If We Knew What We Know Now
布魯克·西姆-2022 年 8 月 19 日
Brooke Siem -August 19, 2022
“我不知道我不知道什麼，”我媽媽說，我正在量一杯麵粉來做一批鬆餅。自從我從嚴重的抗抑鬱藥戒斷中恢復過來已經五年了。自從我服用最後一種抗抑鬱藥以來已經六年了。在我父親突然去世後，我在十幾歲時第一次服用抗抑鬱藥已有 20 年了。
“I didn’t know what I didn’t know,” my mother says while I’m measuring a cup of flour for a batch of muffins. It’s been five years since I recovered from severe antidepressant withdrawal. Six years since I took my last antidepressant. Twenty years since I was first put on antidepressants as a teenager, in the wake of my father’s sudden death.

“我只知道，”媽媽繼續說，“有一天，兒童心理學家打電話給我說，‘你在浪費錢。布魯克需要的是精神科醫生，而不是心理學家。我正在診斷焦慮症和抑鬱症，你應該考慮藥物治療。當我要求對此結論作出解釋時，她說因為 HIPAA，她無法告訴我任何事情。我剛剛失去了三分之一的家人，我無法忍受失去三分之二的想法。專業人士建議用藥。我不是醫生。我還應該做什麼？”
“All I knew,” my mother continues, “was that one day, the child psychologist called me and said, ‘You’re wasting your money. What Brooke needs is a psychiatrist, not a psychologist. I’m diagnosing an anxiety and depressive disorder and you should consider medication.’ When I asked for an explanation for this conclusion, she said she couldn’t tell me anything because of HIPAA. I’d just lost one third of my family and I couldn’t bear the idea of losing two thirds. The professionals recommended medication. I wasn’t a doctor. What else was I supposed to do?”

我點點頭，擦了擦量杯。我現在三十六歲，高中畢業後回到家鄉。回家已經變成了一種清算(reckoning)，讓我可以穿越時空，追隨最終奪走我生命的責任之線。每天我開車經過我過去的雕像。我第一次服用抗抑鬱藥的童年之家。我父親去世的醫院。兒童心理學家辦公室。每天我都在想，如果那位醫生——以及隨後的所有醫生——提出不同的建議，我可能會是誰。
I nod, wiping off a measuring cup. I’m thirty-six now, back in my hometown after being away since high school. The homecoming has turned into a reckoning, allowing me to wander back through time and follow the thread of responsibility that ultimately robbed me of so much of my life. Every day I drive by statues of my past. The childhood home where I took my first antidepressant. The hospital where my father died. The child psychologist’s office. Every day I wonder who I might have been if that doctor—and all the doctors that followed—made a different recommendation.

這一切發生得太快了。那是 2001 年在內華達州里諾市。步槍隨意地放在沙發後面，撥號上網是一種奢侈。通用百憂解最近已獲准出售。只需要與當地的兒童精神科醫生進行一次 20 分鐘的預約即可獲得劇本。舍曲林讓位於文拉法辛，氟伏沙明導致安非他酮。悲傷變成了灰，灰變成了標準。我從來沒有問過我周圍的成年人，也沒有想過藥物是否有必要。當然，它們是必要的。一位醫生這樣說。
It all happened so fast. It was 2001 in Reno, Nevada. Rifles casually rested behind couches and dial-up internet was a luxury. Generic Prozac had been recently cleared for sale. All it took was a single twenty-minute appointment with the local child psychiatrist to get a script. Sertraline gave way to venlafaxine and fluvoxamine led to bupropion. Grief turned to gray and gray became standard. I never questioned the adults around me or wondered if the medications were necessary. Of course they were necessary. A doctor said so.

