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The Depression Monster
WARNING
I insist that if you are considering any prescription mood-altering drugs, that first you attend either one-on-one or (discounted or free) group psychiatric counseling and continue attending until you can halt the use of the drugs.

Dr.Malamud has been under a doctor's care since 1958 and only now, forty-eight years later, understands that fighting depression, for him, will be a life-long battle.

Begin Year 2006 Journal
July 2006

7/27/06:

Went to Dr. Abimelech and he asked how long I'd been depressed. I told him since 1959.

"Ever been on anti-depressants?"
"Never?"
"Never."

I had stopped medicinally dosing myself with tequila on Thursday, July 20th and still felt poorly. He gave me free month of samples. He fixed the six month old fungal rash between my legs with a prescription of Clotrimazole and Betamethasone Dipropionate cream.

I took my first lint-sized pill at 7am Friday. And even though Lexapro is advertised to take effect within a period of weeks, within the hour I felt sharper. Like the haze hovering in front of my eyes was being lifted. One of the side effects listed was "insomnia." So I immediately went to bed and tackled a ten hour nap. No insomnia yet. At hour number eleven (8:00pm Friday) I'm feeling anxious, as if I'm in the wings waiting to step on stage, or for the director to belittle me and claim that all my clients hate me. I seem more on edge, things seem clearer, more alive. I'm all for it if it makes me edgy. The last thing I want to do is join the ranks of the dullards I am daily surrounded by.
7/28/06:

It's 8:49pm and I'm off to the office facing a thirty-three mile drive. Feel like eyelids are open unusually wide. My fingers are tingling as if they are at the end of coming out of a 'falling asleep' episode where one inadvertently cuts off the circulation to a limb. Smells are different. Tongue tastes different. Lights are brighter. Clearer. Almost like a drug trip. Colors are richer, deeper reds of the tail and brake lights of the vehicles around me. The rich greens of the overhead highway signs are just delightful. My lips feel like the tail-end of a novocaine injection from the dentist wearing off. Feeling dull ... almost like it's moving through my face, lips, my filtrum, chin, the saliva glands located at joint of my mandibles. 11:00pm - Feeling pretty normal now. 11:57pm - Eyes feel normal, slight sinking feeling in stomach. 7/29/06:

Thought of doing something constructive positive and my heart did not sink like normal. Had confrontation with three individuals and I did not get as excited as I normally would have. 11:11PM Feeling slightly ill like I'm coming down with an illness. Feeling edgy. Although I need a new prescription for my glasses my vision seems to be clearer. 7/31/06:

When my foot was placed on its ball, my leg began bouncing up and down like it hadn't done in months and months.

August 2006

8/1/06:

Couldn't sleep. Couldn't urinate. Slept from 9:00am to 7:00pm. Hot, sweating. Still hot on drive to work even though car A/C set to 68F degrees. Today's high temperature was a mere 100F degrees. Once at work I began yawning uncontrollably. 8/2/06:

My fingers swelled up like I'm retaining water. I had another situation where normally I would've gotten depressed; instead I just handled the situation. 8/3/06:

As I fell asleep, in my half-empty bed, my legs jerked and woke me up. This hypnagogic myoclonic twitch hasn't happened for months. I slept most of the day. Still feel on edge like one does after not eating for eight or ten hours. Facing money challenges and I'm not getting depressed about it, I just accept I made the mistake that caused the problem. 8/4/06:

Slept from 9am until 8pm. Because a large check I had written went through my account two days sooner than it had the previous two months, I found I bounced three checks. Unlike my pre-Lexapro self, I didn't get hopelessly depressed. Instead I pondered on ways to handle the situation. 8/5/06:

I got to work at 10pm (8/4) and at 4am I began yawning uncontrollably. Once home, I slept from 10am until 7pm. I faced several challenges this day which would have normally made me both overly-anxious and depressed but instead, I just accepted the situations, and handled them to the best of my non-perfect abilities. I'm not as angry twenty-four seven as I formerly was. I was standing in line at a convenience store and the more-than-slightly-inebriated female in front of me turned and asked me why I was smiling. I haven't been asked that, or probably smiled, for a long time. 8/6/06:

I arrived at work at 10pm (8/5) and at 1:50am I am again yawning uncontrollably. After work, from 7am until 11am I suffer a splitting headache which causes profuse sweating. (I normally do not have headaches.) I can't get comfortable. I walk around, I sit down, I lay down, the headache will not go away. I take two aspirins. The headache is excruciating while my sweating reminds me of when I had pneumonia. I find momentary relief by laying down and then sitting up as the headache goes away for minutes. Finally I sleep from 11am until 8pm. At 9:15pm I felt the beginnings of another headache so I downed an Excedrin migraine pill. 8/9/06:

I missed taking my Lexapro at 7am and took it at 1pm instead. 8/10/06:

I took my Lexapro at 3pm instead of 1pm. Couldn't sleep because I was always too hot or too cold. 8/12/06:

Slept from 9am until 8pm. Just my toes were cold. Weird. 8/14/06:

Took Lexapro at 5:30pm. This was the first day in a long time where I didn't feel so darned tired that I had to sleep all day. While I don't feel nearly as depressed and hopeless, it disturbs me that I have a problem proceeding with some projects that I really need to complete. Like finding a decent job and memorizing my lines for a movie audition. 8/16/06:

Lying in bed I notice that with my crossed legs outstretched, I am jiggling my bare feet against each other. I recall that I haven't done this for many months and consider it a return to normality. 8/17/06:

As scheduled I visited Dr. Abimelech this morning. I told him of my sleeping the days away. He asked if maybe it was the fact that I'd had almost five years without adequate sleep (and not a single day of vacation.) He suggested I cut the dose in one-half. Afraid of encountering my depression again I deferred the dosage diminution. I told him that it was unbelievable that I simply do not get depressed anymore. I asked him if this could be a lifetime prescription and he answered that some people were on anti-depressants for months or years. I replied that since I've faced depression since 1959 I would probably be on them for the rest of my life. He dug out another two weeks of free samples and wrote a prescription. He asked me if paying for it would be a problem. I told him that no, instead of spending money on tequila, I would be spending it on Lexapro. As he thought I was kidding, he laughed.

back to 9/4 8/19/06:

I worked from 2pm Friday until 8am Saturday (8/19) for my first eighteen hour day in weeks. So I would be certain to take my daily pill, I set my cell phone alarm to go off at 7:30pm . While at work I'm eating like a recently released prisoner from Sheriff Joe's Tent City where green bologna is the meat de jure. But, I figure, since I've disconnected my tequila drip system, I can 'let go' in another area of my life. I collapsed, unshowered, into my half-empty bed at 9am and my sleep was interrupted every two hours by a foggy bathroom visit. I awoke for the day at 4pm. A semi-solid sleep of seven hours. But, better yet, I awoke fully awake and energized. I actually finally felt like doing something other than going back to bed. This is a pretty good feeling. It's been twenty-three days since I took my first pill. 8/21/06:

I arrived home from work at 8am on Sunday the 20th of August. I felt decent during my ten-hour shift at the office and I was thinking that if I didn't tell someone I was on Lexapro no one would know the difference. I wonder if it would show up on my employer's urine tests. I'd sure hate to tell those bastards I'm on an anti-depressant, they'd think they were winning. Today, Monday, physically, I'm on edge, I notice that my printing isn't its usual flawless self. I'm shaking a little bit as I hand-print envelopes. May be because I haven't eaten since yesterday or it may have something to do with my prescription. I'm actually washing clothes and have plans to drive to some places and do some chores so that's definitely a good sign. 8/22/06:

There are two types of E.D.  Lexapro has cursed me with the second, almost unknown variety: anorgasmia. Even after the Clinton-Monica bathroom episodes were thoroughly exposed on television, on the airwaves, in magazines, and the Lewinsky name has been added to our everyday lexicon, I don't believe the type of E.D. I'm experiencing will see mention soon on any television commercial. Not to be too explicit, my E.D. is the variant that will frustrate the hell out of any male straddled with it (as teenagers, we called it blue balls  ) while his relentless turgidity will raise his female partner to previously undiscovered heights of passion. Now, all I need is a girl friend ... 8/24/06:

While I haven't charted my time spent in my half-empty bed, I'm fairly certain it has returned to the area of eight to ten hours per sleep period. One thing I noticed yesterday, was that before I was scripted for Lexapro, I was so very fearful of Mainio (my son) moving out and leaving me all alone. Literally all alone. Now, I'm simply philosophical about it, more or less thinking: "That's life". I also noticed a physical infirmity that has returned after being absent for many months and that infirmity evidences itself when I am very tired and I begin to drag my right leg slightly when walking. Another thought that struck me was that I am really going to be pissed if I have suffered all these decades from incredible melancholy when there was in existence a pill I could take daily that would have pharmaceutically raised my soul out of the dreary depths of depression. That would actually more or less prove that my search for and emotional solace by swilling slugs of Silver Bullets and sipping shots of the same sacred beverage the Aztec's worshiped, as my psyche sought vainly to pair the intricate dance of chemicals my genetics had left me short of.

September 2006

9/01/06:

Hussein firing pistol I ventured out to my Safeway feeling excellent. Well, not as excellent as if I were not lugging around these fifty extra and unneeded pounds of fat, but still, pretty darn good. I strutted down the aisles again and behaving normally (for me) chuckled at the foibles of many of my fellow shoppers while constantly dialoguing, sotto voce, with myself. (I wondered if the slim lady chatting on her cell phone, stationed in the refrigerated food aisle the entire time I was there, was there to buy foodstuffs or to talk on her cell phone. Maybe the A/C in her house was broken down?) This is the Dr.Malamud I want to be. An outlook where, even though my life, due mostly to my own poor choices or 'non-choices', appears pretty much as bleak as a Saddam Hussein stuffed in a spider hole lined with $750,000 of United States currency, can still laugh. 9/04/06:

After arriving home from work at 9am Sunday (9/3), I slept on and off for maybe seven hours. Because Mainio (my spoiled son & roommate) had, "some friends coming over", at 11:36pm I was unceremoniously shushed off to my bedroom. As I was reading an old Joseph Flynn novel I fell asleep. I slept until 7am this Labor Day morning. I am seriously thinking of cutting my dose of Lexapro in half. There is a scribe mark across each pill to do just that. And since Dr. Abimelech had already discussed this operation, come 8pm tonight I may just do that. Sawing the pills has another advantage, in that since I've almost run out of 'doctor's samples' after only six weeks <grin>, I must begin footing the bill. Footing the bill after my health insurance (that I pay $218.24 a month for ... are you listening Medicare crybabies?) whittles it down some. And if my math skills remain intact, I do believe hacking the pills in half will double the doses I have available. 9/14/06:

