chemical bliss

Something extraordinary happened yesterday morning at my psychiatrist's office: At the end of the appointment he said we could go four whole months before we see each other again. This is the longest leash I've been on since I started seeing him two years ago, and while I like the guy and therefore don't mind visiting with him, this vote of confidence does wonders for my mental health–esteem.

It's possible that he was merely trying to make up for the indignity he had just put me through. "Do you mind if I weigh you?" he asked. Um, like, just for kicks? I wondered. Then he heh-heh'd in his befuddled yet oddly soothing voice, which is so restrained it sounds a little like it's coming from the bottom of a well. (His social discomfort is obvious, and I like to imagine that he entered his field in large part to understand himself better.) "Seroquel is known to cause weight gain in a number of patients," he said, producing a scale from beneath his immaculate desk. "I think we should start monitoring that to make sure we're taking care of you on all fronts."

I attribute my four-month psychiatric leash to the miracle of Seroquel—which was added to my cocktail in late December—so I don't want to hear any bad-mouthing about it. I *heart* Seroquel. Since I've phased it into my daily meds I've felt balanced and calm and productive in a way I haven't experienced in years. Odd to think my psychiatrist thought I might be insulted when he first prescribed it.

Let me try to re-create that day for us: I had had an hysterical therapy session following a couple of weeks of mixed episode, a mood state in which depression and mania converge to make for a singularly unlivable frame of mind. My old friends despair and hopelessness had been joined by some cool kids they met on the rough side of town: constant agitation, paranoia, and rage. You can probably guess that this combination of forces might cause a person to feel somewhat self-destructive, or even obsessively so. And there I was, in session with my therapist, with that wild look in my eye that said, "I really, really need you to fix me. Now!" After offering up the Kaiser Permanente Behavioral Medicine solo getaway package—three nights accommodations, meals and meds included, at their downtown "care unit," within walking distance of Chinatown (if you could get past security)—which I declined, my therapist got me an emergency appointment with my psychiatrist that morning, and she reportedly even whispered the name of a medication in his ear: “Seroquel.”

Seroquel is neither an antidepressant nor antianxiety med—it's an antipsychotic that was developed to treat schizophrenia. It was this bit of information that my psychiatrist thought might be off-putting to me, but I just nodded—in the frenetic way becoming of my mood at the time. First off, as a person who feels that she has modern pharmacology and her mental health care team to thank for her current quality of life, I don't make value judgments about this mental illness versus that mental illness. Second, schizophrenia is the one mental illness that can be identified on MRI scans. Having had two MRIs just last year, I'm thinking my doctors would have mentioned it had it shown up. Third, while I was fairly paranoid at the time, I was pretty sure they were required by law to tell me if I were schizophrenic, so I didn't think they were trying to treat me surreptitiously for a condition I didn't know I had. Fourth, did I mention that I felt effing nuts at the time? I would have taken ground glass, or even my friend's placenta, had I thought it would help me.

They wanted me to try a low dose of Seroquel to see if we could get my hard drive to spin down a bit, to stop the racing thoughts and agitation that were not only dominating my day but disrupting my sleep. I was getting 4–5 hours a night at the time, and I was approaching total dysfunction.

My first week on Seroquel brought tempered highs and lows to replace the mixed mood. I fluctuated between hyperactivity and an intense sadness that nevertheless lacked the self-destructive impulses of the earlier state. By my second week I felt like a human being again, not just someone who was getting through the day but a person who had a future. Modern pharmacology rules!

So, yeah, go ahead and weigh me. I can't imagine that my new pal would betray me so, especially since she's given me so much more energy and ambition to actually live my life. Besides, she'll have to go head-to-head with one of her cocktail-mates, Wellbutrin, which has been observed to stimulate weight loss in about 25% of users and is currently undergoing clinical trials in an attempt to gain FDA approval for obesity treatment. Already prescribed to aid smoking cessation, Wellbutrin is an atypical antidepressant that works on "satisfaction" centers in the brain and delivers a bit of a stimulant effect, truly earning the moniker "happy pill." So, with both Wellbutrin and Seroquel in my system, it's hard to say which pill would win in a bitch fight over my weight regulation. I'm betting they cancel each other out as they get to know each other and become synergistic friends. And even if I do gain a couple of pounds, so what? It's probably just the weight of my soul, finally coming back home.