Opinion: A drug free life

POSTED: 03/6/15 1:33 PM

In the fall of 2014 author Diana Spechler decided to quit the prescription medications she has been taking to treat her anxiety, depression and insomnia, and began the process of gradually reducing her dosages. In Going Off, a series of Anxiety posts, she chronicle the challenges she faces from both the drugs and the withdrawal in her pursuit of a drug-free life. Worth thinking about, also for readers in St. Maarten.

“Two years ago, when my doctor first wrote me a prescription for bupropion, an antidepressant, I asked him, “Will I gain weight?” For me, body image and depression have always been tightly woven together. “Probably not,” he said, which made me nervous. I wanted him to say, Are you kidding? I would never let that happen to you!

“Will I lose weight?” I asked him, touching a tiny hole on the knee of my jeans. I knew I wasn’t supposed to ask. My depression was the urgent matter at hand. And I wasn’t overweight.

“Most people don’t,” he said.

I didn’t say anything more. After all, I’d been in therapy on and off for two decades — my food and body-image issues, which my doctor and I had discussed at length just minutes before, should have been long resolved. Besides, I know how cloying it is to hear a thin person grumble about the roll in her stomach. But my relationship to my body remains fraught: I still find fullness depressing, hunger uplifting, weight-gain depressing, weight-loss uplifting. The more of me there is, the worse I feel.Despite my doctor’s prediction, on bupropion I lost 15 pounds and stayed at that weight for a year and a half.

Only lately, having decreased my dose, have the jeans I bought at my thinnest become suffocating.

Here’s a longstanding habit of mine: In response to depression, I diet. I starve out the darkness, replace it with numbers — calories, pounds, sizes, inches. Those numbers keep me busy. They occupy all the space in my brain. I’ve engaged in so much obsessive adding and subtracting, I’ve become a math whiz. I can mentally divide up a bar tab in seconds. Writers are notoriously bad at math, so my party trick surprises people. “Waitressing,” I explain. While it’s true that I worked in the service industry for years, my math skills are born of dieting.

When I diet, I dream about food. Come morning, I’m relieved by the rumble of my stomach, relieved that the cake I devoured was a zero-calorie figment of my unconscious mind. But during waking hours, I can hold out for only so long. Eventually I let the numbers go, let the darkness back in, let food back in, revert to my shadow self — the one who’s sluggish instead of alert, the one who turns the Doritos bag around so she can’t read the number of calories per serving, the one who buys Doritos in the first place. In this state, I start eating. I eat and eat until I’m horrified by all the eating I’ve done. I eat more. I speed-eat. I’m in a Dorito-eating contest with myself.

A couple of years ago, when I first started seeing my psychiatrist, I was that shadow version of me — tired, miserable, hiding inside a giant sweater, convinced that my body was spreading over the length of the couch. I told him that I didn’t want to take S.S.R.I.s (selective serotonin reuptake inhibitors — Prozac, Zoloft, etc.) because in the past they’d impeded my writing. A decade earlier, I’d taken Wellbutrin, a brand name for bupropion, which doesn’t target serotonin, and it hadn’t affected my writing; my depression, however, had persisted (and my weight had held steady). In 2013, I agreed to try bupropion again anyway. I was so depressed, I almost didn’t care. I’d already decided that medication wouldn’t help me, that nothing could help me. My doctor prescribed a low dose that he gradually increased to a high dose, 450 milligrams.

A few weeks later, I woke and saw the sun shining, outlining the curtain on my bedroom window. It was a Saturday. I ate brunch, the meal of the luxury class. I am not a member of the luxury class, but I felt luxurious, laughing with friends over spicy potatoes. The next day I had to ride in a small car to Boston — four hours with four people — and at no point during the trip did I long to squeeze myself out the back-seat window. When we arrived at our destination, I didn’t go searching for a place to sleep or cry. For the first time in months, the world felt like wide-open space and I wanted to explore it.

For a while, I had so much energy, my eyes burned from not blinking. I felt like I was falling in love. This was the trial-and-error stage and, as my doctor quickly realized, I was overmedicated. I scaled back to 300 milligrams, a moderate dose, to stop involuntarily grinding my teeth and telling everyone they were my best friend. After that, I felt like myself — or, maybe I felt unlike myself because I no longer felt depressed. I could look outside on a gloomy afternoon and think, the sky is gray, instead of, what is the point of ever going outside?

On bupropion, food didn’t hold the appeal it had once held. It became a bit of a chore, chewing food. For the first time in my life, I would forget to have lunch, leave burritos half uneaten, find myself unable to finish dessert. It should be reflexive — to eat when we’re hungry, to stop when we’re satisfied — but this was the first time I could remember my brain receiving those messages. A genie had granted the wish that I had been making since I was a teenager: Release me from my food fixation.

Two years ago, meds delivered me from depression. Now I’d like to find a cleaner escape, one as effective as meds, as compelling to me as self-deprivation. Or I’d like to learn to live without trying to escape. Or maybe I’d like to refocus my lens, to stop seeing my brain, my body, as a prison.

At 150 milligrams of bupropion, with my halcyon days of thinness most likely behind me, I wish that I could taper off meds without regaining weight. At least, I wish that I felt about extra pounds the way I feel when my hair gets too long — no big deal, really, and maybe the excess even looks nice. I wish that I lived in a society devoid of clavicle-fetishizing, industrialized food, Calvin Klein billboards, that mysterious berry called acai. I wish that I was too smart for this. I wish that I’d aged out of this. I wish that my feminism protected me from this. But I’ll likely wind up dieting again, doing calorie math in my head, because few things make me feel as hopeful or invigorated.

It’s embarrassing to admit that.

As a child, I heard a story about a man sentenced to life in prison who refused all of his meals, but always saved the butter packets. When he was finally thin enough, he buttered the bars and slid out. When the guards came to his cell in the morning, they found his clothes discarded on his cot. Before I understood that this story wasn’t true, I always wondered how he pulled it off, how he crept naked past the guards, out of the building, out of town, how he shuffled himself into the world unnoticed. I often think of him — a man in despair, trapped in a cage, whose only way out was to shrink.”


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