I want to talk about the common thread which I think is apparent in the experiences of everyone who has been through paroxetine withdrawal; and, in big bold letters, that common thread is THE FEELING OF BEING CUT OFF FROM THE WORLD. Often it’s not just a feeling; it’s a reality. There are plenty of other crappy things I could single out, things others may consider more important issues, but for me, this is the big one because I’m still working on it; it’s the one which I think causes the most damage and requires the most healing.

Oliver Sacks addresses this in his book, Awakenings (1990 edition), when he describes how a disease can consume a person’s life, consume all of their energy and attention for such a long period of time that (from page 240): “they feel, on the one hand, cut-off or withdrawn from the world, on the other hand immersed, or engrossed, in their illness,” a feeling which I’m sure anyone living with paroxetine withdrawal can relate to. Then he goes on to speak about the ‘awakening,’ or the recovery, in which one ceases to feel the presence of the dis-ease, but is instead naturally drawn towards and engaged by the presence of everything in the living world around them.

It’s been just over a year since my initial withdrawal experience and I wish I could say that I no longer feel the presence of this disease, but I can’t. (Paroxetine withdrawal, and post-withdrawal, is a dis-ease. I’d love to meet someone going through withdrawal who’s sitting back at ease with all of it.) It is less present than it used to be for me, but, along with other symptoms which I am too sick and tired of to describe in detail, I have chronic pain (as in all the time) which disrupts the relaxed flow of my thoughts and feelings and kind of takes the fun out of things; it gets to me at times. It is this cognitive disruption, one which seems physiological in origin, that interferes with my fully feeling the presence of the world around me like I used to, of my fully being able to be myself. I’ve been trying to “walk it off” all this time, but I can’t.

Throughout my Paxil Experience I’ve had people full of good intentions pass on to me the age-old advice, “Don’t dwell on what’s happening to you. Just go outside and enjoy the sunshine and the simple things. You’ll feel a whole lot better.” That’s a simple solution that works, and I know it works because I’ve lived by it for many years — but it works for people who have their health, not for someone who feels like they’ve been hit in the head with an aluminum bat from the withdrawal seizures and the constant headaches and body aches. Let’s crack one of these good-intentioned people across the head with a two-by-four and then tell them not to focus on the pain (impossible); tell them to go out for a leisurely walk while their head is pulsing with pain and enjoy the sunshine which will surely make them feel so much better. Maybe then they’ll realize how misplaced and absurd some of that age-old wisdom can be, especially when it comes from people who don’t have the experience to back it up.

Paroxetine withdrawal isn’t a case of someone feeling ‘a little blue.’ You can’t just walk it off by going outside and enjoying the sunshine. It’s an assault on a person’s entire being, not just emotional. The neurological and physiological effects of paroxetine withdrawal are real — as real as if you were to break both of your legs. It’s not as physically apparent, but the injuries are just as real and just as disabling. (“Unless you’re bleeding from a head wound or in a full body cast,” someone recently wrote to me, “nobody seems to get it.”) You wouldn’t tell someone with two broken legs to ‘walk it off.’ But that’s exactly what many people going through withdrawal are told. Because of the general ignorance about paroxetine withdrawal within the medical community, and because it isn’t as blatantly disabling as a physical injury, one is often treated by family, friends, co-workers and doctors as if the whole thing is ‘just in your head,’ and this kind of treatment from others only compounds the feelings of loneliness, isolation, of being cut off from the world.

Something else which adds to this feeling is how we, those of us who are living with paroxetine withdrawal, react to it within the context of our relationships with others. But it’s not just how we react, but how those closest to us react. Specifically I’m talking about the effects of not knowing how to react. People end up over-reacting or not reacting at all — two extremes which can cause a whole lot of hurt and can separate people easier than it can bring them together. That’s the poison of this experience; I can taste it in most of the stories I have heard in the past year from other people withdrawing from paroxetine, in listening closely to what they have shared with me. In the background of all these personal experiences there’s a feeling of sadness, a sadness which I think comes from being deprived of the human relationships that normally ground us, the relationships we trust, the ones that let us know who we are, that allow us to feel connected and involved with the world around us.

