Withdrawing from my last psychiatric medication has reminded me how much the pills taught me. Until recently, I believed their tutorage instructed me only about dreadful side effects, about feelings of dependence, and about the sad fact that pharmaceuticals couldn’t save me. But now I see how they also enhanced my understanding of the mind and its sensitivity.
A little over two weeks ago I took my final buproprion dose. I had already tapered my intake down to a quarter tablet a day. The painlessness of my slow reduction had lulled me into imagining that complete cessation would go unnoticed by my nervous system. Wishful thinking. The withdrawal symptoms have been mild compared to previous drug tapers, but they’re strongly affecting me.
Buproprion (a.k.a. Wellbutrin) acts on dopamine synapses. I mentioned dopaminergic neurons in a recent post, and pointed out how they mediate our sense of ‘payoff.’ Cocaine and amphetamines work on this exact system, and are highly addictive as a result. In the early days of research into such agents, neuroscientists described dopamine as the “orgasm” substance. Rodents will obsessively push a lever to stimulate the relevant brain structures even as they die of thirst and starvation. Because of their indifference to all other stimuli, it was believed the poor animals must experience utter bliss while pushing the bar. However, their appearance differs from the mousy equivalent of sensual ecstasy. They look stricken and anxious, like a crack addict, you might say.
With further study, the researchers clarified dopamine’s role: it provides a sense of anticipation. When active, this neural system serves up what psychiatrists call salience: the feeling that an activity is guaranteed to provide a huge reward. Maybe the payoff will be an orgasm. Or maybe it will be a delicious, high calorie meal. The brain doesn’t specify what the prize will be, only that it will be outstanding. This is why drugs that directly stimulate dopamine neurons are so addictive: every time they’re ingested, the nervous system gets excited. In fact, it appears all addictive drugs, and automatic habits also, directly or indirectly activate this neural system of anticipatory reward.
So what happens when you stop a medication that tickles these structures? Granted, buproprion doesn’t provide the addictive rush of cocaine, but it is an ‘activating’ drug. It generates feelings of heightened energy, bordering on jitteriness. Many people tolerate it poorly as a result. When one withdraws from the medication, on the other hand, one loses this ongoing stimulation of the dopamine system. The result, in my case at least, is fatigue and sleepiness. These symptoms aren’t intolerable, and in fact my chronic insomnia has lessened a bit, a welcome change. However, the feeling that my daily activities are worth the effort has also lessened. The sense of ‘payoff’ has vanished.
When I withdrew from SSRI agents (the class of drugs exemplified by Prozac), the result was clear-cut depression. I felt down for a few months. This is different. I’m not feeling sad or defeated. I’m just not motivated. Nothing I anticipate feels worth much investment. The ordinary delights of day-to-day life hold little allure. Sex? Sure, if it’s not too much trouble. Employment? Fine, if I don’t have to work too hard. Writing? Why not, it doesn’t take much out of me anyway. I continue to pursue all these activities, but with little delight or hopefulness.
So where is the lesson in this? If I felt this way and hadn’t just stopped a powerful psychiatric drug, I might be inclined to take this anhedonia to heart. I might believe effort to be pointless. But since it occurs so obviously following the drug taper, I can observe it scientifically.
Hmmm… Motivation can be swayed by a simple chemical. What to make of that? All those activities that ‘hook’ me start to look less essential to happiness. They provide, after all, nothing but moments of anticipation. Right now, I’m living reasonably effectively without much sense that a reward is in the offing. So how truly necessary are life’s prizes? Why get so involved in sensory payoffs if they can be so easily erased by a simple change in chemistry?
See the subtle lesson here? I’m not advocating austerity or apathy. I’m just making the point that the mind is at the mercy of myriad influences, some of which have no real basis. Has the world changed in any fundamental way now that I no longer take buproprion? Of course not. The universe is exactly the same, but something in my brain is different. Life has lost much of its flavor and attraction, and I feel less engaged, but only because of a chemical shift. There has been no true alteration in circumstance or prospect.
It’s enough to make me mistrust emotion. And guess what? That point came up in both of my last two essays.
The good thing about writing, for me, is that it facilitates my insight. There was at least one Eastern sage who only wrote and never meditated, but still achieved enlightenment (OK, I admit the man’s name eludes me–but it’s true). I was vaguely aware of the withdrawal effect during the penning of the last two pieces, but talking about it openly helps me better understand how strongly it has influenced my outlook recently. That awareness, in turn, makes me even better appreciate the contingency of my feelings. Why would I take seriously effects that can be so easily and artificially swayed?
You can see how this has been a beneficial insight. You can see how my development has been enhanced by my taking of this medication, or at least its cessation. As I’ve written before, we often learn from painful experiences. There have been few episodes of my adult life so disheartening as my foray into the world of psychiatric drugs, but the saga taught me many valuable lessons. Pharmaceuticals never eased my emotional distress in any lasting or healthy way, but they taught me much about the susceptibility of mind to transient and external forces. Should I thank Big Pharma for this enlightening?