LIVING THE PHARMACEUTICAL LIFE

By Walter Kirn

I didn't know what serotonin was until I found out I didn't have enough of it. I hadn't been sleeping well--for years, it seemed--and I went to my general practitioner for help. I described a pattern of waking up two or three times every night. "That's textbook," my doctor said. "Textbook what?" I asked. He stunned me by answering, "Textbook depression."

Though I was pretty sure I didn't need it, I went home with a prescription for amitriptiline, a tricyclic antidepressant of the pre-Prozac age. The crinkly pamphlet that came with the pills mentioned some side effects: weight gain, dry mouth, sluggishness. It also informed me that it might take weeks for the drug to relieve my symptoms. I filled a glass of water and downed my pills, and within an hour, my mouth was dry as sand. Because all this happened seven years ago, before depression and its chemical basis were staple topics on the morning shows, I went to bed that night feeling slightly ashamed.

And woke up nine hours later feeling terrific. The drug had worked immediately--no waiting period--and it continued to work night after night. What's more, my days were different. Brighter. Smoother. My famously spiky temper tapered off. Like a headache one doesn't know he has until it's gone away, my serotonin deficiency revealed itself only once a drug had filled it in.

The change was so profound it spooked me. I'd done some reading by then on neurotransmitters, and I wasn't entirely comfortable with the notion that human laughter is, at bottom, a chemical phenomenon. After hearing from several friends how much more relaxed I looked, some whip-wielding inner Puritan took over and convinced me that I should throw away my pills.

At first nothing happened. My mood stayed bright. I slept. I concluded that I had a soul after all and that my moods weren't merely molecular. Then the inevitable slippage started. With plottable predictability, as if my brain were a slowly draining beaker, my sense of well-being sank and sank until I felt lower and darker than ever before. I went back to a doctor--a specialist this time--and asked flat out for Prozac, by then the subject of books and articles. One week later I felt fully restored and resigned myself to a humbling new self-image: neurochemical robot. I felt like one of those cutaway human heads used in TV commercials for decongestants.

Once I'd lost my pharmaceutical virginity, it was impossible to get it back. The Prozac, as my doctor had warned it might, stalled my libido. From approximately my waist down to my knees, I felt like the Invisible Man. I tried another drug, Effexor, but didn't like the trembling in my hands. Next came Wellbutrin. It packed a punch. The week I started taking it I was watching CNN when news of Yitzhak Rabin's assassination broke. I wept through the night and the following day. Oddly, the crying felt good, like a catharsis, and I wondered if my reaction to the tragedy--far from being excessive or drug related--wasn't in fact the genuinely human one. But 12 hours later, still shedding burning tears, I concluded that robot Walter needed a tune-up.

In time I found a mix of pills--a little amitriptiline at night, a little Effexor at noon--that I could live with. In the process I became highly sensitive to the play of my mental chemicals. I fancy that I can feel them rise and fall according to the weather, the time of year, and what I've had for lunch. In the morning, after waking up, I take a moment to look within and check my emotional thermostat, so to speak. And in the same way veteran dieters see a steak and register a certain number of fat grams, I see a grumpy or irritable person and estimate his or her serotonin level. It's an odd way to view the world, or oneself, and I wonder sometimes if I'll ever really get used to it.

--By Walter Kirn

Walter Kirn is a novelist and TIME contributor who lives in Livingston, Mont.