沒多久，我的頭髮就一團團地掉了下來。我在半夜醒來，腿抽筋很厲害。有時我會隨機吐出膽汁。驗血顯示甲狀腺功能低下，內窺鏡檢查證實膽汁反流病，這是一種罕見的情況，膽汁從肝臟回流到胃部。分別為甲狀腺功能減退症和膽汁反流病開了兩劑 Synthroid 和四劑硫糖鋁。最後，我得到了標準的美國青少年節育處方，然後是四環素治療頑固痤瘡的處方。總而言之，當我大到可以點啤酒時，我已經服用了七種不同的藥物。在接下來的十五年裡，我會一直服用這套藥物。

Soon, my hair was falling out in clumps. I woke up in the middle of the night with excruciating leg cramps. Sometimes I randomly threw up bile. A blood test showed low thyroid function and an endoscopy confirmed Bile Reflux Disease, an uncommon condition where bile from the liver backs up into the stomach. Two doses of Synthroid and four doses of Sucralfate were prescribed for hypothyroidism and Bile Reflux Disease, respectively. Finally, I was given the standard American teen prescription for birth control, which was followed by a script for tetracycline to treat stubborn acne. All in, I was on seven different medications by the time I was old enough to order a beer. I would stay on this set of drugs for the next fifteen years.

“事後看來，這一切似乎都那麼明顯，”我媽媽一邊攪拌鬆餅麵糊一邊說。“你服用了這些抗抑鬱藥，突然我們每兩分鐘就去看一次胃腸病學家。我認為它們是不同的問題。從來沒有人向我暗示過抗抑鬱藥可能會導致所有這些身體症狀。你在大學或紐約的醫生有沒有做過這種聯繫？”
“It all seems so obvious with beautiful hindsight,” my mother says as I stir the muffin batter. “You got on these antidepressants and suddenly we’re at the gastroenterologist every two minutes. I thought they were separate issues. No one ever suggested to me that the antidepressants could be causing all these physical symptoms. Did any of your doctors in college or in New York ever make that connection?”

我停止攪拌鬆餅並回想起來。我在四年內見過我的大學心理醫生四次。她介於中年和老年人之間，眼神善良，頭髮花白，穿著格子鈕扣和勃肯鞋。她把頭髮編成辮子掛在她的右肩上，當很明顯我只是在那裡盡職盡責時，她沒有逼我說話。我喜歡她的這一點，我喜歡帶著一摞新的處方單走出她的辦公室的舒適感。每一個塗鴉都證實了憂鬱、缺乏雄心和漫無目的。我很沮喪。破碎到需要藥物修復。破碎到無法對自己或我的生活抱有太多期望。破碎到放棄嘗試幫助自己，並且年輕到認為我已經想通了。
I stop stirring the muffins and think back. I saw my college psychiatrist four times in four years. She was somewhere between middle-aged and elderly, kind-eyed, gray-haired, and clad in plaid button-downs and Birkenstocks. She wore her hair in a braid that hung over her right shoulder and didn’t push me to talk when it was clear that I was just there to do my due diligence. I liked that about her, and I liked the comfort of walking out of her office with a fresh new stack of prescription slips. Each scribble validated the melancholy, the lack of ambition, and the aimlessness. I was big-D Depressed. Broken enough to need pharmaceutical fixing. Broken enough not to expect much of myself or my life. Broken enough to give up trying to help myself, and young enough to think I had it all figured out.

“大學裡沒有人提到它，”我說，把注意力轉移到把鬆餅襯裡塞進罐子裡，“反正我也不會聽。當你二十歲還在上大學的時候，假裝你很深沉，很沮喪，沒有人能真正理解你，這很可愛。但我確實記得搬到曼哈頓並想，‘我住在公寓裡。我負責用食堂裡找不到的食物餵自己。是時候至少試著把我的狗屎放在一起了。’”
“No one mentioned it in college,” I say, returning my attention to slipping muffin liners into tins, “and it’s not like I would have listened anyway. When you’re twenty and still in college, it’s cute to pretend you’re deep and depressed and that no one can truly understand you. But I do remember moving to Manhattan and thinking, ‘I live in an apartment. I am in charge of feeding myself with food not found in a dining hall. It’s time to at least try to get my shit together.’”

“那是你去看那個可怕的德國精神病醫生的時候？” 我媽媽說。“她又叫什麼名字？”
“And that’s when you went to see that awful German psychiatrist?” my mother says. “What was her name again?”

