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The Backcountry Prescription Experiment

Illustration by Natalie Nelson

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.
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