Trying to get off paroxetine can push even the most civilized of us to the edge of our sanity, and that in itself can make a person feel like they’re walking through a strange land with no one by their side to comfort them. The physical and emotional strain is beyond anything most of us have ever known. Maintaining the relationships that are the foundation of our lives, whether they are professional, familial or intimate, becomes too much for some people who are battling — by the hour at times — with the effects the paroxetine withdrawal. The result is that this disease can cut a person off from the people who mean the most to them, from the structure of normal relationships that provides one with a sense of reality and a sense of self. Your whole world, everything you breathe, becomes burdened by this disease. Under the strain, professional relationships disintegrate (a person can only take so many sick days before they lose their job), marriages fall apart, friends become acquaintances, those closest to us become strangers, and the people we trusted the most become the people who hurt us the most.

This happens because paroxetine withdrawal is beyond the scope of normal experience for most of us (including our trusted medical professionals), and therefore, not knowing how to react to it, we make mistakes — especially in our relationships with those closest to us. This is where some serious damage is done.

An understanding of this situation, though, doesn’t seem to solve the problem which — from my experience and understanding — is a problem of faith, losing faith and trying to regain it. I’m not talking about Yahweh or Allah or Buddha or Jesus. I’m talking about the human relationships that make us feel secure, that let us know who we are — and the foundation of trust that keeps them alive.

There’s a scene near the end of the 1995 film Smoke, starring William Hurt and Harvey Keitel, where Keitel’s character says to Hurt, “If you can’t share your secrets with your friends, then what kind of friend are you?” Hurt’s character thinks about this for a minute, smiles and finally says, “Exactly. Life just wouldn’t be worth living, would it?”

During my withdrawal, I found out who my friends were. Someone would ask me how I was doing, and I’d tell them the truth. It’s absolutely disheartening how many of my so-called friends never called back after that. Well, I didn’t react too well (or with much kindness) to this. I think it’s fair to say that when I realized how alone I was with this experience — that’s when I began to go insane (having unexplained and terrifying seizures at the same time didn’t really help either). But what really happened is that I lost my faith. From my doctor’s grossly misinformed medical advice (“The great thing about Paxil is that you can stop taking it cold turkey.”) to being left alone with this horrible experience by friends I thought I could count on, my ability to trust people on the most fundamental level — my faith — died. That’s the only word for it. We take for granted the trust and the belief which holds our everyday relationships together. But try facing the day without that trust; it’s like being dead to the world. That was the worst aspect of my withdrawal experience. It still is.

During the seven months of my withdrawal, it was simply impossible to have normal social relationships because of the debilitating effects of the withdrawal. And after the worst of my withdrawal was over, the world didn’t suddenly become a beautiful and wondrous place for me. Besides developing a post-withdrawal condition similar to fibromyalgia, which began as severe headaches, body aches and muscular rigidity, a condition I may have to live with for the rest of my life, the effects of my withdrawal experience are far from over. For instance, there were psychologically disturbing aspects of the experience I dealt with at the time but only in a superficial manner so I could get through that particular day or hour or minute of my withdrawal. Now that I’ve survived it, though, the reality of it comes back to me — such as the reality of the time I nearly killed myself and then wanting to kill myself through countless days of my withdrawal. One doesn’t easily forget this kind of thing. It’s as if I have a knowledge of death that is with me now all the time, I can’t shake it, and I don’t know what to do with it. I haven’t been able to write or talk about most of this because it’s just too much to take. It’s too disturbing. Nevertheless, I’m not ignoring any of it; I’m just pacing myself. It may take me the rest of my life to find all the right words for what has happened here, but maybe that’s what life is all about anyway.

One writes out of one thing only — one’s own experience. Everything depends on how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give. This is the only real concern of the artist, to recreate out of the disorder of life that order which is art.

Being able to write has kept me grounded better than anything else I got going for me. Normally I can create some kind order out of the disorder of my life by finding the words that allow me to grasp the experience. This is the first time, though, I’ve come up against something that has stopped me in my tracks — and I find that disturbing as much as anything else. Except for emails and what I occasionally add to this site, I haven’t been able to write for months. I don’t know what keeps me going, but I’m still here. I move much more slowly and cautiously now, but I do move. That’s what’s most important, because not doing anything — not responding — would be the worst thing I could do. It’s the worst thing anyone could do.