After typing my last entry of Monday, September 4th, I did attempt to slice a Lexapro pill in half. I ended up with two pieces that were about as evenly matched as a spelling bee between Stephen Hawking and Mike Tyson. I swept the bits and their dust into my palm, grimaced and dumped the white gravel into my mouth. At the CVS Pharmacy I queried the comely blonde assistant behind the counter if there was some secret to cutting pills in half, that displayed a factory-molded scribe in them indicating that they might be cut in half. She told me what I already knew: that they make a device to cut them in half. Now, Thursday, after two sleeping sessions totalling almost twelve hours, I got up, pulled up my checking account balance and found I had bounced three more checks. Dammit. It seems that while this SSRI miraculously erased any thoughts  of suicide and yanked me from beneath the crushing weight of depression, however it seems to have left my initiative behind like the snagged skin of a shedding reptile. I ventured to the store and bought a guillotine-type pill cutter and discovered that it worked perfectly. Perhaps by cutting my dosage in half I'll be able to stay awake longer than four hours and perhaps accomplish something more monumental than going to and from work. 9/15/06:

Effectively cutting my dosage by fifty percent, last night at 10:05pm I swallowed one-half of a Lexapro pill. When I arrived home at 6:30am I was not nearly so tired. As a matter of fact, I had to head for bed knowing I needed the sleep rather than my body signalling me that it was crashing. Now, in an indication that my dosage is too small, I must keep an eye out for the dark clouds of depression swirling around my soul. 9/16/06:

Many of us American's are just too damned soft. And most of us are so gawd damned spoiled that if someone cuts in front of us on the freeway, we throw a temper tantrum (I know I do). After taking about as much concern about our personal health as a hippopotamus does of river silt in his belly button, we interrupt our most urgent lifestyle with a visit to our P.P.O.-empowered physician, believing he can cure our illness with an injection or a hurriedly scribbled prescription. What I'm talking about is, that, in an effort to put a halt to sleeping ten to twelve hours each day since late July when I began Dr. Abimelech's Lexapro regimen, my unilateral decision to halve my dosage of the fifty dollar a month selective serontonin reuptake inhibitor. My lower dose has made a profound difference as my last sleep period was a mere four hours, but I awoke, awake. And I stayed awake until I departed tony Paradise Valley for my sixteen hour shift five hours later. 9/19/06:

On my new regime of 'the half-pill', I am feeling pretty darned swell these days. Once again, I find myself laughing out loud at my own sotto voce observations of those around me. Much of the time I feel on-edge, as a person does when he has fasted most of the day, or that micro-instant after someone swerves into your traffic lane and adrenals flood your emotions as you hit the brakes. To many people, being 'on-edge' would not be something they would enjoy, or ... even savor. But my former depression was so great that any sign of life, any prick of emotion, anything was appreciated. 9/25/06:

A couple of nights ago as "When the Saints Come Marching In" ring-tone played out of my LG cell phone, I flipped it open to answer a very early morning request from one of my children. The poor kid is in a horrible fix. An entirely predictable and avoidable fix. A fix, that even if I had the tens of thousands of dollars to fix it, I would not. A truly rock and a hard spot situation. After I rang off I was overtaken with an unusual emotion. And, while at the funny farm, they taught us (non-violent ones) that "feelings" could be described in a single word, whereas "thoughts" were virtually always more than one word, I still had a challenge giving this mental state a label. However, while I was pondering naming this infant emotion, it struck me that prior to my SSRI prescription, I was almost certain that an episode such as this would have triggered a bout of depression that would have justified me drinking myself silly. Instead, I was simply saddled with the not unpleasant feelings generated by this newly erupted emotion.


Unexpectedly I am still constantly overcome with the urge to sleep. And I do not believe that this weariness is being generated by depression or an attempt to avoid the world, but is due to too much serotonin being allowed to circulate in my system. Although doing a quick check on the internet reveals that a common side effect of SSRI's is insomnia not hypersomnia so this may indicate there is yet another chemical imbalance in my gray matter. 9/27/06:

It has been eleven days since I sliced my Lexapro dosage in half, and yet I continue to sleep my life away. I am reminded that I have always been able to dose off anywhere (except during the rare plane flight), and at any time, so apparently this SSRI inhibitor is fertilizing my natural ability to fall asleep with even more serotonin. I'm hoping that since this class of drug requires a two to four week period to achieve its full effects, my sleep pattern may return to normal sometime in October. As it is now, if I lay down in bed I can read about one and one-half pages of a paperback before I fall asleep. Now, this sleep pattern was more or less normal for me prior to be medicated however, at that time I was working at least sixty-four hours a week, seven days a week, for months on end. I imagine that if I added some aerobic exercises, which are a medically documented means of fighting depression, this alone, as contrary as it sounds, might give me the boost of energy I need to remain awake for the hours I am not at work.

