Nothing At All: How Antidepressants Failed Me
By Calvin May -July 8, 2022
一個我在社交媒體上關注的作家最近要求她的聽眾分享他們對 Wellbutrin(安非他酮)的體驗，如果有的話，因為她正在考慮服用它來治療抑鬱症。我的 Wellbutrin 故事太無聊了，無法分享，因為我經歷的唯一負面影響是它未能緩解我的抑鬱症。它沒有像地昔帕明那樣將我的心率提高到危險水平，也沒有像卡馬西平那樣讓我昏昏沉沉以至於無法開車。儘管讓我失敗的藥物平淡無奇，但Wellbutrin的失敗卻是非凡的。它是唯一一種在我的抑鬱症堅持我必須死的情況下沒有將其自身衰弱的副作用堆積起來的抗抑鬱藥。它只是站在一旁，看著我在一天比一天更重的重量下跌跌撞撞，對我的幸福產生的影響就像什麼都沒有。
A writer I follow on social media recently asked her audience to share their experiences with Wellbutrin, if any, as she was considering taking it for depression. My Wellbutrin story was too boring to share, as the only negative effect I experienced was its failure to ease my depression. It didn’t elevate my heart rate to dangerous levels the way desipramine had, nor did it make me so groggy that I couldn’t drive, the way carbamazipine had. As medications that failed me unremarkably go, Wellbutrin’s failure was remarkable nonetheless; it was the only antidepressant that didn’t pile its own debilitating side effects on top of my depression’s insistence that I had to die. It simply stood aside and watched me stumble under a weight that grew heavier every day, exerting the same influence on my well-being as nothing at all.

如果“什麼都沒有”總結了我使用抗抑鬱藥的最佳經驗，那麼它也代表了開這些藥的精神科醫生的平均努力。公平地說，我的精神科醫生是優秀的、勤奮的人，他們願意提供幫助。以下軼事顯示了他們的努力如何受到精神醫學的不完美以及我們作為人的不完美的阻礙，包括我的。
If “nothing at all” sums up my best experience with antidepressants, it also represents the averaged efforts of the psychiatrists who prescribed them. To be fair, my psychiatrists were good, hard-working people who wanted to help. The following anecdotes show how their efforts were hampered by the imperfection of psychiatric medicine and our imperfections as people, including mine.

我的第一位精神科醫生不可能知道地昔帕明會將我的心率提高到危險水平。在嘗試之前，藥物的效果是未知的。然而，我責怪他沒有警告我這樣的效果是可能的。當時我在軍隊，每周有幾天強制要求跑一英里半。如果他不得不開出一種藥物，這種藥物在與軍事生活相結合時可能會引發心髒病，他至少可以告訴我要注意什麼。我“幸運”的是，導致我第一次自殺未遂的事件發生在我開始服用地昔帕明後不久。我的生命體徵經常在精神病房檢查，問題很快就被發現了。但這次經歷讓我對精神病醫生的信任能力出現了細微的裂痕。
My first psychiatrist could not have known that desipramine would elevate my heart rate to dangerous levels. The effect of a medication isn’t known until it is tried. I fault him, however, for not warning me that such an effect was possible. I was in the military at the time, doing mandatory mile and a half runs several days a week. If he had to prescribe a medication that could provoke a heart attack when combined with the exertions that accompany military life, the least he could have done was tell me what to watch for. I was “fortunate” that the events leading to my first suicide attempt occurred shortly after I started desipramine. My vitals were checked frequently in the psych ward and the problem was soon discovered. But this experience left a hairline crack in my ability to trust psychiatrists. I was still willing to give antidepressants a try, but every successive medication failure and every bad interaction with a psychiatrist eroded that trust a bit more.

我的第二位精神科醫生有一個不幸的缺陷，破壞了他的同情心和正派：當他決定把我塞進哪個鴿舍時，他就不再聽我說話了。他弄錯了很多事情，當我試圖解釋他的觀點與事實有何不同時，他並不感興趣。具有諷刺意味的是，當我們第一次見面時，他告訴我的第一件事是，他知道我需要時間才能放心地分享傷害我的事情。顯然，當這些事情集中在他對與我的情況有關的事實的駁回上時，他不想听到它。有一天，我取消了與他的約會，再也沒有回來。我的信任被進一步打破；有效的治療取決於對問題的深刻理解，如果他不願意傾聽，我們就無法做到這一點。
My second psychiatrist possessed an unfortunate flaw that undermined his compassion and decency: the moment he decided which pigeonhole to stuff me into, he stopped listening to me. He got a number of things wrong, and when I tried to explain how his opinion differed from the facts, he wasn’t interested. Ironically, one of the first things he told me when we first met was that he knew it would take time for me to feel comfortable sharing the things that were hurting me. Apparently, he did not want to hear it when those things centered around his dismissal of the facts pertaining to my situation. I blew off an appointment with him one day and never returned. My trust was broken further; effective treatment depends on a solid understanding of the problem, and we could not achieve that if he wasn’t willing to listen.