“All it takes for evil to triumph is for good men to do nothing.” (Edmund Burke.) That’s what I’ve learned most intimately from this experience. I mean it. The majority of medical professionals who encounter paroxetine withdrawal in their practice respond with one of the GlaxoSmithKline patented sales pitches ranging from, “You don’t have to wean yourself off this drug,” to, “The withdrawal effects are minimal and don’t last long.” This kind of answer is a non sequitur — it has no relationship at all to the reality of paroxetine withdrawal, it is completely dismissive, and it does nothing to alleviate the suffering of the people who are experiencing withdrawal. By ignoring reality, it only makes things worse.

A word to those of you who have a friend, family member, husband, wife, or someone close to you going through paroxetine withdrawal: Do NOT ignore them. Responsibility is the ability to respond. Even if you have to say to them, “This is too much for me; I don’t think I can deal with this right now,” that’s better than not saying anything at all. At least it’s a response, an acknowledgement of what they’re going through. Some people are so afraid of saying the right thing that they don’t say anything at all. DON’T be one of those people. I understand that kind of fear, but in this case, again, understanding doesn’t make the situation any better. When I turn to someone I trust and they don’t acknowledge me with even the slightest response, it’s not only dismissive of what I’m going through; it’s dismissive of me as a person. It’s bad enough to get this from doctors, but when it also comes from a close or intimate friend, the effect is more personal, and the inherent trust that holds together any kind of meaningful relationship or friendship suffers. Not until it’s gone does one realize how fundamental this belief-in-others is to all of our relationships, to just waking up and facing the day. If you know someone who is going through withdrawal, please don’t be so afraid to say the right thing that you ignore them altogether. That’s the worst thing you could do. Paroxetine withdrawal is lonely and horrible enough on it’s own; treating someone going through withdrawal like they don’t exist will only further beat down their spirit. Any response, even if it turns out to be the wrong one, is always better than no response at all.

Take my word on this. During this kind of dis-ease, the most powerful medicine is friendship; that means being there. There is nothing more nourishing to a person’s body and spirit than the knowledge that they’re not alone. This, I’m sure, is the difference between life and death for some people experiencing paroxetine withdrawal. I’ve mentioned before how I read in Oliver Sacks’s book Awakenings of Parkinsonian patients whose symptoms did not progress in severity as long as they had the support of their family, something to look forward to, secure relationships and experiences of some kind that provided them with a sense of personal fulfilment and meaning. Take away these relationships, take away the feeling of fulfilment, the meaning these experiences provide, and the patient would immediately fall back into severe Parkinsonian tremors. Sacks speaks of the power of a compassionate human touch to bring a patient out of the painful physicality of their disease, and I believe that I have experienced something akin to this during my withdrawal. The best days of my withdrawal, not just mentally but physically as well, were the days in which I felt a connection to someone, usually in a moment of friendship, talking about something, it didn’t matter what; enjoying each other’s company, being touched by another person’s presence. The effect could be so profound that, sometimes for two or three hours even, my withdrawal symptoms would disappear altogether. Again, all I’m talking about is being there. You can never take away anyone’s pain, but you can help make it bearable.

Friendship is unnecessary, like philosophy, like art… It has no survival value; rather it is one of those things that gives value to survival.

My deepest belief (here it comes) is that we are here to be here for one another. It’s a pretty simple, straightforward belief, but there it is. It’s the fundamental foundation of how I try to live my life (and why I created this web site). It may not be perfect, but when the cold rain is falling, whether it’s on me or someone I care about, this belief is what pulls me through and keeps me breathing most of the time. It’s about the only thing I’ve ever really had faith in, the one thing that has always made sense to me.

After everything I’ve been through this past year, it’s going to be a while before I regain that faith. I feel like I have nothing without it. I don’t have much faith in doctors anymore. I question the depth of all of my old friendships now. The thought of simply trusting anything or anyone is like contemplating climbing Mount Everest. It couldn’t be more daunting. I’m facing life without trust, without faith, and I’m starting from zero. That’s the effect paroxetine withdrawal has had on my life.

