Monday, December 13, 2010

Artifical Contentment

I ingested my last Celexa tablet a few weeks ago, part of a drug holiday I gave myself after muffing a scheduled platelet donation last month by mindlessly taking an 81mg enteric coated aspirin tablet that I neglected to omit from my weekly pill case. So until the next platelet donation last weekend, I treated myself to a drug holiday. No aspirin as the blood bank program requires but also no statin, PPI, multivit or SSRI. Other than some wicked heartburn tided over by antacids, while disabling initially but just slightly annoying at present, no medicines. Yesterday, I restored the pill case with all but the SSRI. Aspirin and statin have evidence of life prolongation and other than some achiness early on as the Crestor dose was increased, there have been no adverse effects, though I always wondered if I really would need the PPI if I deep sixed the aspirin. I accept the endoscopist's finding that there really is some reflux but no Barretts, so both the aspirin and omeprazole returned to the pill case. I have a whole jar of OTC house brand men's formula multivitamin, so that went back to the pill case too. My citalopram tablets, even though of ample supply, stayed in the amber tube that I got from the Super G pharmacy a couple of months ago for $10.

Other than some annoying reflux, I clearly feel better without the medicine. It has been a tenuous course with the SSRI, starting many years ago with Prozac samples from the office, then Paxil samples which made me feel drugged and finally Celexa samples which became the generic citalopram. It is not my first withdrawal but unless a lot of people start complaining about me I do not plan to return to this medication.

Peter Kramer in his Listening to Prozac best seller of twenty years back described using the medicine for Obsessive-Compulsive Disorder, which at the time was an experimental use, and for which I worked out with my doctor my first trial of it in the 1990's. Dr. Kramer described Tess who became charming and sociable. I did not become charming, or at least nobody gave me feedback. What I became instead was dulled, almost emotionally neutral, without placing a value judgment on it. Irritants no longer irritated me. My patience improved and I could read or watch TV for longer periods of time with greater safety than if I had tried to achieve the same result with ADHD agents. In exchange for some form of artificial inner peace and perhaps a slightly better attention span, my mind wasn't as sharp. I had no particular inclination to look up medical information I did not already know. My abiltiy to write in an incisive way and to follow thoughts in sequence declined dramatically. Moreover, I felt tired, this being the symptom that prompted each of the previous withdrawals and return of irritibility guiding each restart.

So now I again find myself able to think clearly with very little inhibition to my natural candor. I am less tolerant of myself for not accomplishing at the end of the day and less tolerant of others who now irritate me.

Another book on the subject, Artificial Happiness, comes from Ronald Dworkin a few years ago. While the writing and analysis seem almost primitive next to Dr. Kramer's more elegant prose, he makes an important point that sometimes life's goals are best persued while irritated. If AKSE leaves me unsatisfied and treats me like a picador with multiple little sharp provocations, then using a pill as a surrogate to disaffiliating when I should diminishes my Jewish future. While patients may also irritate me more, I owe them the full measure of my skill which should not be set aside for my own inner peace. As I compile my intentions for the next six months I really want to work on conducting myself in a more gracious, less abrasive fashion than has been my history. But I need to give myself a genuine chance to do this without the phony pharmaceutical restraint.

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