The Backcountry Prescription Experiment

Mathina Calliope | Longreads | December 2019 | 13 minutes (3,134 words)

In 2014 my doctor took me off the antidepressant I had credited with making life okay for the previous 16 years; at 41 I was trying to have a baby with my boyfriend, Inti. I didn’t get pregnant, but this story isn’t about my failure to become a mother. Instead it’s about how a break from my meds led, ultimately and circuitously, to another kind of birth; to a different life for myself.

My doctor’s orders seemed rash. Going off antidepressants is fraught, especially since so many people who want to stop taking them have been on them for so long. New guidelines are emerging that acknowledge this danger; a 2019 study in The Lancet Psychiatry recommended patients taper “over a period of months and down to amounts much lower than minimum therapeutic doses.” But my doctor was nonchalant. “You have something to be happy about now,” he quipped. “You’re trying to have a baby.” Skeptical, but with a tendency to assent to authority figures, I followed his command to stop cold turkey.

Wellbutrin (bupropion) had helped me leave a stifling marriage (though this story is also not about that). It let me dance salsa two to four nights a week through all my 30s. It gave me the energy to earn an MFA. It fueled ten-mile races, half marathons, and a marathon. It supported me throwing myself a 40th birthday party, my favorite night of my life. And the drug helped me have the clarity to see sweet, steady, easy-going Inti — my dear friend of 11 years — as more.

If the drugs didn’t fundamentally change my depression, did they, instead, by altering hormone levels, merely mask what might be a treatable source of discontent?

In addition to trying for parenthood, I had recently changed almost everything else about my life. In 2013 I had asked Inti to be my boyfriend and move in. To save money toward a house, in summer 2014, shortly after I quit meds, we put my place on Airbnb and went to live with his mother and brother. That fall I achieved a promotion at work, but the role presented unexpected challenges — not least the fact that the job itself, the career even, was not fulfilling. For the first time in more than a decade, anxiety appeared. The usual infelicities of intergenerational living — different standards of kitchen cleanliness, for example — set me on an edge that felt unwarranted. Fortunately my usual yoga, running, and dancing did a lot of the heavy lifting Wellbutrin used to do. Things were rocky, but they weren’t bleak.

A year after going off the drug, I was not quite depressed, but also not quite the same person I had been on the meds. It had become clear pregnancy wouldn’t happen without heroic measures we were disinclined to take. I grew restless and cast about for something meaningful, something, perhaps, to fill the hole I expected a baby would have filled.

Inti and I moved that January 2015 into a posher-than-necessary apartment of our own, and, with no fetus to protect, I started drinking wine socially and coffee daily again. Circumstances evened out and anxiety dissolved. Depression remained at bay, too, so there seemed no need to restart Wellbutrin. Still, something was off.

Although millions of people take antidepressants and are helped — saved, even — by them, psychoactive substances were not, in fact, first used to treat mental illness but to alter one’s state of mind, going at least as far back prehistory (e.g., chewing coca leaves). It was only later and “serendipitously,” as author and MD Marcia Angell writes in a 2011 New York Review of Books article, that scientists realized such drugs altered brain chemistry. They then hypothesized that since, for example, Thorazine, which helped patients who had schizophrenia, lowered dopamine levels, maybe a surplus of dopamine caused the condition. Similarly, since antidepressants increased serotonin and helped patients with depression, perhaps a serotonin shortage caused depression. “Thus, instead of developing a drug to treat an abnormality,” she writes, “an abnormality was postulated to fit a drug.”

Psychologist Irving Kirsch writes in his 2011 book The Emperor’s New Drugs: Exploding the Antidepressant Myth that double-blind, placebo-controlled studies of antidepressants show the drugs to be infinitesimally more effective than placebos. In other words, although many people attest to the medicines’ good, they may in fact be responding only to the placebo effect. Jerome Groopman, an M.D., notes more recently in the New Yorker that clinical trials have “stirred up intense controversy about whether antidepressants greatly outperform the placebo effect. And, while SSRIs [selective serotonin reuptake inhibitors] do boost serotonin, it doesn’t appear that people with depression have low serotonin levels.” (Bupropion is not an SSRI; rather, it inhibits the reuptake of norepinephrine and dopamine.)

