(Note: This post references to the existence of sex)
The pharmacy isn't far away, and it doesn't occur to me to put down the prescription along the way. I hold the small slip of paper in my right hand and it sways, blurry, in the foreground as I steer. It's effectively invisible as my eyes and flailing brain focus beyond it, on the road ahead.
The pharmacist takes my prescription, deciphers the scribbles, and smacks a label on a whole bottle of Lexapro. I've never gotten a whole bottle of prescribed medication in my life - this really drives home the "long-term" thing. When I decline a consultation with the pharmacist, the technician pops the bottle and roughly 600 pages of drug information into a paper bag that crinkles loudly as she hands it to me. Just as I turn to leave, she says, "Remember not to stop if you don't notice anything right away, it can take several weeks to have an effect."
Apparently I’m a delicate flower, because my drug-naive body changes by dinner. I’m relieved to see the same positive effects as Xanax, but more subtly: my mind quiets, my thoughts flow more intentionally, I see less danger lurking everywhere, my muscles relax. My mind calms from a chaotic storm into a more organized flow.
Over the next few weeks, the effects strengthen. I’m no longer held down under an avalanche of fear and distraction. My internal chatter quiets and I can think more clearly; my memory improves. My neck and back pain completely resolve and my migraines become less frequent. My baseline mood improves and I become more present and more engaged with those around me. I become more patient and more secure. My counseling appointments become more productive, school becomes more manageable. I experience life more fully. Medicated, I feel more naturally myself. It sounds sappy, but Lexapro changes my life.
Of course, it’s not all rainbows and butterflies. A few days after starting the Lexapro, I start having extremely vivid nightmares that feel like real-life memories after I wake up. Thankfully, these subside and then disappear over time. I develop some consistent GI upset - which isn’t unusual, since about 90% of serotonin lives in the GI tract. This symptom subsides, but never fully resolves.
The most challenging part of Lexapro turns out to be the cost. Not long after levelling out the dosage and effects, my doctor and I decide to switch to another SSRI called citalopram, or Celexa. It's not a big change, because Lexapro is just a purified version of Celexa. The transition goes smoothly and I remain on Celexa throughout veterinary school, with my wallet none the worse for the wear.
Though I never sink as low as I did in Block 1, veterinary school never stops feeling unnecessarily oppressive. In my final year, one of the anesthesiologists gives a talk about medical errors. The audience is a mix of students, professors, and technicians. I expect to hear a list of recommendations - check the label three times, label syringes, have two people calculate dosages - but instead sit riveted by an exhaustive discussion of sociology and cognition studies. To summarize the talk: people learn less and make a lot more mistakes when they’re tired and stressed out.
At the end, I ask, “If stress and fatigue reduce learning and endanger patients, why do we make vet school so god-awfully stressful and fatiguing?”
The anesthesiologist shrugs and says, “Yeah, doesn’t seem productive, does it?”
I’m infuriated. I have so much to say, but I have to go take care of a patient.
After graduating, I spend a year in an internship that’s even more oppressive and made much worse by an abusive boss. I burn out once more about midway through and nearly get fired. I come out the other side a far better doctor, but with zero enthusiasm for the job. Finally, after another year or so, I get to a point where going off the Celexa seems reasonable. The transition goes smoothly.
The blessing and curse of long-term drug therapy is that I have time to forget some of the lessons I learn along the way. I forget about the gastrointestinal side effects and spend a fair amount of time spinning my wheels considering unrelated diagnoses - lactose intolerance, gluten intolerance, IBD, etc. Appetite stimulation and weight gain also sneak up on me, and I forget to factor the medication into my lifelong struggle with body consciousness and insecurity.
Most significantly, I completely forget that SSRI's have a well-known risk of causing sexual dysfunction. It’s the most common reason people go off SSRI's.
In 2014, after being off Celexa for a year or two, I lose my job and sink into a depression. My doctor and I decide to restart Celexa, and I don’t draw a connection when my sex drive nosedives shortly thereafter. I tell myself, “Depression can do that, right?” Over the next year, my low libido (among other factors) contributes to the disintegration of my relationship. As I begin to battle back against the depression in the fall of 2015, my stepfather unexpectedly dies.
Chalking it up to a series of major blows, my libido remains low and starts to take a toll on my new relationship. My girlfriend, Heather, is understanding, but a lack of sexual intimacy can be hugely disruptive to any relationship. My heart aches when Heather starts to ask the same questions as my ex about whether I’m losing interest, or whether she’s not doing enough to keep me interested. Over that same period, my anxiety increases back to a pre-medication level.
