So, the Paxil thing

June 8th, 2010

As I mentioned last week, I went on Paxil in December. My digestive system had not been working well for a couple of years, and what had once been an occasional annoyance turned into a full-time debilitation by last fall. As it turned out, I have the trifecta: IBS, gastritis, and esophageal reflux disease. This was going to require not only medication, time, and rest, but significant changes to my diet and cutting out alcohol. And as my gastroenterologist is one of the good ones who realizes that I am not a bunch of interconnected malfunctioning tubes, but a person, she suggested I go to behavioral health and get myself on, as she put it, “something that will help you cope without dissolving your esophagus.”

Now, here’s the thing. Every time I had gone to this doctor before with a bout of gut misery, she would ask, “Are you under any particular stress?” And I would say, “No.”

And, having seen the incredible difference that Paxil has made in my life, I was obviously wrong. Why didn’t I answer the question correctly?

Because of how it was asked, that’s why. People are notoriously susceptible to answering a question based on how it’s worded: for example, a recent study showed that more people agreed that “gay men and lesbians” should be able to serve in the military than that “homosexuals” should be able to serve in the military. Same question, obviously, but “homosexuals” sounds clinical and perverted, while “gay men and lesbians” sounds like people you know.

The question “Are you under stress?” or “Are there particular stressors in your life?” is a question that leads me to look outward, away from my emotions and to the objective circumstances of my life. And every time I did, I simply couldn’t see anything that could be, almost literally, twisting my gut into knots. My husband and I get along well. We are both in relatively good health, physically and financially. Yes, sometimes it can be difficult to juggle multiple jobs and projects, but I’ve always preferred to have a lot going on (and in this economy, having multiple sources of income seems like a good thing). I have good friends to confide in. What did I have to be stressed about?

But if she’d said, “Do you feel anxious?” — oh, I would have given a very different answer to that. Because that’s a question that would lead me to look inside, to how I felt. And I am an anxious person. Not because of my life circumstances, but because of how my brain chemicals are mixed. My flight-or-fight response threshold is ridiculously low.

And it isn’t anymore. I don’t have the off-the-chain startle reflex that I used to. I find it easier to read e-mails criticizing my work, even when they’re completely hateful, without my heartbeat going into overdrive. To my great surprise, even Milo has picked up on this. Before, if he was sitting on my lap at night while I watched TV or movies, he’d leap out of the chair and run to the window barking at the slightest noise. Now, he’s more likely to lift his head, growl, and settle back down immediately when I say “It’s just the wind, little guy.”

I’m amazed that the way a question was worded kept me from getting the help I needed for several years. I study this kind of thing: I know about cognitive biases, and the power of language and framing, and even a fair bit about temperament and brain chemistry. It’s a good lesson in staying humble and always, always, remembering to look at a situation from more than one perspective.

Going on Paxil really did a job on my dream life, too, in some fairly amusing ways. But I’ll save that for another post.


5 Responses to “So, the Paxil thing”

  1. Rubiatonta on June 8, 2010 9:23 am

    It’s wonderful that you’re feeling better!

    Thank you so much for sharing your experiences. I’m a long-time antidepressant user, and I think it’s important for those of us who take these meds to be as open about them, and how they’ve helped us, as we can. (It’s equally important to be open about the challenges they can present, too.)

    After all, it was someone who was willing to talk to me about her experiences before and after using antidepressants that convinced me that I should be willing to try them, thereby quite literally saving my life.

  2. Shulamuth on June 8, 2010 1:42 pm

    Interesting how subtle word use can be. Asked if I was “under stress” I’d generally say not much, or maybe “only until the next deadline”. But if you asked me if I “felt stressed” the answer would be yes.

    On the other hand, anxiety is such constant companion that I didn’t even realize I felt it until I started filling out a weekly anxiety-assessment from that asked about more specific things (feeling detached, fears of abandonment, upset stomach, etc.) that I was forced to accept that I have issues here.

    FWIW, I also feel that anti-depressants (and anti-anxiety meds and mood stabilizers) probably saved my life; they have certainly made it feel like it’s worth living. And I also go out of my way to be out about it, to educated and maybe help people, and to do what little I can to address the whole stigma thing.

  3. Sandrd on June 8, 2010 10:17 pm

    I find it wierd that I thought it was great when friends or co workers were helped by SSRIs, but when I needed prozac I felt like a total wuss, and kept trying to get by without.(Not any more – i know better now!!)

  4. Ajay on June 9, 2010 9:59 am

    When asked “Are you under any particular stress?” my mind immediately snaps back to the worst days of my life. Everything else is cupcakes. So, like you, my answer would be “No.”

    If pressed for more than a one word answer, I’d still say “Compared to what? To when? To whom?”

    Fortunately for you someone (the behavioral health people?) shared some of the other tools in the toolbox. Whatever works, right?

    Good for you for being persistent. Might as well enjoy the dreams too ; )

  5. Stupendousness on June 9, 2010 1:25 pm

    I think the same thing as Ajay. And I also think of what I consider to be socially acceptable sources of stress, like getting married, becoming a parent, changing careers, dealing with the death of a loved one, etc. The big ones, I guess. Everything else seems small in comparison, or that it’s supposed to be small.

    My mother was a hypochondriac about herself and her children. She wanted to take me to the doctor for every little cough or sniffle, always thinking I needed antibiotics. This led to me not wanting to go to the doctor at all, so as an adult, I don’t often complain when I’m sick or in pain. It took me 4 years in one case and 7 years in another to see a doctor about two different problems that were severely interfering with my daily functioning.
    That behavior has spilled over into other parts of my life, such that I don’t see stress for what it is. Subconsciously I think, “If I’ve been able to bear this up to now, then I’m not really suffering any harm.” Which just isn’t true. Because I am suffering from stress right now, stress from things that seem trivial to my logical mind but nonetheless create a negative impact.

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