我的第三位心理醫生很不幸。我們見面時他做的第一件事就是拿起手機告訴我他必須回電話，然後慢慢收回手說，不，我已經等得夠久了，讓我們開始吧，好嗎？如果大衛馬梅特站在角落裡，在場景結束時大喊“切”，他的獨白就再上演了。當時我參加了 VA 的 voc 康復計劃，我的參與取決於是否接受針對我的問題的治療。所以我繼續看到那個不誠實的蠢貨，因為我不相信我有選擇。當我告訴他最近剪裁的衝動很快消散時，情況發生了變化。他說：“你讀書嗎？這是一個相當高級的詞！既然你好像有詞彙量，我就不用和你說了。” 不開玩笑，笨蛋。我四歲才開始讀書 “消散”並不是一個特別高級的詞，而且該設施中的其他提供者設法尊重他們的患者，無論他們對他們的智力的看法如何。當然，我不相信我可以說出這些，因為我擔心我會因此受到懲罰。但我信任能力的裂縫已經不可挽回地加深了。我再也沒見過他。
My third psychiatrist was simply unfortunate. The first thing he did when we met was reach for his phone and tell me that he had to return a call, then withdraw his hand slowly and say, no, I had waited long enough so let’s get started, shall we? His monologue couldn’t have been more staged if David Mamet had been standing in the corner, yelling “cut” as the scene ended. I was in the VA’s voc rehab program at the time, and my participation was contingent on receiving treatment for my issues. So I continued to see that disingenuous jackass because I didn’t believe I had a choice. That changed when I told him that a recent urge to cut had dissipated quickly. He said, “Do you read? That is a pretty advanced word! Since you seem to have a vocabulary, I don’t need to talk down to you.” No kidding, jackass. I’ve only been reading since I was four, “dissipated” is not a particularly advanced word, and other providers in this facility manage to treat their patients with respect whatever their opinions of their intellects may be. Of course, I didn’t believe that I could voice any of this, as I feared I would be punished for doing so. But the cracks in my ability to trust had deepened irrevocably. I never saw him again.

我的第四位也是最後一位精神科醫生終於開車回家了，治療是多麼絕望。我遠非一個理想的病人。我日益惡化的信任和對被迫重新接受治療的日益增長的怨恨使我充滿惡意，不願分享可能有幫助的事情。我最後的心理醫生似乎願意聽，但很多時候，我什麼也沒說。我需要感覺到我可以控制自己的命運，並且我用我認為自己擁有的唯一力量來堅持這一點。我的沉默。我過去的經歷在本應進行富有成效的對話的空白中發酵。對以前互動的記憶使我對新人的期望很少，再加上對以前藥物的回憶，這些藥物對我的抑鬱症沒有任何作用，同時阻礙了我的副作用，從刺激性到危險。儘管有這個包袱，如果我們要坐在他的辦公室裡，佔用彼此的時間，我本可以努力的。很多時候，我沒有。
My fourth and final psychiatrist finally drove home how hopeless treatment was. I was far from an ideal patient. My deteriorating trust and growing resentment over having been forced back into treatment made me spiteful and unwilling to share things that might have helped. My final psychiatrist seemed willing to listen, but much of the time, I said nothing. I needed to feel that I had control over my fate, and I asserted this with the only power I believed I had. My silence. My past experiences stewed in that void where a productive conversation should have taken place. Memories of previous interactions that had conditioned me to expect little from the new guy coupled with recollections of previous medications that had done nothing for my depression while impeding me with side effects that ranged from irritating to dangerous. Despite this baggage, I could have made an effort if we were going to sit in his office and take up each other’s time. Much of the time, I didn’t.

當然，當我有機會告訴新來的人我需要什麼藥物時，他讓我大吃一驚，這並沒有幫助。我想成為一名木匠，而佐洛夫特讓我行動遲緩，工作變得困難。請問我可以服用一種不會阻礙我的目標的抗抑鬱藥嗎？當他描述他選擇的藥物卡馬西平時，我知道他打消了我的顧慮。“當你在上面時，你將無法駕駛或操作機器。” “太好了，”我說。“通勤我在櫥櫃店的工作已經結束了。” “哦，你在櫥櫃店工作？你在那兒做什麼？” “操作機器。” 也許沒有一種藥物會起作用。但他不願討論我的擔憂並沒有扭轉我已經存在的信任問題。
Of course, it didn’t help that when I took a chance on telling the new guy what I needed from my medication, he blew me off. I was trying to become a cabinetmaker and Zoloft had made me sluggish, making it difficult to work. Could I please have an antidepressant that didn’t obstruct my goals? I knew he’d blown off my concerns when he described carbamazepine, the medication he had chosen. “You won’t be able to drive or operate machinery while you are on this.” “Great,” I said. “Commuting to my job at the cabinet shop is out.” “Oh, you work in a cabinet shop? What do you do there?” “Operate machinery.” Maybe there wasn’t a medication that would have worked. But his unwillingness to discuss my concerns did little to reverse the trust issues I already had.

