Pills, pills, pills.

So one thing I've learned through this anxiety journey is that it is completely individualized. In my case, the roughest part has been -- and continues to be -- finding the right medication. My general practitioner told me earlier in the year that it can take nine to twelve months to find the right combination of medication. When she first told me that, I laughed it off and thought, "No, not me -- I'll figure this out super-quickly."

And here I am with no good answer, yet.

I wasn't sure that I wanted to write this post because I already covered some of this in a previous post. The other question I kept asking myself -- would it be too much information? Would it be useful for people to know?

But anxiety likes to hide and it makes you afraid of being open and sharing. It is that little voice whispering, "Sarah, you are not enough. Sarah, no one cares. Sarah, people are going to change what they think of you." At times, every fiber of my being says that I have said enough and that it is okay to go back and hide again.

Shedding the mask one day at a time.

Then I become brave and emboldened anew -- because I need to speak out and help be a voice for myself and for others. If I can connect with one person through this blog and provide them some comfort with my experience, it is enough. If I help someone relate to a friend or family member who is struggling with mental illness, it is enough.

Many people are willing to talk about anxiety or depression in a vague, high-level way. But I'm a storyteller at heart -- no story that I write is complete without character development and small details. So today I'm going to continue my own story.

Pills, pills, pills -- both the saving grace and the bane of my existence.

First of all, if medicine works perfectly for you, no need to share that little fact. If your body loved the first thing that you tried, perhaps it's not best to brag about it. This is the same insensitivity, even if it is unintended, that hurts people dealing with infertility when they hear people gleefully share that they conceived on the first try, or when people battling their weight watch someone stuff their faces with pizza and say, "I guess I just don't put on weight -- I'm lucky!"

I talked earlier on in the process about struggling with meds. What made the journey particularly difficult for me was that the initial diagnosis (depression) was wrong. Yet, in true Sarah fashion, I ran out and bought books so I could come up to speed, so I could understand the monster I had to defeat. When I read over the symptoms, some of them fit -- but some didn't. Not at all. Not even if I squinted. It felt like a personality assessment gone wrong because the face validity wasn't there.

No wonder the first few rounds of medication were so hard -- some of them were exacerbating my symptoms. Anxiety and depression are much more related than I ever thought they were -- but the right diagnosis makes all of the difference when you select ways to treat it.

But the decision to go on these medications is even more difficult than I thought. I'm not opposed to medicine if provides a better quality of life. These medications impact who are you right now and have long-term impacts. It is such a case of tradeoffs -- how do I find some stability now while still leaving options for myself in the future?

Certain classes of medicine have very different side effects. Most of the anxiety meds -- the tranquilizers and benzodiazepines -- were awful, hateful things. At some point when my panic attacks were bad, they had me try Xanax or Klonopin. Ten minutes after the pill had passed my lips I was numb -- the anxiety was gone, but I felt emptiness, nothingness, oblivion. I spent most of the evening staring at a wall -- literally. I hate that word but that was the whole evening -- me and the bright orange wall of my living room.

Other medications have the opposite impact. As I mentioned in my previous post, anti-depressants can be very effective for some people suffering with anxiety disorders. One of my medications my psychiatrist decided to try was Prozac, the pill everyone loves to hate. Two weeks into the medication, I felt fantastic. But the following week? I was so anxious I was physically shaking or always moving, playing with my hands, eyes darting around the room. I broke down in my therapist's office later that week. "I'm not me, I'm not me," I sobbed as I rocked back and forth on the couch.

That was the end of the Prozac. Sort of -- it's never just a quick end. Some of these medications are known for challenging withdrawal periods, so it's always a constant tapering-up or tapering-down or, my favorite, the "cross taper," which is both at the same time.

I'm thrilled that I'm stable-enough with a combination of BuSpar (atypical anxiety medication that is anxiolytic) and Effexor (traditional serotonin-norepinephrine reuptake inhibitator (SNRI) antidepressent). BuSpar is calming but nauseating and Effexor is calming but deadening, so in playing with the doses and helping them balance one another, you get close. Ish. But both can cause insomnia, so the third drug in the cocktail is Lunesta (nonbenzodiazepine hypnotic), which, ironically, occasionally exacerbates anxiety. So I wake up in the morning petrified of everything I have to get done in the day. It takes me ten minutes of reminding myself that I am safe in my bed before I feel ready to try getting up.

If you have a headache after reading that paragraph, try learning more about these meds. Take Effexor, currently prescribed to about seventeen million Americas. They know it impacts the brain's serotonin and norepinephrine. And maybe the dopamine, but they're not sure. They can draw the molecule and nice little diagrams of absorption rates, But how it actually works? It's the medical equivalent of a /shrug.

They don't know. They don't know! They can make some educated deductions. That's it.

And it's even less clearer for the newest medications. Effexor went to market in the US in 1993 -- we have learned a lot about anxiety and depression since then. Insurance companies won't cover the newer (and generally more effective) medications until the patient tries and cannot tolerate the older options. Six failed antidepressents in and my psychiatrist could start trying the new pills that came on the market in 2011-2013 (Viibryd, Brintillix, and the one I'm about to start, Fetzima). And if you think the information about the others is scant, these medicines work much better but they really don't know why.

[Side note: Names for medicine are a never-ending source of amusement for me. Where in the world do they come up with these names?]

So on good days when all of the stars align (I've slept well, I eat, I can get to the gym, my stress isn't sky-high), I feel almost normal. And on the crappy days, I just conk out on the couch and wait for the symptoms to pass.

The scarier set of implications are a few years down the road and it feels like this is going to be a long, long series of tradeoffs. Take Lithium -- that was the only medicine I've taken that didn't have many side effects. But long-term Lithium use leads to chronic kidney issues, even kidney failure.

Even scarier than that? Almost none of these medications are approved for use during pregnancy -- so that's a huge anti-announcement, if anything. It's so overwhelming -- not only do I have to deal with the anxiety, but if I want to have biological kids, it means having to beat these demons on my own, medication-free. I haven't wrapped my head around that one. I can't deal. I'm in full-on denial.

Preach, E.M. Forster.

So this is all about the pills -- but, really, it's not. What it's really about is examining what you want and expect for yourself and readjusting what your idea of normal is. It's about letting go of what you think life should be and being mindful of what it is.

But there are moments when I can step through the confusion and grief and see that things might be okay after all. I'm not a quitter -- never have been, never will be -- so I won't let this take me down. Every pill trial, every odd side effects, and every dizzying moments helps me remind myself that I am brave, I am strong, and I am doing the best I can.

For now, that's enough.

xo,
Sarah