able to concentrate enough to keep getting things done? Would I have managed to be unanxious enough to not come off as completely socially inept? Would I have avoided having a breakdown that might have driven me to fail or give up? I'm inclined to stay on the meds just because they might be what's keeping me sane enough to at least get some work done. They certainly aren't bringing me joy or bliss--and I wonder if they're preventing me from highs as well as lows--but I'm pretty sure they are play a role in making sure I stay functional. I'm thinking in functionality I've got a pretty good thing going, and I therefore should count my blessings and feel lucky to have found in these meds something that seems to guarantee that I'll live a life where I feel at least O.K. and probably do some worthwhile things, even if I never feel great.

Is anyone ever this ambivalent about, say, taking their blood pressure medication?


At 2:28 PM, Blogger metalife said...

I think the important thing is to keep on watching yourself to see how you are doing with it. Personally, I'm a HUGE proponent of the talk therapy thing. I think every person in America in the modern world is lunatic fucking crazy and needs a mentor of some kind to keep a check on their compulsions and meme-infections. Ideas can be just as helpful\destructive as drugs, both prescribed and otherwise. I actually was just talking to someone about whether or not they should go back on Ritalin in order to focus more and I was just surprised that they were trying to make the decision on their own rather than seeking the opinion of a trained professional who has an objective interest in making sure you are doing the right thing for yourself. I pretty much went to a therapist not to get a drug prescribed but in order to build an internal regulator of my psychoactive substance intake. I've succeeded in the sense that I make it to class these days and spend more money on sushi than pot, but it's not like I have complete control over my demotivational cycle. Basically, everyone makes their lifestyle choices, and is afraid to break out of the status quo. Maybe my quirkiness and ability to calm the fuck down would be replaced by broomstick-up-my-ass-edness and med-student-style neurosis if I gave up pot altogether. And that's just not a risk I'm willing to take, especially if my life is living itself with a reasonable degree of functionality in the meantime. :-)


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