October 2006

10/03/06:

Yesterday, October 2nd, I had planned to do three things after I took a nap after work. I was going to 1) get some new pants tailored, 2) get my expensive and extremely comfortable Redwing Oxfords rebuilt after four years of wear, and 3) trade in my two-year old Verizon LG cellphone for something a little more modern. I drove the one-tenth of the mile to my Chinaman dry cleaner and found out his Chinaman-tailor had left at 2:30pm. Then I drove to the Cobblestone Quality Shoe Repair and found a note taped to the glass door announcing "Gone Fishing for Yom Kippur" or something like that. Not giving up hope yet, I lastly made it to the Verizon wireless store. Sticking my head inside the door and seeing more people than at a Puerto Rican airport terminal, I turned and left. I was three for three. I struck out. But even so, it was more ambition than I'd shown in a long time. 10/05/06:

Being on Lexapro is similar to suffering through one of the 'normal' colds or un-nameable illnesses we all endure. You awake, knowing you will trudge off to work feeling terrible (unless you are an adult-child still living with your parents, in which case you simply remain in bed.) Once up and about, you discover that the longer you remain up and about, the better you feel. And, only at the end of the workday (due to the effects of non-drowsy over-the-counter drugs and the threat of eviction if you can't make rent) when the pressure is finally off, do you realize that you are still sick, while you simultaneously collapse face first into bed. Only I don't feel  sick. I just feel tired. Not so much tired as non-motivated. In 21st Century America we're all demanding a simple cure, a resolution within the twenty-two or forty-four minutes of the television programs so many of us are addicted to. But even without the burden of my doctorate I have always understood that nothing is simple. Hell, just take a look at quantum physics. 10/09/06:

Slept nine and one-half hours, got up worked on the net, drove down to the grocery store to get my annual $30 flu shot and once home again, consumed a Swanson's Hungry Man dinner and then went back to bed. Even though I had an eighteen hour shift following a six hour break, preceded by a fourteen hour shift, for about forty hours awake-and-working with only four hours of sleep, I still shouldn't be sleeping that much. Especially since I slept many hours before my nine and one-half hour sleep that began this paragraph. One of the causes could be that my BPH causes me to wake up virtually every ninety minutes to go tinkle. And I do mean tinkle  versus a manly tsunami generating toilet bowl blast. So I don't continue to blow my eardrums out while attempting to expel a thimble full of urine after awakening four times each sleep period, I'm forced to ask my Dr. Abimelech for prescription medicine to shrink the size of my urethra-constricting prostate gland. I want to be certain that Lexapro is not the entire cause of my hypersomnia before I request another anti-depression medicine. I am so in fear of descending into the pre-Lexapro constant feelings of doom and gloom and self-blaming and pitying, that I dread the thought of relinquishing my prescription crutch. In any case, it's actually more like a Star Wars light-saber than a crutch. I continue to be in awe of the fact that while I can have negative thoughts and rant and rave (and I do  rant and rave), since beginning my SSRI prescription, I have no desire for this life to end in anything but a natural manner. In any case, I'm beginning to understand why, as one gets older in America, the bottles of prescription medicine begin to line up on the bathroom counter. I am one hundred percent aware that my initiative has been hugely scaled back, but I'm not certain that is a side effect of the prescription, or the fact that I just can't get an eight hour stretch of the uninterrupted sleep my previous tequila-swilling habit ensured. 10/18/06:

I saw Dr. Abimelech on Friday the 13th. Wrapped up in describing the doubling-over pain I experienced coming from my abdomen during the middle of an acting class, I almost forgot to bring up the fact that my penis was behaving more like a clogged up 'non-clogging' catsup bottle than the efficient and free-flowing drain for the contents of my bladder it was designed to be. He wrote me a prescription for Terazosin (where do they come up with these names?) saying it was a blood-pressure reducing medicine. I e-mailed the ex-Dr.Mrs.Malamud and she informed me it was also used for prostate problems. Reading further myself, I discovered that Terazosin relaxes the smooth muscles of the something-or-other and allows greater urine flow. It works on both accounts. 'Both accounts' you ask? Yes, one capsule enabled me to sleep a blissful and uninterrupted eight hours, after which I arose to pee like the oft-mentioned race horse. And it lowered my blood pressure. Wooie. It was as if I had loaded up on weed, sans the smoke and the stench and the paranoia or early morning drive to Jack-in-the-Box. I was floating around the room and even occasionally stumbling over dust mites. The manufacturer states that these effects will wear off over time and with taking it only before hitting the sack, it should not interfere with work. However, it does have another side effect, that of sleepiness. 10/29/06:

The Terazosin has been doing its job. As you recall it relaxes the smooth muscles of the bladder so an old gentleman like Dr.Malamud isn't faced with the urge to squeeze out a thimble-full of urine every hour. A grueling eighteen-hour shift (yes eighteen hours) put me in the mood for some deep sleep this Sunday morning. Getting home I promptly gulped my pair of Cipro and Terazonsin pills. Shortly I happily chewed a soaked-in-Tillamook-brand-butter toasted piece of Thomas' square bagel bread followed by a slowly savored pint of Ben & Jerry's premium ice cream. Talking Back to Prozac Yes, it's true, I have pretty much been a health nut all my life. After consuming my breakfast of 50% carbs and 50% fat, I hit the half-empty Malamud's bed at 9am. I awoke once at 12:30pm and again at 3:30pm. Wonderful. If you haven't been getting but snatches of decent sleep for decades, you really don't know how good it feels to sleep for extended periods of time. I'm even beginning to wonder if my lack of decent sleep isn't an invisible cause of the severe depression I've been wrestling with since the ex-Mrs.Dr.Malamud cut out for the Lone Star state. Chatting with the beautiful blond pharmacist at my Albertson's-Osco-Right-Aid pharmacy, and with my mentioning of halving the dose on my Lexapro and still sleeping all the time, she suggested that I might ask Dr. Abimelech to prescribe Prozac® (fluoxetine) next time. She said patients on Prozac did not seem to have the sleeping challenges I was, well, sleeping through. Sadly, author Peter Breggin suggests in his 1995 book: Talking Back to Prozac suggests that the drug causes everything from alien abductions to vapor trails. I guess the only way I'll find out is to talk to Dr. Abimelech.