And if so, I wondered, who cares? The placebo effect is real. But if the drugs didn’t fundamentally change my depression, did they, instead, by altering hormone levels, merely mask what might be a treatable source of discontent? What if my problem was never my brain chemistry to begin with? What if it was my life?

One day shortly after moving into the nice apartment, I ditched work for a day hike on the Appalachian Trail, where I met a couple of backpackers who were walking the whole thing, 2,189 miles from Georgia to Maine. I admired their audacity, and the man told me, “It’s never too late.” I had never backpacked, so I almost laughed out loud. But the idea took hold.

Day hiking had always induced unequaled tranquility, in short supply in the prior year. Surely full-time forest living would do more of the same. I had read and enjoyed Cheryl Strayed’s memoir, Wild, and Bill Bryson’s A Walk in the Woods. Theoretically I was a fan of nature. All reasonableness to the contrary, I decided to try it: A thru-hike. I would quit my job, put my furniture in my parents’ basement, break the lease on our apartment (Inti would wait for me in the house he owned with his mother), and spend from mid-April 2016 until whenever I finished, sometime in October, living in and walking through the woods. It was preposterous.

***

Five weeks into my journey, sometime in late May, scorched logs and rhododendron leaves, curled lengthwise like cigars, litter the charred hillside on the climb out of Hot Springs, North Carolina. Everything is burnt — eerie and apocalyptic — and the barren scene deepens a malaise I feel unable to shake.

After a couple miles, the forest turns green: tall, juicy-leaved deciduous trees, lushly vegetated hills sweeping under them and rolling off into the distance. It’s pretty, particularly in its contrast to the Armageddon behind me, but the air is frigid, the tree trunks shrouded, and the cloud cover engulfing.

The path steepens as I climb this ascent, as it so often does when approaching a summit; mountain profiles resemble exponential line graphs. The mist is so thick I can’t tell whether it’s raining. Can it rain inside a cloud? Yes, it can. Here’s a puddle the size of a small lake, swamping the trail, circles blooming on it where raindrops alight.

***

My lack of experience made the venture at once so great and so ludicrous that it changed not just my mindset but my identity. Depending on your perspective, I was either Someone Who Does What Lots of People Wish They Had the Balls To — or Someone Who Clearly Has Issues and Is Probably Running from Something.

On good days leading up to my departure, I felt a keen sense of privilege that my life had led me to such an idea, and that circumstances plus timing made acting on it possible. On bad days it was just plain nonsensical. There was the matter of having to give up the nice apartment. I’d have to quit my job and grieve the potential of motherhood. And, I was high-maintenance, the type of person who cared where her coffee beans came from. Sleeping in the woods and being filthy all the time would be less fun for me than for the majority of thru-hikers — overwhelmingly twentysomething men. Still, it seemed a surplus of the kind of peace the woods are known for instilling — proponents of forest bathing understand that the backcountry alters brain chemistry, too, increasing calmness and elation and decreasing rumination — certainly wouldn’t worsen my malaise.

Maybe time in the wilderness was the best antidepressant, as inspirational memes in online backpacking forums promised. Maybe it would even change me in a grand, sweeping way. Adventure-inspired clarity would reveal my true purpose and set me to living an authentic life.

Maybe time in the wilderness was the best antidepressant, as inspirational memes in online backpacking forums promised.

The depression I had before medication had been dull, but the illness can be sharper, weightier. My mother has, over the years, landed in the hospital several times for intentional overdoses. Antidepressants, hospitalizations, and analysis have had mixed results for her. As far as I am aware, she has not tried to take her life for many years, but she describes herself as depressed even still, at 73. Before antidepressants existed, her grandfather boarded a train going from Michigan to California in 1911 (no one remembers why), locked himself in the toilet, put a pistol to his head, and killed himself. My depression started becoming visible when I was in my late 20s. I was feeling engulfed by the responsibility of teaching elementary school, and unhappy in my marriage. I was also not writing. A friend urged me to see a therapist, but I associated that with shame, since my family had tried to keep my mother’s condition secret. I saw how depression warped her perception. I understood, theoretically, that it was not her fault, and yet I felt that for me to see a counselor would be to admit to some personal and moral failing. I resented my mother’s depression but found it easier to blame her than an abstract condition. If I had judged her for being depressed, how could I admit to having the same constitution? But when I did finally start going to counseling and taking Wellbutrin — the first and only drug I ever used to treat depression — the change in my disposition was positive, thorough, and immediate. If something could be corrected by a drug, I then reasoned, it must obviously have been a chemical imbalance to begin with.

