David's Inferno (15 page)

My most vivid memories of returning home from my trip out west in spring 2006 are of the calmingly familiar smells, sounds, and textures of early spring in Vermont. While I certainly wasn't out of the woods, the comforts of home did keep the vibrations in my chest and throat down to a dull roar.

Spring came particularly early for me that year, because I'd followed
it all the way from Missouri, daring the dogwood to keep up with me on my mad dash north.

By the time I arrived at our home, the forsythia were in full bloom, the maple buds were swelling, and the sweet smell of manure (it's an acquired taste) was in the air. I did my best to join in this riotous celebration of renewal. Instead of relying on divine intervention, I found a down-to-earth mechanic to replace my VW's starter. I successfully poured some of my restless energy into regular squash games and bike rides. I transformed the stories of my hellish weeks on the road into a collection of humorous
shticks
. I acted relatively normal during a three-day visit from mom. I even had a crown made—the tooth kind—and, while I may have gagged on that clay stuff they use to make the cast, I refrained from bolting out of the chair, uttering unearthly screams, ripping the dental bib off, and running out the door.

Most impressively, one day I had a flat tire a few miles from home and fixed it calmly, actually smiling as I imagined all the far worse places (mostly in Kansas) where it could have happened.

Throughout the spring of 2006, I told myself and anyone who asked that the hard periods weren't quite so hard, and the okay periods were a bit more okay. But, in reality, I didn't really feel all that different from when I'd left. Occasionally, in the privacy of my own solitude, I dropped the thin veneer of optimism. One day, I made these notes “for future reference.”

Speaking of Valium, among my more vivid memories is the look on my doctor's face when I confessed that once or twice I'd taken up to 30 mg of Valium between about 4
A.M
. and 8
A.M
. as I desperately tried to avoid facing the day.

He managed to retain his calm, clinical tone while explaining that he didn't mind prescribing that much for someone who arrived at the ER just one un-restrain-able thrash short of a straitjacket. In that case, they usually gave an injection. Fortunately, the idea of self-injection never appealed to me, or else he would have been giving the wrong person the wrong idea at the wrong time. I mean it's not like I was overdosing per se: 30 mg–40 mg is, as far as I can tell, the maximum daily prescribed dose. It was probably the 4-hour time period that troubled him. And the fact I was down to 125 pounds. And the fact that I wasn't eating much. The shot of Jameson's the evening before may have also helped visions of rehab dance in his head. It wasn't like I was taking that much every night, either, I reassured him. Often I took as little as 5 mg–10 mg.

I'd been hoping my trip, some spring sunshine, and warm weather would cook the madness out of my system. Instead, I continued negotiating hard turns and false tops on a daily, weekly, and monthly basis. Trying to catch my breath on the occasional downhill.

Just act normal. Those three words are the legendary mantra of all who've ever been drunk, stoned, or more seriously inebriated in public. They are also the moment-by-moment mantra of the mentally incapacitated.

As the spring of 2006 went on, I got a lot of practice.

There was the trip to Burlington with a close friend to see our daughters who both happened to be living there. A calming drive
through the familiar Vermont hills. A fascinating conversation that ranged from farming to writing to politics to education to God. Followed by a wonderful brunch with all four of us, before each of us wandered off to catch up on the life and times of our respective daughters. Yet, what I remember most is trying to act normal; trying to act normal; trying to act normal. My friend and my daughter were both as aware as they could be of what was going on inside me, but I wanted to do whatever I could to make it normal for them, too. Regardless, when that perfect day was over I heaved a sigh of relief.

There was the trip to New York to do some presentations, during which I frantically dug around in my deep store of small talk so I wouldn't suddenly burst into tears and freak out the young, enthusiastic PR person who was guiding me through the day.

There were all those lunches and dinners and midday coffees with friends and acquaintances, during which I managed to provide reasonably good color commentary about what I going through, while trying to mask the fact that I was actually doing play-by-play. My friends weren't totally oblivious, but they had little choice but to play along.