“我不記得了，”我說，舔著抹刀上的麵糊。“我一直認為她是弗洛伊德的淑女版，穿著櫻桃紅色的褲子套裝。我希望我能知道她是誰，因為我很想知道她是否還有醫療執照。”
“I can’t remember,” I say, licking batter off the spatula. “I always thought of her as a lady-version of Freud, dressed in a cherry-red pants suit. I wish I had some idea of who she was, because I’d be curious to see if she still has a medical license.”

至少根據《紐約雜誌》，Ladyfreud 博士被認為是紐約市最好的醫生之一。她被列為他們年度“最佳”問題的一部分，就在“最佳定制木工”和“紐約最佳通靈師”旁邊。
Dr. Ladyfreud was considered one of New York City’s Best Doctors, at least according to New York Magazine. She was listed as part of their annual “Best Of” issue, right next to “Best Custom Woodworkers” and “Best Psychics in New York.”

在 22 歲時，我放棄了所有醫生生來平等的想法，所以我沒有想到從印在紐約市最好的等級制度旁邊的名單中挑選一名精神科醫生的想法手工蛋黃醬。此外，Ladyfreud 博士正在接受新患者並且在我的保險網絡中，這兩個要求被證明很難找到。
At twenty-two years old, I operated off the idea that all doctors were created equal, so it didn’t occur to me to question the idea of picking a psychiatrist off of a list printed right next to a hierarchy of New York City’s best artisanal mayonnaise. Besides, Dr. Ladyfreud was taking new patients and was in my insurance network, two requirements that proved tricky to find.

在一個陽光明媚的秋日，我漫步到 Ladyfreud 博士的辦公室，當時我正要適應紐約市的生活。明亮的戶外讓位於一個黑暗的候診室，藍色氈椅，玻璃板後面的男性接待員。
I wandered to Dr. Ladyfreud’s office on a sunny fall day, just as I was settling into my new New York City life. The bright outdoors gave way to a dark waiting room, with blue felt chairs, a male receptionist behind a glass plate.

“在您見到 Ladyfreud 博士之前，她需要您觀看視頻並進行測試。大約有四十五分鐘，”接待員說，帶我到一個六英尺乘六英尺的房間，有一把椅子和一台舊電視。他遞給我一疊紙和一支鉛筆。“準備好後，只需推入磁帶並按‘播放’即可。”
“Before you see Dr. Ladyfreud, she needs you to watch a video and take a test. It’s about forty-five minutes long,” the receptionist said, leading me to a six-foot by six-foot room, with a single chair and an old TV. He handed me a stack of paper and a pencil. “When you’re ready, just push in the tape and press ‘play.’”

他指了指電視機下方的錄像機。
He gestured to the VCR below the TV.

“對不起，”我困惑地說。“要我考試嗎？我不能去看醫生嗎？我想談談我服用了六年的藥物。”
“I’m sorry,” I said, confused. “You want me to take a test? Can’t I just see the doctor? I want to talk about the medication I’ve been on for six years.”

“這是她診斷的一部分。完成後她會和你一起檢查你的結果。說完就出來找我。”
“This is part of her diagnosis. She’ll go over your results with you after you’re finished. When you’re done, just come out and find me.”

他走出門，關掉了主燈，只剩下電視的眩光來照亮我的測試。
He walked out the door and turned off the main light, leaving me with nothing but the glare from the TV to illuminate my test.

我嘆了口氣，啟動了錄像機。舊電視一直在閃爍，直到片尾字幕播放完畢，很快，穿著櫻桃紅褲子套裝的 Ladyfreud 博士就在屏幕上用濃重的口音跟我說話。
I sighed and started the VCR. The old TV flickered until the intro credits ran, and soon Dr. Ladyfreud, in the cherry-red pants suit, was talking to me in a thick accent from the screen.

“你好。我是Ladyfreud 博士。謝謝你來我的辦公室。請花時間仔細觀看以下視頻，並按照視頻的指示回答考試中的相應問題。您將有足夠的時間來回答每個問題。不要跳過，並確保在回答之前仔細觀看每個部分。誠實地回答是非常重要的。我們現在就開始測試。”
“Hello. I am Dr. Ladyfreud. Thank you for coming to my office. Please take this time to watch the following video closely, and to answer the corresponding questions on your test, as the video instructs. You will be given plenty of time to answer each question. Do not skip ahead and be sure to watch each part carefully before answering. It is very important that you are honest in your answers. We will begin the test now.”