I had to remind myself that sadness and depression aren’t synonyms. Sadness answers situation, but depression is on a plane apart from circumstance. Things seemed bad before Wellbutrin, but I couldn’t finger anything particular. I didn’t feel unhappy; I didn’t feel. Seeking sensation, I ate or drank. That this didn’t work the way I intended didn’t stop me, because in a depressed state I lacked the wherewithal to identify a true solution.

***

The pond on the path reflects a leaden sky. Almost as much as before I loved day-hiking, I now hate backpacking: extended unpleasantness punctuated by instants of unspeakable joy. Now suddenly, despair overtakes me. Its cold hands arrest my progress toward the summit. Sobs surge out, my whole being says, Enough. This isn’t working. Stop. I’ve been any combination of cold and tired and homesick and lonesome the five weeks I’ve been hiking, but this is new, this unmitigated feeling of futility.

As I stand there crying on the mountainside a terrible truth dawns on me: not only is the journey not working — not transforming me into someone less high-maintenance, more willing to endure discomfort in the service of a more meaningful life — its very aim, I now see, is a sham: life itself is existentially vacant.

Since only a helicopter ride will get me off the mountain this minute, when I want to quit more than anything I’ve ever wanted to do, I choke back my tears and climb on. Then, unbidden, Inti springs to mind. Patient, steadfast Inti, round faced and dimple cheeked, rebuke to the macho South American stereotype. He has supported and cheered me from afar, never questioned my decision to do this by myself, never doubted it was what I needed, never believed I wouldn’t make it. His smile, unguarded, flashing in response to some dumb joke I’ve made, comes to my mind. Gratitude floods me — for the fact of him, for our partnership.

It’s not futile, I suddenly and irrefutably know. True human connection exists, I think. I’m lucky enough to have it. It is enough.

Finally at the summit, I confront a whiteout — thick fog that blocks what is probably a lovely vista. At least it has stopped raining. I sigh and lie down on a boulder to rest. Slowly, from behind my eyelids I sense a brightening. Squinting into the glare of sun refracting through water vapor, I detect the clouds’ thinning. I scramble up to look out and there, far below, the wind has poked a tiny hole in the clouds to reveal a valley of sunlight, a patchwork of farmland. This beauty exists. Even when I don’t see it.

***

It wasn’t too much of a stretch to blame, or credit, depending on your perspective, all the choices leading up to and including the thru-hike attempt on the initial decision to quit Wellbutrin. The posh apartment, for instance. But 10-foot ceilings and endless windows weren’t filling whatever hole detox had opened in me. Work, exercise, cooking, and cleaning failed, too. On Wellbutrin, would I have sought the promotion or the pad?

When I was almost a third of the way to Maine, five weeks after my mountaintop epiphany, a stress fracture in my foot became unignorable and ended the journey. Stationed in my parents’ McLean, Virginia, basement with Inti, unable to walk, run, dance, or hike and unwilling to swim or bike, I “went off” my final safeguard against depression: exercise. Used to consuming the copious calories needed to exercise eight hours a day and suddenly without purpose, industry, or enterprise, I ate. Absent the source of endorphins I’d grown used to — pack-weighted mountain climbing — my body turned for a hit to alternatives. Sugar provided one. Alcohol was a nice, numbing chaser.