November 2006

11/07/06:

I visited Dr. Abimelech on Thursday, the second of November, and my results were nothing less than astounding. Having closely read five or six books on how the brain works, the last being Mind Wide Open: Your Brain and the Neuroscience of Everyday Life (by Steven Johnson who I am certain is voting a straight Democratic ticket today) I know quite a bit more about how our brains function than the average bear. And I was  under the impression that selective serotonin re-uptake inhibitors, i.e., SSRIs, were developed under the guise of intense clinical and real-world testing, while the scientists were not understanding exactly why they did what they did and hence, pretty much all SSRI drugs, Prozac, Lexapro,Wellbutrin, etc., were pretty much the same.

Boy was I wrong. Since Dr. Abimelech needed only one more 'script to earn enough points for a cruise to Bermuda this winter, he prescribed Wellbutrin for me. Wellbutrin XL 150mg vs. U.S. Quarter I was just reading the side effects of the drug and it is a good thing that I was not started out on Wellbutrin way back in July of 2006, for one of its many side effects (seizures) could occur if the patient had abruptly stopped drinking, which is exactly what I had done. Another weird thing is that Wellbutrin could cause dangerously high blood pressure, but yet because I am using terazonsin to relieve my BPH, and terazonsin is also a medication used to lower blood pressure, high B.P. should not be a fear.

While on Lexapro, I found my pants size ballooned from 40W to 44W and my tee shirt size from XL to XXL. I assumed these results to be my own unrestrained gluttony. I slept anywhere from fourteen to eighteen hours a day, which I knew (for me) to be a side-effect of Lexapro.

On Wellbutrin, almost instantly I no longer longed to sleep my life away like J.D. Salinger after he penned his monumental book titled Catcher in the Rye. Also, almost immediately, I no longer desired to consume buckets of food. Although I have developed the habit of eating like the fat lady in the circus, I realize it is merely a habit, it is no longer a driving need. More to come ...

11/10-11/06:

I started to actually clean up around the house Wednesday. This I have not done for ages. Today I began arranging things on my newly appointed writing desk. I was feeling so good on Wellbutrin-XL that I wondered why I did not post to these pages sooner. I think my subconscious was holding me back. For Wednesday and then Thursday night I encountered what should have been a familiar feeling but it wasn't until late Friday night that I put a name to the vaguely familiar feeling. Depression. I know my regular readers will find this hard to believe, but it is the God's honest truth. Friday night I found myself driving and lamenting my life and heard the very familiar 'I should just put a gun in my mouth and pull the trigger' echoing in my head. Of course, after my second Theophany in late March of 2003 suicide is simply out of the question. I only say it to myself so I can feel sorry myself and generate even more depression. I don't know if I wrote about how Dr. Abimelech related to me that sometimes a depressed patient might on two different anti-depression drugs at the same time. I now know on a first-hand basis why that might happen.

11/23/2006:

I have continued to get caught up on my web pages, which, I was thinking the other day, would be a full-time paying job for so many people. While I just do it for the fun of it. And to learn. And to learn about me. I even re-designed a book-review site of mine and that was an immense task taking two days and probably fourteen hours. I told my ex-wife's sister that I would be coming over for Thanksgiving Dinner today, but I didn't go. I heard them calling me on the cell phone as it played a song from A Charlie Brown Christmas. I let it play, while my right knee throbbed (yesterday it was a brain-rattling toothache generated from grinding my teeth in my sleep) and I recounted that the drive was both monumental and deadly, with drivers last year exceeding 100mph trailed by pairs of Arizona Department of Public Safety patrol cars. I should have said I couldn't make it yesterday. They are far too kind to me. They are, basically, my only family. How sad is that? My 2nd older brother lives in Washington State and he's insane and my senior brother lives in Mainland China and he's insaner. In any case, normally, I would feel so, so, guilty for not attending Thanksgiving with the ex-Mrs.Dr.Malamud's family and especially for not calling. Now, I honestly don't feel anything. Not guilt certainly. I think  I am lonely, but the actual feeling is far away; like the dozens of so colorful passenger jets I crane my neck back to see every day flying over my tony Town of Paradise Valley townhouse. And I know, those lack of feelings are from the Wellbutrin XL I'm dropping every day ...

11/24/2006:

What I was getting at in yesterday's posting is, that even though I thought it was one hundred percent impossible that a drug, a prescription drug especially, could change your thoughts, I was wrong. But, and this is probably the first time, the first time this century for certain, that I was in error. Actually Wellbutrin-XL is changing my feelings and/or maybe my physical reactions to my feelings. It is changing my emotions. On Wellbutrin-XL, while I have occasionally felt the clawing of depression at the door of my soul, for the most part the darkness is kept away. But to not feel guilt? How odd is that of someone raised by a Finnish mother who instilled guilt in me from the day 'I spilled' the afterbirth on the hospital floor?