The next month or two, returning to what used to be my old life, is going to be a hell of a challenge. I’ve already done what I can to get back on track by writing this blog. If it’s provided comfort or reassurance to anyone going through withdrawal, then it’s been worth the effort. And if I’ve gotten through to anyone else so that they’re not so afraid to care, so that they understand how essential it is to be there, then I’ve hit a home run. Right out of the park.

I hope that’s the truth.

Thinking the worst was over, I began looking for work on February 16th, 2001, about three months after I got off Paxil. I began to take what I thought were the first steps towards living my life again. I still had a hypersensitivity to light and sound, but it didn’t seem to kick in until much later on in the day, usually somewhere between 7 and 8pm, which was manageable to me and which seemed to indicate the withdrawal effects were gradually working themselves out of my system.

Psychologically, the transition was more difficult than I thought it would be. Just being around people again in a normal social environment took some getting used to. I found myself feeling apprehensive, hesitant and less spontaneous than I was used to being. But after seven months of social isolation, I suppose this was understandable. Socially, I was feeling a little rusty, but I was confident that I’d be all right as soon as I could find a job, get into a routine and develop a normal structure of social relationships again, all that good stuff. I’d been in starting-from-scratch situations before and, although I had my down days, I knew I could get through it if I kept pushing myself.

The social adjustment wasn’t easy. Things were made even more difficult when I began having bad headaches after the first week. I now understand what people mean when they refer to a “pounding headache.” It was as if I could feel my heart pounding — but inside my head; it was a pulsating pain. I took every kind of headache pill to fight off the headaches, but nothing worked. As the headaches continued, the hypersensitivity began to set in earlier during the day until I was eventually hypersensitive all the time, twenty-four hours a day.

It was a sinking realization the day I said to myself, “It’s still not over.” The withdrawal seizures were over and done with, but my life still wasn’t mine. I was determined not to let this experience take away any more of my life, and so I tried to jump back on the horse the first chance I had. But that determination may have gotten the better of me.

I can’t say for certain, but I probably shouldn’t have pushed so hard so soon after my withdrawal. My body, physiologically, neurologically, was still in recovery and in need of healing. I don’t know what the hell I should have done (sitting around on my ass out in the country by myself was driving me crazy), but I probably should have given myself another month to take it easy, to give myself more time to heal instead of throwing myself into a situation that was more stressful than I anticipated. It’s as if I was trying to will my life back, but my body wouldn’t let me. Mind over matter, my ass.

The headaches and the hypersensitivity got so bad that I could barely function. Trying to put on a pleasant face during an interview or any kind of social interaction was — well, it wasn’t working. I couldn’t fake it. I was so physically miserable that my spirit couldn’t fight it anymore. And after a month or so of trying to walk it off, I had to give in to the damn withdrawal again. At this point I may have wanted to blow my brains out. I wasn’t exactly taking track and was having a hard time really giving a damn about anything anymore.

That was about two months ago as I write this. I’m taking a small dose of Xanax to help with the headaches, and although I can still feel a pounding in my head, it’s not killing me like it was before, and my hypersensitivity is gone. (But I don’t know how long I want to keep taking these pills.)

In the opening to her novel, Ordinary People, Judith Guest writes that to have a reason to get up in the morning, it is necessary to possess a guiding principle, a belief of some kind; even a bumper sticker will do. But I don’t know what the hell keeps me going anymore. I don’t know what my next move is. I’m still waiting around for the withdrawal to work itself out of my system, I guess.

I’m not so sure how high my confidence is flying right now, or even if it’s confidence that I’m lacking. Which leads me to a question of faith (not religion). This is a big one.

I’ll leave my final thoughts on that, though, for when we get to the end of this blog. Until then, what follows is a sample of how my post-withdrawal experience played itself out between February and July 2001. (July 2001 would be a year since my initial withdrawal experience.)

Scott said:

“I was driving into work through the most beautiful countryside this morning and remembering something someone said about how the colours are so much more vibrant when you are off the Paxil, and I was thinking about the fact that nothing has really touched me since I went on the Paxil, and that I don’t feel like I’ve really experienced things deeply — colours or smells or joy or excitement.”

