Sufficient Champagne

shuffstuff asked: How is the new medication working out? And what's the progress report with writing?

Hey, one I can answer soberish! It’s very kind of you to ask, you know.

I’m not quite sure yet how the new meds are working, and I’m trying to be very careful about not talking myself into a narrative about them. My psychopharm and I are titrating up on what’s called Emsam, which is the brand name of a transdermal patch that delivers 6mg, 9mg, or 12mg per 24 hours of the MAOI selegiline. I’m up to 9mg/24hr as of today. MAOIs are of course a venerable and powerful class of antidepressants, normally relegated to near-last-resort status (nowadays, one normally has to fail a few categories of the modern reuptake inhibitors as well as tricyclic antidepressants before a doctor will try an MAOI; I’ve failed various combinations of SSRIs, SNRIs, and Wellbutrin, with and without mood-stabilizer kickers, as well as ECT, but insisted that we skip over tricyclics and straight to the real ball-busting stuff) in part because they normally require severe dietary restrictions. But because Emsam is delivered through the skin directly into the bloodstream, it bypasses the liver and goes straight to the brain on its first pass through your system and can therefore be used on any diet.

At the lowest dose, two weeks in, I’ve had good days and bad days. But I’d say that the absolute lows that I’ve experienced in the past and came close to again during the pre-MAOI med washout aren’t there. I’m tempted to say that I’m responding about as well to a baby dose of Emsam as I did to massive doses of other drugs, which is a positive sign. Really, the fact that I detected any response is a positive sign: in what I’ve read and heard, people either don’t respond at all or it changes their lives. Anecdotally, there doesn’t seem to be a middle ground. Of the ten people my psychopharm has prescribed Emsam to, five turned completely around and five didn’t notice a thing; people on the wild wild web report either complete remission or nothing. I’m cautiously optimistic—MAOIs are particularly effective for treating atypical depression like mine, and they’re seriously fucking potent (I take the fact that eating cheese on most MAOIs can kill you to indicate that clearly they do a lot of something). Meanwhile, I also terminated with my old shrink and I’m making the transition into full-blown classical psychoanalysis, which is something I have far more faith in than the half-measures of relational psychotherapy or the infantilizing nonsense of the *BTs.

The danger, it seems, lies in mistaking optimism for neurochemical balance—that is, in getting so amped about the potential inherent in the change that I pink-cloud myself into believing that the new drug is working when it isn’t. I suspect—I can’t be sure, of course, but I suspect—that I’ve done that to myself before and it’s ended ugly.

As for work, I had a wonderfully productive few weeks in January when my neurochemistry was all fluxed up with the meds draining out but I could still take my Adderall and Dexedrine and if I stopped writing for even a second I completely and totally collapsed, so, hounded by the threat of melancholic dis-integration, the threat of going gooey à la Margaret Hamilton, I worked constantly and wrote forty or so not-bad pages. I have since become more torpid, but I’m trying to booze and amphetamize—both ends of the candle and all that—my way back into productivity tonight and make a dent in the ethnography section.