11/26/2006:

I spent Thanksgiving alone. Again. But thanks to the Wellbutrin-XL I feel okay about it. To me, benefiting from the effects of this literally mind-altering drug, I am amazed that by regulating the smaller-than-a-teardrop-amount of serotonin swimming within the fluids of my brain such profound changes have been made in my usually absolutely uncontrollable emotional responses. I think this may mean that I've always been subject to severe depression due to a pair of factors. One would be the chemical ratios in my brain have always been a little 'off' and the other is that my thought processes, which have always been on the severely practical and negative side have themselves unbalanced the molecular ratios of my brain fluids. Following is an explanation of how scientists understand the human serotoninergic system.

"The serotoninergic system is known to modulate mood, emotion, sleep and appetite and thus is implicated in the control of numerous behavioural and physiological functions. Decreased serotoninergic neurotransmission has been proposed to play a key role in the aetiology of depression. The concentration of synaptic serotonin is controlled directly by its reuptake into the pre-synaptic terminal and, thus, drugs blocking serotonin transport have been successfully used for the treatment of depression. In addition to tricyclic antidepressants (TCAs; e.g. imipramine) which also block noradrenaline reuptake, highly specific serotonin reuptake inhibitors (SSRIs) such as fluoxetine and paroxetine have been developed, which are increasingly prescribed for depressed patients. The mode of action of these antidepressant drugs on their direct target, the serotonin transport protein, and possible regulatory mechanisms with respect to long-term alleviation of depression, although having been investigated both neurobiologically and clinically over the last years, are not yet understood. The cloning of the cDNA encoding the serotonin transporter has allowed a more precise characterization of this protein at the molecular level. This will show how antidepressants act at this target, thereby affecting the biochemical, pharmacological and electrophysiological properties of the serotoninergic system and give an introduction of how they might exert their therapeutic effect."



Schloss P, Williams DC
Biochemistry Department,
University of Dublin,
Trinity College, Ireland
1998
(used without permission)
December 2006

12/07/2006:

I'm thinking that in about ten years the dedicated and gifted chemists at the drug companies will have designed anti-depression pharmaceuticals focused so finely that only 'depression' itself is alleviated, without affecting sleep or eating patterns, or almost imperceptibly dulling that sharpness that a non-drug-dosed brain cuts through life with. Yes, I'm feeling pretty good, and, since I've not been reading any self-help, feel-good bestsellers. And since I remain as lonely as Cindy Sheehan at the bar of any V.F.W. hall. And since I'm still not exercising, my high spirits pretty much have to be the results of my Wellbutrin-XL prescription. In the past few days I've put together a bookcase, which was immediately stuffed with books formerly horizontally shelved on the floor, and added-to or heavily modified several of my 160 megabytes of web pages. I've purchased and wrapped the vast majority of the Christmas presents. Actually, the "vast majority" of the presents were, as is my habit, purchased throughout the year. I've even found myself singing while I walk to and from my car parked at the Albertson's grocery store. And I've been seriously considering getting back into acting and exploiting my writing talents for a decent income. In other words, except to post an occasional notice here about how the Wellbutrin-XL is affecting my life, I'll begin posting again to my Dr.Malamud pages. See ya!

12/12/2006:

Lois: Mother. Lover.
Click to visit Family Guy! Here I am again. Already. But good news in that I'm feeling so much better. I still seem to sleep far too much, and when I get up, it requires a struggle of about ninety minutes of dedicated concentration to resist going back to bed and to instant sleep. However, I believe that is due to my absurd breakfast diet of Jack-in-the-Box® curly fries, meaty beef & cocaine burro, and a seasonal large pumpkin shake. Erin w/Dr.Malamud at
The Satisfied Frog
Cave Creek, Arizona That's one thing us depression-prone psychotics need to be acutely aware of and that is ... what ... we ... eat. (And if you are reading this without being bored out of your gourd, you are a depression-prone-psychotic just like me: Dr. Hammurabi Malamud.) I have learned how easily my unconscious emotions and oftentimes, physical state is influenced by what I put in my mouth ... especially if it is a body-part of a woman I love. Sorry, couldn't help it. Hell, I've been looking real hard at Lois, The Family Guy's wife, and I have been even eying the much-younger-than-me Erin the esurance® girl. Damn, I miss being married.

12/27/2006:

I just had to write to this page to let you all know that my prescription of Wellbutrin-XL is working its magic. Hope Breaking Through DepressionAlthough aerobic exercise is the number one relief for depression (and is free) if you cannot get up the gumption to run, you are pretty much left with gulping prescription anti-depressants versus gulping the freshly turned earth of your grave. (I'm assuming a really cheap funeral ceremony.) And I remember so clearly, back when I was pumping iron and working the Stairclimbers at LA Fitness four days a week, how I would sit in the parking lot and from behind the wheel of my Suburban weep like Donald Trump at tax time. I just finished an e-mail to an actress friend of mine describing my Christmas: no friends, no Christmas dinner, no wife, no girlfriend, no dog, no presents from two of my three children (including a son I adopted twenty-years ago suddenly calling me 'step-dad' rather than 'dad'), a job about fifteen rungs below my capability (that required me to labor fourteen hours on December 25th) and celebrating Christmas with an eighteen inch tall and dark aluminum tree that finally burnt out the motor that ran its lights. All that would be enough to depress a normally emotionally stable individual, much less a Dr. Gloomy Gus like Dr.Malamud. But yet, thanks to the chemical balance Wellbutrin-XL has restored between the fluids of my massive brain <grin>, while I'm not ready to audition for the remake of "It's A Wonderful Life", I am grateful to be alive.