視頻切換到另一個介紹，這次是一個男人告訴我，在他問完每個問題後，他會停下來給我時間回答。
The video cut to another introduction, this time with a man telling me that after he asked each question, he would pause to give me time to answer.

“第一個問題，”男人繼續說道。“沒有明顯的原因，我有時會非常生氣或充滿敵意。答：完全沒有。只是一點點。有些。適度。非常多。非常頻繁。請用你的鉛筆在你的測試中圈出最能回答這個問題的選項。”
“Question number one,” the man continued. “For no obvious reason, I sometimes have been very angry or hostile. Answer: Not at all. Just a little. Somewhat. Moderately. Quite a lot. Very frequently. Using your pencil, please circle the option on your test that best answers this question.”

我像父親一樣急躁，“適度”地盤旋並等待。
Quick to anger just like my father, I circled “moderately” and waited.

“第二個問題：有時我比平時更健談或說得更快。一點也不。只是一點點。有些。適度。非常多。非常頻繁。” 我圈了，“有時。” 不是每個人在興奮或著急的時候說話都快嗎？
“Question number two: At times I am much more talkative or speak much faster than usual. Not at all. Just a little. Somewhat. Moderately. Quite a lot. Very frequently.” I circled, “Sometimes.” Doesn’t everyone talk faster when they’re excited or in a hurry?

我讓下一組陳述來來去去，當我意識到這個人需要多長時間才能進入下一個問題時，我變得越來越沮喪。
I let the next set of statements come and go, growing frustrated as I realized how long it would take for the man to move on to the next question.

“有時我對性比平時更感興趣。” 一點也不。
“At times I am much more interested in sex than usual.” Not at all.

“有時我會有死亡的念頭，比如早上不想醒來或繼續想自殺。” 適度。
“At times I have thoughts of death, such as not wanting to wake up in the morning or continuing thoughts of suicide.” Moderately.

“有時我的工作質量或數量會有很大差異。” 適度。
“At times there have been great variations in the quality or quantity of my work.” Moderately.

“儘管睡眠時間比平時少很多，但我發現我很放鬆，精力充沛。” 一點也不。
“Despite getting a lot less sleep than usual, I find I am rested and full of energy.” Not at all.

“有時我的精神很遲鈍，有時我的想法很有創意。” 我對這個問題失去了耐心，意識到這個視頻是關於確定我是否患有雙相情感障礙。我知道我不是躁鬱症。即使我是，我知道它不應該通過錄像帶來診斷。
“Sometimes I am mentally dull and sometimes I think very creatively.” I lose my patience with this question, realizing that this video is about determining whether or not I have bipolar disorder. I know I’m not bipolar. And even if I was, I knew it shouldn’t be diagnosed through a videotape.

我停止了視頻，瀏覽了剩下的測試，然後回到接待員那裡。他看了看表，道：“還不到四十五分鐘。”
I stopped the video, thumbed through the rest of the test, and went back to the receptionist. He looked at his watch and said, “It hasn’t been forty-five minutes yet.”

“我一直是一個快速的應試者，”我說，砰的一聲把試卷放在桌子上。我考慮過放棄約會，但我只剩下一個筆芯了，並且已經支付了我的共付額。如果不出意外，至少我可以得到一個新的處方(script)，並讓自己從這個地獄中再過幾個月。
“I’ve always been a fast test taker,” I said, slamming the papers on the desk. I considered walking away from the appointment, but I only had one refill remaining and had already paid my copay. If nothing else, at least I could get a fresh script and save myself from this hell for another few months.