大約在這個時候，我開始自殺，同時經歷了我有史以來最嚴重的精神病發作。回到精神病房是清醒的。我的問題很嚴重，促使我決定給卡馬西平打一針。挫折感很快就開始了。必須監測血液中藥物的含量，所以我在去看精神科醫生之前就向實驗室報告了。他會檢查他的電腦，發現我的結果還沒有在系統中，然後打電話給實驗室。實驗室會告訴他，卡馬西平小組是在夜班前完成的，第二天早上就會得到結果。第二天我會回來，他會說它沒有達到治療水平，所以我們需要增加劑量，“但不要太多，因為你的肝功能讓我擔心。” 像鋰一樣，卡馬西平對肝臟很不利。這讓我很擔心，因為我得知這位精神科醫生有記憶問題。每次我見到他，他看到我的結果沒有出來，他就會打電話給實驗室，他們每次都告訴他，夜班做那些，明天再打。我是否會因為他無法跟踪我的血液檢查而最終需要進行肝移植？
Around this time, I became suicidal while experiencing my worst psychotic episode ever. Returning to the psych ward was sobering. My problems were serious, spurring my decision to give carbamazepine a shot. The frustrations began quickly. The levels of the medication in the blood must be monitored, so I reported to the lab before I saw the psychiatrist. He would check his computer, discover that my results weren’t in the system yet, and call the lab. The lab would tell him that carbamazepine panels were done by the night shift and the result would be available the next morning. I would come back the following day and he would say it wasn’t at therapeutic levels so we needed to up the dose, “but not too much because your liver function is worrying me.” Like lithium, carbamazepine is hard on the liver. This was worrisome for me because I learned that this psychiatrist had memory problems. Every time I saw him, he would call the lab when he saw that my results weren’t in, and they told him every time that the night shift does those, call back tomorrow. Was I going to end up needing a liver transplant because he couldn’t keep track of my blood panels?

最重要的是，藥物使我昏昏沉沉，以至於我經常錯過工作。很多天我不能開車。當我在工作時，我無法集中註意力。因為無法專心做事，我差點被電鋸割斷拇指的那一天，是我接受精神病治療的最後一天。我處理掉了剩下的藥片，再也沒有見過那個精神科醫生——或任何精神科醫生——。我的需求與精神科醫生和抗抑鬱藥提供的護理截然不同，以至於製藥公司圖表上描述我們的三條線永遠無法解決。
On top of that, the medication made me so groggy that I often missed work. Many days I couldn’t drive. When I was at work I couldn’t focus. The day I nearly cut my thumb off on a power saw because I couldn’t concentrate on what I was doing was my final day under psychiatric care. I disposed of my remaining pills and never saw that psychiatrist—or any psychiatrist—again. My needs differ so radically from the care that psychiatrists and antidepressants provide that the three lines describing us on a pharmaceutical company’s graph will never meet at a solution.

儘管我認為我的 Wellbutrin 故事太無聊而無法分享，但我還是與作者分享了它，作為在這裡更全面地講述這個故事的前奏。很多時候，我不得不證明我決定停藥是合理的，我希望這個敘述能做到這一點。雖然我選擇不服用藥物來治療我的抑鬱症，但我並不主張每個人都應該放棄他們的藥物，或者我們應該將精神科醫生從醫療保健中驅逐出去。我只是希望精神科醫生更好地識別患者的個性，並幫助他們找到適合他們的願望和疾病的解決方案。正如我在給作者的最後一封信中所說，“我希望你能找到適合你的解決方案，無論是否涉及抗抑鬱藥。祝你好運。”
Despite my assessment that my Wellbutrin story was too boring to share, I shared it with the writer anyway as a prelude to telling the story more fully here. Many times, I have had to justify my decision to go off meds and I hope that this narrative will do that. While I have opted out of taking medication to treat my depression, I do not claim that everyone should abandon their meds or that we should exile psychiatrists from healthcare. I would simply like psychiatrists to do a better job of recognizing the individual character of their patients and to help them find solutions that suit their aspirations as well as their illnesses. As I said in my final message to the writer, “I hope you find a solution that works for you, whether it involves antidepressants or not. Good luck.”

***
原文:
https://www.madinamerica.com/2022/07/nothing-at-all-how-antidepressants-failed-me/

Mad in America 擁有不同作家群體的博客。這些帖子旨在作為一個公共論壇，廣泛地討論精神病學及其治療。所表達的意見是作者自己的。

卡爾文·梅一代人中出現了一個具有非凡能力來解釋人類狀況的人。卡爾文·梅不是那個人。但他知道在對人類需求或痛苦漠不關心的系統中導航時自殺是什麼感覺。