In early 2016, Heather, who also suffers from mental illness, is prescribed Lexapro for depression and anxiety. This turns out to be a bit of a misdiagnosis - but that’s her story and she tells it better than I do. After being on Lexapro for only a few days, she asks, “Derek, is THIS what you’re feeling? I had no idea, but now I totally get it.” She no longer doubts herself, understanding that my sexual dysfunction has nothing to do with her.
This experience sends me back to the doctor. I sit on the exam table, Heather occupies a chair to my right. The physician enters and sits on a low stool in front of me. He’s slightly older than me, energetic, with a warm face and a decisive manner. I’m sheepish in broaching the subject, talking first about my increasing anxiety and mentioning my low sex drive as an aside. He doesn’t even hesitate.
“It’s the meds.”
“R...really? That easy, huh?”
“Sure, it’s super common with SSRIs. It’s the most common reason people stop them.”
He reads in my face that I could use further clarification. “You’re young. You’re healthy. You have no other clear reason. SSRIs do that all the time. And a healthy sex life is important.” He looks over to Heather and reiterates, “It’s important.” He looks back at me. “Let’s switch the meds.” I feel instantly lighter and I take a deep, easy breath. The last year and a half of sexual anxiety, frustration, and shame get swept away completely with a few words. It’s a beautiful and frustrating moment.
I’m now in the process of adjusting my medications and reconstructing a mental health team. My mental health is not static and will always require maintenance. But I’m learning.
My experience with anxiety is an individual chapter in a much larger story. Mental illness in the U.S. is staggeringly common. More than a third of us - over 100 million people - suffer from anxiety disorders. The risk is higher for medical professionals, and even higher still for veterinarians and women. About half of veterinarians are women and that number is growing rapidly (82 of my 86 classmates at Cornell were women, which is typical around the country). Depression and other mental illnesses are also common. In fact, if you know six veterinarians, one of them has killed themselves, tried to, or seriously considered it.
Mental health statistics indicate that in my veterinary class of under 400 people, between 60 and 80 of us experienced anxiety that significantly disrupted our lives. I was practically swimming in a sea of suffering - and it almost none of us talked about it publicly. When we did, it was rarely in the context of mental illness.
Far more often, people would see the symptoms in others or themselves and say, “She’s just gotta learn to deal with the workload,” or, “I’m just struggling more right now,” or, “She’s just a type-A personality.” The most perverse and indicative excuse of all was, “Welcome to vet school.”
My doctor was right. When people have an acute illness like pneumonia, we say, “I’m ill,” and seek treatment. When we have a chronic physical illness like arthritis, we say, “I’m ill,” and seek treatment. But when we have mental illness, we say nothing, and usually don’t seek treatment. Only about a third of anxiety sufferers receive treatment for their disorder. My mental health team might have seen “a lot” of my colleagues, but there were far more patients they never did see.
Part of the problem is lack of awareness, often self-awareness. Anxiety is a healthy response to stressful situations, but anxiety that persists, is out of proportion to the trigger, or limits productivity is unhealthy. It’s not a weakness, it’s a medical problem.
Another part of the problem is the nonsensical stigma of the “mental illness” label. We’re used to applying that term to folks we pity or fear. We fail to see that the vast majority of mentally ill people function as “normal,” or even “successful,” members of society.
It’s sadly ironic that doctors fall victim to the same traps that hold us back from seeking relief. Even as we become experts in recognizing illness and applying appropriate therapy without judgement, we remain blind to our own illness, or choose to suffer when effective treatment exists. What’s more, we design our medical education to maximize mental stress, creating and furthering our suffering.
We should know better. I should know better. But it’s been ten years since my General Anxiety Disorder diagnosis and I’ve only just now started using the term “mental illness” to describe my GAD. I’m still struggling with what society tells me that being mentally ill says about me. It feels dangerous to admit to mental illness as a caretaker. I love who I am, but I’m unable to reconcile that with having a mental illness. I’m trying to get my heart to follow my head on this one. Saying it out loud helps. Sharing helps.
I’m a veterinarian, and I have a mental illness.
I love who I am, and I have a mental illness.
Thank you for letting me share that with you.
See Part 1 of 3, Part 2 of 3
If you’re struggling, you’re not alone. Reach out - to me, to a friend or family member, to your doctor, to a helpline. Give yourself permission to use every reasonable tool available to you. You deserve it.
National Suicide Prevention Lifeline - Call or chat 24/7 if you are considering suicide
Phone (800)-273-TALK (8255), Online Live Chat
Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline - Get general information on mental health and locate treatment services in your area. Speak to a live person, Monday through Friday from 8 a.m. to 8 p.m. EST.
Phone (877)‑SAMHSA7 (726‑4727), Online SAMHSA Website