Ladyfreud 博士把我叫到她的辦公室，我發現她坐在行政辦公桌後面，房間裡擺滿了她所有的證書、獎項，當然還有她提到的紐約最佳醫生的剪報。我和她坐了十分鐘，告訴她我正在服用的所有藥物，我不認為我是雙相情感障礙，我只是來這裡談論停止服用抗抑鬱藥或補充藥物。她似乎在看我的測試時看穿了我，用她濃重的口音告訴我，“對於像你這樣的患者，我不建議停止服藥，因為你的測試中的一些答案可能是個問題。” 她從來沒有要求我詳細說明或問我為什麼吸毒。即使我坐在她面前，我也只是一個數據點。
Dr. Ladyfreud called me into her office and I found her sitting behind an executive desk in a room adorned with all of her certificates, awards, and of course, clippings from each of her Best Doctor in New York mentions. I sat with her for ten minutes, told her all the medications I was taking, that I didn’t think I was bipolar, and that I was only here to talk about getting off my antidepressants or get a refill. She seemed to look through me in between glances at my test, telling me in her thick accent, “For patients like you, I do not recommend going off the medications as some of the answers on your test could be a problem.” At no point did she ask me to elaborate or ask me why I was put on the drugs. Even though I sat right in front of her, I was nothing but a data point.

“當你的筆芯用完時回來，然後我們會談談。您可以提前預約。謝謝你進來。”
“Come back when you are out of refills and we will talk then. You can make another appointment out front. Thanks for coming in.”

“我記得你告訴我那個故事的時候，”我媽媽一邊說，一邊凝視著鬆餅罐，我把麵糊舀進內襯裡。“我簡直不敢相信。”
“I remember when you told me that story,” my mother says, peering into the muffin tins as I scoop batter into the liners. “I couldn’t believe it.”

“紐約市最好的之一，”我說。

“One of New York City’s best,” I say.

“如果那是紐約最好的之一，我想知道紐約最差的在做什麼。”

“好吧，如果我的曼哈頓全科醫生有任何跡象，他們會在沒有進行身體檢查的情況下接受新患者。他歡迎我來到紐約​​市，問我是否對我的藥物平衡感到滿意，並將處方寄給藥房。這很容易而且沒有頭腦。比不得不拖著自己在城裡走來走去，每次共付額花費 50 美元，試圖找到一個“得到”我的精神病醫生來說，工作量要少得多。似乎沒有人擔心，那我為什麼要質疑呢？”

“我質疑它，”我媽媽說。“隨著歲月的流逝，你似乎正走在這條下降的軌道上。但我知道你沒有任何問題。每次我建議藥物可能是問題的一部分時，你就讓我失望了。”

“我想我聽不到你的聲音。我對這些藥物感到非常沮喪，我無法想像我會變得多麼糟糕。” 我擦掉鬆餅罐邊緣的幾滴麵糊，然後把鬆餅放進烤箱。“但當我 30 歲時，我突然意識到我已經吸食了大半輩子的藥物，但我仍然在想著自殺，終於有什麼事情發生了。經過十五年的抗抑鬱藥治療後，我不應該如此沮喪。”

“你終於準備好了，”我媽媽說。

我安靜下來，想著接下來會發生什麼。如果我對如何擺脫抗抑鬱藥進行更多研究，可能會避免什麼痛苦？或者如果我得到了第二意見？2016 年，抗抑鬱藥撤藥並非鮮為人知。主要報紙還沒有就該主題發表文章，但 Giovanni Fava 的研究已經存在，並且互聯網上存在強大的支持網絡。我已經 30 歲了，準備把所有事情都做好。我準備與可以幫助我的醫生合作。我準備停止戰鬥。我已經準備好相信一種不同的生活，更好的生活的可能性。

我做了我應該做的一切。我找到了一位新的精神科醫生，並告訴了她一切，關於我父親的死亡，十五年的毒品，以及作為一個沒有藥物治療的成年人了解自己的願望。當她說她認為我在壓力和變化期間更換藥物對我來說不是一個好主意時，我反駁說：“我身上發生的一些事情不起作用。我不知道是不是用錯了抗抑鬱藥，還是這些藥不再起作用了，或者我的腦袋太糟了，這就是永遠的樣子。我不明白如果不通過處方來確定我的基線，我應該如何獲得這些問題的答案。”