Begin Year 2007 Journal

July 2007
07/24/2007:

I've been feeling really strange lately. 'Strange' in the physical department, most of it manifesting itself in a mental fog. A fog like when you wash your eye-glasses and they remain smeared no matter how many times they are wiped. Or like that film that forms on the inside of your automobile windshield that can only be removed after three consecutive washings with Windex brand glass cleaner.

Lexapro My waking hours are seen through that slight blurring, that little bit out-of-focus perception that usually only greets me as an aftereffect of waking up after letting a pint of Ben & Jerry's Vanilla Heath Bar Crunch, spoonful after spoonful, melt in my mouth two hours earlier.

And even though I've been feeling emotionally neutral to slightly positive, this mental fog, teamed with my Humpty-Dumpty-tight work pants, my screaming right knee (only being able to be quieted by regular 600mg doses of Motrin), my lower back aching as if all afternoon I'd been unloading a boxcar filled with sixty-pound bags of rock salt and occasionally my right hip hurting so badly I can barely stand upright and wth my newly erupted corns (which cannot be converted into ethanol) shooting stabbing pain through the junction of my little toe and foot as if I'm stepping on red-hot roofing nails are tending to destroy my mood. A neutral to slightly positive mood which then can only be repaired by ten straight hours of sleep which, in my life, is about a common as a pay raise.

And then I read the possible contraindications (ancillary reactions) to my Wellbutrin-XL prescription and the fog began to dissipate.

    Undesired Reactions of Wellbutrin-XL Use:

    Wellbutrin XL

  • insomnia
  • mania
  • change in appetite
  • weight gain
  • photosensitivity
  • hyperglycemia
  • hypoglycemia
  • tremors
  • syndrome of inappropriate ADH secretion
  • others not listed here

I have also repeatedly seen things that aren't there, such as a crouching man actually being a bush, or piece of machinery looking like a javelina. And I've had some not-suicidal, or sexual, or dangerous thoughts, but just a few very strange notions that enter my brain, and before I can think "What the hell is that?" evaporate like a dream does after waking.

Do not get me wrong, I am very glad that when I was virtually totally alone in the depths of depression over my divorce, I had my SSRI's to keep me almost sane. As my regular reader's realize, the death of my twenty-seven year marriage was, and probably will remain, the most traumatic event to occur in my life, that is until my own passing. And Lexapro and Wellbutrin were needed.

In the beginning, my SSRI prescriptions were like a fresh and buoyant, life-preserver, smelling of recently unfolded new plastic and easily kept my head above the waves of darkness and doom. However, now they have now become water-logged and heavy and are beginning to drag me down to the bottom. The chemicals balances inside our body are far more delicate than the balance we must live our lives in . . .

August 2007
08/20/2007:

Driving to work tonight I found myself pondering sad stuff with probably the saddest of all, is that in ninety-six hours, I will have arrived in my XXL blue and yellow checkered shirt sewn in Saudia Arabia, at my 56th birthday. Fifty-six years old and earning less than I did working in the New Jersey-based Picker-Packers union at the now-shuttered, Lower Baseline Road Revlon® Phoenix, warehouse in the last year of my teens, i.e., 1970.

However, being the Wellbutrin XL is doing its job suppressing feelings, no emotions, either positive or negative, are allowed to surface. Like in an old World War II movie when the destroyer above is forcing the submarine to stay deep down by dropping exploding depth charges.

It just struck me, is my lauded SSRI keeping me from not only depression by also from enjoying full measure of positive emotions? Is it demanding sleep of up to thirteen hours per day? Is it creating yearnings to eat even when I'm not hungry? If I remember correctly, a memory that is becoming more and more befuddled, all these complications are indeed companions of Wellbutrin consumption.

To avoid blowing a jagged, cinder-edged hole in my slacks, I lean to the right in my harder-than-my-ex-wife's-heart chair and let escape a noxious blast from my intestines into my corner of this Starbucks cafe. That was definitely the result of non-stop carbohydrate consumption. I wonder where the fire extinguisher is in this place?

This evening I looked into the hospital-white depths of my Wellbutrin XL bottle, and seeing only three of the so tiny dollar and thirty-three cents pills left, I was reminded that now is the perfect occasion to switch to the non-time release and also generic version. And then, under Dr.Abimelech's supervision, Tito's Handmade Sippin' Vodka to slowly wean myself off of my now very real physical addiction to this Selective Serotonin Reuptake Inhibitor.

Am I ready to release all my emotions from the chemical cage erected almost thirteen months ago? Am I ready to again feel the fullness of life that only unrestrained passion can provide? Since consuming alcohol on an SSRI can cause seizures, I've not had a touch for over a year. Yes, not a touch, a gulp, a drop, a dribble, nothing, nada. So, am I ready to enjoy an emerald green bottle of Heineken made sweaty by Arizona's 'Monsoon Season', a bargain-basement Merlot, a 'Southside' cocktail (recently written about in the W.S.J. 'How's Your Drink' column), a triple-ounce dose of Tito's Vodka on a trio of crystal clear cubes and to eventually sip several straight double-shots of Jose Cuervo, from my purloined jigger only to fall face first into my first eight-hour-straight alcoholic slumber in a year? I think so. I think so.