By late August I believed my foot was healed and stopped wearing the boot. A former colleague offered us the use of his beach condo, and Inti and I gratefully escaped to the shore. There, some terrible things happened. First, fresh pain flared up in my foot to the point that I feared it had rebroken. Next, changes to the rest of my body achieved unignorable status. Eight weeks of gluttony and inactivity had more than reversed any leaning out the trail had provided. I lay in bed touching my sides, my stomach, my thighs. Something I hadn’t felt since my 20s reared its ugliness: shame. Cruelly, my body and psyche wanted only more gluttony. I loaded the grocery basket with chips and mass-produced cookies, processed crap that hadn’t tempted me for decades but which seemed the only possible salve to my gloom.

Gloom’s not the word though, is it? That wasn’t how depression manifested for me. Gloom implied sensation, a fightable entity: sunshine combatted a gray day. But depression, with its sundry expressions, was wilier than that. Depression was grimmer because it was no feeling at all. Depression was numbness (overeating’s reward), dissatisfaction. It was a restless, unrelenting want — an absence of something vital. During a depressive episode in 2003, someone asked me what it was like. I thought for a moment and replied, “I don’t feel like killing myself, but I’m not sure why.”

My time on the Appalachian Trail, cut short as it was, changed my life. It wasn’t a better antidepressant than Wellbutrin; but it was a more effective mechanism for transformation.

Lying in bed feeling ashamed, I recognized depression and knew what to do. At home I went straight the next day to a clinic. The psychiatrist listened to my story — five minutes, the barest of outlines — and called the decision to hike the Appalachian Trail depression-driven and “not well thought out.” I can accept his theory that mental illness, however circuitously, drove me to the trail. But I’d definitely thought it out. Either way, he gave me what I came for — the prescription. On Wellbutrin again, as I had been 16 years before, I rose quickly out of depression. What can I say? Placebos — if that’s what antidepressants are — work.

Looking back, I’m glad my ob-gyn ordered me off meds, even if in the end I wound up back on them. Off meds, I could more clearly see an aspect of my life — its lack of meaning — that I possessed the capacity to address. Where would I be otherwise? In my old job, talking myself into believing my team’s dubious pursuits were more than busywork created to justify our six-figure incomes? Of course, even healthy, happy people might change their scenery every five or 10 years. Still, on medication I probably wouldn’t have tried the hike. It was only off meds that I deeply understood I wanted a different life from what I had — and took the reins to create it. It takes my breath away in a really bad way to imagine not having had that experience.

My time on the AT, cut short as it was, changed my life. It wasn’t a better antidepressant than Wellbutrin; but it was a more effective mechanism for transformation. Deprived of creature comforts for 10 weeks, apart from civilization and my loved ones, reduced to the essentials of life, I could more clearly see what really mattered. It wasn’t a promotion or pregnancy or the right pad; it was, of course, people.

Three years after I set out from Georgia’s Springer Mountain, bawling in anticipatory longing for Inti, I’m writing this from the co-working office space I rent with the freelance income I earn. I’m now a writer (what my heart really wanted to do), editor, teacher, and writing coach. I produce more — and more straightforwardly useful — work now, and although I make less money and lack paid vacation, I’m happier. Through my work I find the connection Inti’s smile reminded me was all that really mattered. My clients and students become better writers under my guidance. I get to see their craft change, see their lightbulb moments of improvement and know I helped.

I’ve been back on Wellbutrin three years now. I seek sensation from other sources than just food and alcohol: snuggling with Inti, doing meaningful work well, creating community in my classroom, and getting better at my truest avocation, writing. It may be Wellbutrin that permits this, and it may be depression that, via dissatisfaction that led to the dramatic gesture, created it. Could I have gone straight to freelancing, skipping the anguished weeks in the woods? Maybe. Or maybe it took an epic outlay of physical effort and a period of severe deprivation to be brave enough to make the change. Maybe it took a little time with my old friend, darkness.

* * *

Mathina Calliope is a writer, teacher, editor, and writing coach living in Arlington, Virginia. Her work has appeared in Outside, Real Simple, the Wall Street Journal, Off Assignment, Streetlight Magazine, and elsewhere. She is at work on a memoir about how intentional deprivation (backpacking) prepared her to risk going broke as a writer.

Editor: Sari Botton