All these experiences reflect the endless internal tug-of-war of agitated depression or mixed states. You want to be alone—away from the pressure to “act normal.” You want to be with people—away from the prison of your own experience. You want to sit still and relax. You have to keep moving or you'll explode. You desperately want to do something. You desperately want to rest.

Like an actor struggling to remember his lines, you present a slightly frazzled, but usually reasonable facsimile of who you were before, while trying to restrain the crazed director from dragging you off the stage. And so you walk through life—the two of you—side by side.

I
'
VE NEVER TAKEN A CHEMISTRY CLASS
. So, when I was prescribed 40 mg of C20H22BrFN2O (a.k.a. Celexa) back in 1999, I just rolled my eyes, rolled the dice, and swallowed.

But, the more I've explored the deep dark recesses of libraries and the Internet, the more curious I've become about what's going on in that twisted bundle of ganglia on top of my neck.

I certainly don't want to belittle the efforts of anyone who's spent countless years and dollars trying to master the jargon and formulae of modern biochemistry. But, neither do I want to belittle the intelligence of any of us who take the drugs they prescribe.

I figure if doctors insist that the best patient is a well-informed patient, we might as well give them a run for their money.

Admittedly, the fact that I spent a couple of hours trying to figure out how many molecules are in a 100 mg tablet of Lamictal may be more a reflection of my OCD than my thirst for knowledge. Fortunately, I gave up and asked my favorite Physics Ph.D., who told me 100 mg of Lamictal has 24.5 hundred billion tera molecules. A tera being a thousand billion. That's a lot of zeroes. (See the Chapter Notes for his entire email. Good luck!)

With the caveat that professionals might quarrel with some of the following, or even the fact that a guy who's never taken a chemistry class is trying to explain it in the first place, I'll try to describe the neurotransmitter theory of depression in terms we ordinary mortals can understand.

This explanation is based on many hours staring at illustrations in a lot of books and on a lot of websites. So, if you really want to follow along, you might want to look up one of those pictures for reference. If, however, this explanation is already giving you headaches, dizziness, palpitations, or, God forbid, sexual dysfunction, I encourage you to move right along to the next chapter.

In other words, “Abandon all hope, ye who enter here.”

It's all in your mind. Sure, but what exactly “it” is, what causes “it,” how to fix “it,” what “fix” even means under the circumstances, and whether it really is “all” … well, there are a whole lot of angels dancing on the heads of those pins and, if you're going to write about the science of depression, you're going to have to dance with quite a few of them.

About fifteen years ago, I came across an article in
Scientific American
(June 1998) entitled, “The Neurobiology of Depression.” After reading it, I convinced myself and many unsuspecting friends that I understood how antidepressants worked. My spiel went something like this:

Since then, researchers have learned a lot more about these processes. And, although it's not a bad overview, I've learned a
lot
more about how
little
I know.

Brain cells (a.k.a. neurons) can't stop talking. Even after you're dead, they keep talking. For a day or more. Until the last one realizes there's no one left to talk to, gets bored, and sends its molecules off to greener pastures.

What with there being ±100 billion neurons up there, you'd think they could just communicate by rubbing up against each other. Unfortunately, they're not allowed to touch. It's against the rules. Instead, each one is separated by a “great” divide called a
synapse
. Synapses are 20–40 billionth of a meter across. That might not sound like very much to you and me, but for a little neuron, it's quite a leap.

Fortunately, neurons know how to make molecules that can leap across that great divide. Those molecules are called
neurotransmitters
, because they
transmit
information between
neurons
.

If you've seen one neurotransmitter, you definitely
haven't
seen them all. Depending on who's counting, there are more than a hundred different kinds, and each one is a slightly different size and shape. However, in terms of whether you are optimistic, pessimistic, paranoid, confident, compulsive, or laid back, there are only a few we need to worry about. Actually, there's no reason to worry. Although, if your neurotransmitters are a little off-kilter, you might not have a lot of choice.