Sunday, February 22, 2009

A Farewell to Pasta

For many years I took a middling twice-daily dose of bupropion (a.k.a. wellbutrin or zyban) to moderate depression and anxiety. This December I tailed off, and finally quit altogether.

It was a good drug for me, arrived at after a fair amount of experimentation and observation by a terrific nurse-practitioner, who understood that antidepressant prescription is a fiddly incremental process, requiring experimentation and observation. We ran through a number of drugs, in different combinations and dosages, to arrive at it.

I didn't ordinarily so much notice the drug's effect as notice its absence if I forgot to take it. If I forgot it in the morning, by noon I could feel my anxiety levels rising; I could feel depression starting to stalk me, looming behind me, weighing his club. But the short-term effect that was a dead give-away, which happened even before that, was that I became angry, and found myself obsessing on some trivial irritation. Crankiness is one of the few vices I don't have, so if I found myself composing vituperative letters to the editor, or imagining domestic showdowns and ultimatums over, say, putting away the hairbrush in the same place every day, I'd check my pillbox. Sure enough. Forgot them this morning. (This sort of monitoring of my own emotional state, by the way, and being able to back off from it and evaluate it, is something I attribute directly to meditation: it's something I learned on the cushion, and it's been immensely useful.)

I've always hated taking the meds. They're scary drugs, and nobody really knows what happens when you take them long-term. Over the years I'd experimented several times with dropping my bupropion dosages. (You should do this very carefully, by the way, with any antidepressant, especially the SSRI's: it's easy to precipitate a psychotic episode by stopping them abruptly.) After the initial uncharacteristic crankiness, I could sail along all right for a few days. But pretty soon anxiety and depression would be disabling me again. Back to the meds.

This time, though, it worked. No depression. No anxiety. No crankiness even. I've been on an even keel for months now, without meds. Until last week.

On thursday morning I went into the kitchen to find a considerable mess, dirty pots and pans, sink full of dishes, half-empty cat food cans, the stovetop obscured by the pancake griddle (dirty.) I was furious. That was it. "If you don't want to clean up after yourself, you can find someplace else to live," I told the perpetrators (in my head.) I told them all about their delusions of privilege, and how their assumption that I was their servant was actually mistaken, thank you very much, and how I'd supported their useless parasitic lives for long enough, and this was my house, and if they wanted to keep living there, etc., etc. At that point, the monitor gently intervened, with his habitual question: "uh, half a moment, Dale. Have you by any chance forgotten your meds?"

Well, no, I hadn't, because I wasn't taking them any more. But this was clearly, clearly brain chemistry run amok. What was going on?

And in a moment of illumination, I knew, I knew both why I was cranky that morning, and why I hadn't been needing the antidepressants for the past few months. I knew what was different. I had bowed gracefully to the anxiety of these launches by telling myself (as I did over Christmas time) that for these three days I was dealing with enough, and I didn't need to pressure myself about my eating as well. Forget the carb restriction. Eat whatever you want, Dale. We'll get back to it when we're done with the scary stuff.

So the night before I had eaten an enormous bowl of pasta, and feasted on corn chips after that. And a few chocolate chips to round it off. A huge hit of high-glycemic carbohydrates. I could feel it, now that my awareness was on it: that desperate hunger, the insulin backswing. It was no accident that what made me so angry was an obstacle on my way to getting food. I would need to clean to stove before making my eggs. Breakfast would be five minutes later than I thought. Absolutely intolerable.

I was so delighted by this discovery that my anger began to ebb. I cleaned the stove and made my eggs. And after eating them, I no longer wanted to order people out of my house. I was able to formulate the thought that perhaps asking them to clean up would be a more proportionate and reasonable response. I was able also to note that I had actually generated a good third of the mess myself, something that had been completely invisible to me before.

The weight-loss has been interesting. I dropped twenty-some pounds right away when I started this, but then I levelled off at a shade over 200 lbs. I'm not sure whether I'm losing any more weight or not. The variations since then have been within my measurement margin of error. I'm guessing not: that if I eat "white stuff" (white flour, sugar, corn syrup, white rice, potatoes, pasta) my weight will tend to hover at 235, and that if I don't it will hover around 200. I'd love to be lean, but I have no intention of inflicting a restricted-calorie diet (what Gary Taubes accurately designates "a semi-starvation diet") on myself. If my hypothalamus wants me to weigh 200 lbs., 200 lbs. it is. I'm a big stocky Norwegian with a lot of muscle: 200 lbs. doesn't look that bad on me.

So this is it, I think. A farewell to white stuff. Pasta, adieu!

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