她看了看鐘。在她的剪貼板上劃了一些東西。嘆了口氣，搖了搖頭。

“如果你決定繼續前進，我認為你最好從 Effexor 開始一個一個地嘗試關閉它們，因為你已經處於最低劑量，所以我們不能逐漸減少。Effexor 比 Wellbutrin 更有可能產生戒斷作用。”

我不知道這是一個糟糕的建議，而冷火雞停止Effexor——即使是最低劑量——也會引發一連串痛苦的、持久的戒斷效應。

“這一切能持續多久？” 我問她。

她聳了聳肩。“我真的不能說。幾天。也許一個星期。我聽說這有點像感冒，但因人而異。我可以給你開百憂解來幫助控制這些副作用。停止服用 Effexor，看看效果如何。這是我的名片。如果您有任何問題，請致電辦公室，讓我們從現在開始預約一個月。”

烤箱計時器發出嗶嗶聲，我被拉出退出的記憶：對光和聲音的無法忍受的敏感性，強烈的憤怒，我將金屬熨衣板折成兩半，生動的殺人幻象，害怕告訴我的精神病醫生這一切以防她非自願地讓我接受 72 小時的精神病治療。

“我一直認為戒掉抗抑鬱藥就像服用它們一樣容易。我從來沒有想過聽從精神科醫生的建議會毀了我的生活，”我說，關掉了計時器。我媽媽用紙巾擦了擦眼睛。

“我很早就在某種程度上否認了這一點，”我母親說。“我記得有一次你從大學回到家，你的藥用完了。給你補貨是一場爭先恐後的事。你真的很緊張。我們正在考慮撤軍，這並沒有落在我身上。”

“因為在我服用這些藥物的 15 年裡沒有一次提到它！”

我把鬆餅從烤箱裡拿出來放在櫃檯上，回想起我曾經在抗抑鬱藥停藥期間用手臂刷熱鍋的情景。燒傷並不嚴重，但沒有抗抑鬱藥的麻木盔甲，我幾乎因疼痛而昏倒。儘管那次燒傷留下的傷疤很久以前就消失了，但情感上的傷疤仍然存在。

“你是唯一一個看到我完整的人，”我說。

“當時我不知道它有多重要，但現在我發現它很重要，”我媽媽說。“心理學家和精神科醫生需要將他們的客戶視為一個整體，而不是破碎的。因為如果你的醫生認為你壞了，你就會認為你壞了。”

我問我媽媽，“如果你能把十歲/十一歲的我投射到我在十幾歲和二十歲出頭時做出的選擇上，在我服藥後，你認為我會做出同樣的選擇嗎？”

“不，”她說。“你總是說抗抑鬱藥讓你變得遲鈍，所以如果你不想活下去，就沒有理由有野心。因此，如果在十五歲時，我們讓你悲傷，讓所有的抑鬱症離開你，你仍然會是十歲和十一歲時的那個緊張的孩子。但你不會被剝奪你的雄心壯志和生活的樂趣。而且你不會感到如此渺小。”

我遞給媽媽一個熱鬆餅，看著她撕下紙。烤箱裡的熱氣和甜香蕉的味道充滿了廚房，壓倒了我的感官。正是像這樣的小時刻，當我感受到生活的感覺時，時間變慢了，我現在抓住了。它們提醒著我已經走了多遠，因為用抗抑鬱藥麻醉了十五年的人無法欣賞新鮮出爐的鬆餅的味道，也無法感謝與賦予我生命的女人一起度過的寧靜早晨。這就是抗抑鬱藥從我身上奪走的東西。

但我懷念的並不是這十五年的標誌性經歷。這是中間美麗的歲月。每一片葉子的飄動。涼水滑過肌膚的感覺。黎明前的寂靜。決定我們生活的豐富性的是中間值，抗抑鬱藥審查的是中間值。也許有些醫生願意為年輕人和弱勢群體做出犧牲。但這讓我覺得他們也早已忘記了自己的感受。因為如果他們知道我現在所知道的，他們會做出不同的選擇。

***

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。

布魯克·西姆Brooke Siem (@brookesiem) 是《可能導致副作用》的作者，這是第一本為公眾撰寫的關於抗抑鬱藥戒斷的回憶錄。在brookesiem.com上了解更多信息。

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