08/30/2007:

Where do they come up with the names for these drugs? Lexapro ? In any case it's been five days since I took my last Wellbutrin XL bupropion HCl extended-release tablets. Other than at times a feeling of nausea, I've noticed not many withdrawal effects. I know that with the bupropion HCI's absence I will soon be suffering from my life-long battle with allergies, including, once again, asthma. Although touted as being very selective in what family of serotonin chemicals these SSRIs inhibit, it does not seem to me that, for depression,  they should also inhibit the Histaminic receptors which are what cause all the sneezing, coughing and wheezing that comes with an allergy attack.

While I can sleep pretty much all the time, I am not longer drop-dead tired after a work day comprising of five and one-half hours of driving and four of sitting. I get home to my soon-to-be-vacated tony Town of Paradise Valley apartment and flop down on the half-empty Malamud mattress simply out of habit. I hope to organically awake ten hours later and then hang out with the civilians after the sun burns the sky red as it sinks into the west. And after the temperatures have dropped below the one-hundred-teens. All this done prior to departing for another much despised work day.

I notice I am quite a bit more easily agitated, as the other morning I screamed and yelled into my rear view mirror at the tailgater who could no longer fill up my rear window as we entered a sweeping turn, as if I were Will Smith yelling at the ET chasing him down the canyon in the movie Independence Day. But I am not feeling so much 'on edge' but more like my emotions are filling up to their normal volume.

Listening to the Drudge Report Radio Live tonight, I learned of Owen Wilson's attempted suicide-after-breaking-up-with-a-woman. I felt it was an entirely predictable event, for his openness on film is not an act and someone that open also leaves his heart open to a so very cruel world. I have a feeling that Mr.Wilson, like Dr.Malamud, looks around him and sees all the sadness and feeling the pain, sighs, shakes his head and wonders why. As I've already stated, I was forced into not seeing my psychiatrist for fear that simply mentioning thoughts of suicide would require him to inform the State of Arizona officials who would then collect me and toss me over the razor-wired-topped walls of my 1970s Alma Mater.

Although it was over thirteen months ago, it seems to me that I went on my first SSRI, Lexapro, just the other day--and just like when those chemicals were first flowing into my nerve endings--I noticed that my vision was becoming clearer. My physical eyesight is becoming as if I had just gotten a new and stronger prescription for my eyeglass lenses. My hands are tingling as if they are 'waking up' after having their circulation cut-off. As I was typing the other day I felt odd, I felt confused and decided I'd weather my chemical withdrawal while asleep.

I'm not in the best shape financially and facing a move and hopefully a move to a decent job and I am surprised that I am not feeling either depressed or excited or pretty much of anything. It's as if there is a thinking analytical part of me studying my situation and a wholly separate emotional part that behaves as if its been numbed with an injection of novocaine. Feelings which fit quite well into the known left-hemisphere 'analytical' brain and the right-hemisphere 'emotional' brain.

All in all, my withdrawal from my selective serotonin reuptake inhibitor could take up to three weeks, although I was on the lowest dose, and so far the symptoms seem quite bearable

September 2007

09/13/2007:

Foreground: Shot Glass
Background: Cuervo Gold Almost three weeks without my Wellbutrin XL. Two days ago I began drinking alcohol again. At 7:00am in the morning. Which isn't as bad as it seems since my 'day' actually begins twelve hours prior to my imbibing.

However, I am already up to two shots before my 9:00am bout of somnolence. It's quite odd, because it is not so much the C2H5OH buzz, but the particular taste that cannot be had any other way. Although I understand that licking the skin of our local Sonoran Desert toad (Bufo alvarius) after chasing one for ninety-seven seconds can result in much the same tang as Jose Cuervo Gold, only with a different, more lethal kick. Sonoran Toad
Takes a Licking Hell, I wonder how that would show up on the Man's Drug Test?

Testing Laboratory Technician: "Well, Dr. Malamud. Uh, it appears that you have Bufo alvarius toxin in your blood stream. Care to explain that?"
Dr. Hammurabi Malamud: "Young man, are you accusing me of chasing Sonoran Desert toads for ninety-seven seconds and then licking their skin?"
I love the taste of Tito's Handmade Vodka (of which I am dependent on client's purchasing for me) and the tang of Cuervo Gold tequila, which is aged about as long as newspaper ink. But still, regardless, my attraction to these highly regulated beverages, other than the bedroom staying power they engender, cannot really bring anything good into my life. Can it?

As I've been typing this, I have also been listening to symphonic music, and fighting off the cravings, the call of alcohol, with, first, a huge steaming tumbler of French-Press coffee. Then summer sausage. Then blue cheese that crumbled like an Indonesian town facing an earthquake.

But my avoidance techniques are all for not, as I soon tilt my favorite square shot glass (stolen from a friend's cabinet) and the warm golden liquid slides out and sears my tongue as it burns its way down my half-century-worn gullet.

I think I'll slip in my James Bond 1964 "Goldfinger" DVD.

End of Year 2007 Entries
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