This is something I can relate to. It’s something I’ve noticed even more since I began weaning myself off the Paxil, which completely messed with my normal capacity to appreciate the world around me. Over the years I’ve developed an appreciation and a connection to simple things, uncomplicated things. Things which are diminished by words: sunshine, gut-driven laughter, a compassionate touch, a genuine smile, a cool breeze that can lift you out of the weight of your days, poetry. All that good stuff.

I can remember the last time I had a moment like this. It was somewhere between the hell of my cold turkey withdrawal and the beginning of my weaning off the Paxil. I was on shaky ground, but I remember taking a walk behind our house in the woods with my father’s dog. I was walking past a crab apple tree in our backyard just at the edge of the woods when I heard a thump. It didn’t make me jump ten feet in the air like it would later on in the withdrawal.

I turned slowly and looked around, trying to figure out what had made the sound. I was standing there looking at this crab apple tree, a crab apple tree that was weighed down with these huge red and yellow apples. Then I knew it: One of those big apples had fallen out of the tree and thumped against the ground. That was the sound. And just as I was thinking that, another apple fell free, and I smiled.

It was one of those moments that wouldn’t have happened had I been three footsteps further down the path when the first apple fell. The whole thing probably took less than a minute to be over and done with, but I can still remember the joy of being able to appreciate that moment, the calm and the quiet of it all. Reading this you may not have any idea what I’m talking about it. But it was a moment of deep of appreciation, of being glad to be alive.

That sort of appreciation requires a certain kind of willingness, a certain kind of calm that allows a moment like that to happen in the first place. And since I’ve been living in Paxil Hell, I haven’t lived a single second like that. Believe me, I have wanted to die.

But there is a happy ending to this (I think). But I’ll tell you about that in a day or two. I’m not ready yet.

Dave wrote:

My emotions are all over the place. I keep bursting into tears very suddenly and out of the blue. Also, in the evenings/nights the last few days I have had really frightening feelings that I’m going to suddenly do something really awful and will just lose control. I feel like something inside me that usually inhibits these actions has come undone and is in danger of activating. It’s really scary.

Has anyone else felt this? It’s not a feeling of wanting it all to end — it’s a feeling that it just suddenly will with some rash action. This is very hard to write — probably to read to. Please reply if you’ve felt the same. I just want to hear there are others going through the same thing — please don’t write and tell how SSRIs are thought to induce suicide — I can’t handle that.

My response:

I know the feeling. You don’t have to describe it to me, and I don’t feel like elaborating on it. I know it too well to want to think about it too much. Since my first attempt at cold turkey withdrawal, I have experienced what you’re describing more than once (the last time I experienced it was about five days ago). I’ve experienced it at various times during my withdrawal and in many variations, but it’s all basically the same thing. It’s extremely difficult and scary to describe, but it’s like a knowledge that I could die now; a human being can only take so much, then something’s gotta give. But that doesn’t even come close to it.

Anyhow, I have lived through it, and continue to do so, because I’m able to avoid things that could set me off.

How I’ve managed to live through these moments, I don’t know. Recently, I even wrote a suicide note. Then I spent an hour or so polishing it up. And so I wrote a note instead of jumping off a bridge. By the time I finished polishing up the note, I’d managed to live through it, and although I wasn’t feeling too hot, I was no longer in danger. It’s the scariest thing I’ve ever had to face. And maybe I survived it by not facing it, by doing something else. Or maybe by actually facing it through writing and saying, “You won’t get me, you motherf**ker!” I don’t really know, and I’m not sure I can talk about it because it’s still very fresh in my mind.

But I’ve survived it and done most of it alone. There are times when I don’t want to talk to anyone, and don’t. I know when I have to be careful. That’s probably what got me through it, a knowledge that, “I have to be careful now.” And I run from everything — probably not the best thing to do (social isolation is usually not a good thing), but when even the slightest thing can set me off, can push my buttons in the wrong way, I make sure not to bump into anything or anyone who could push me more over the line.

Don’t push yourself. Know that now may be a time to be careful. Very careful.

None of this is probably any comfort to you, but what I can I tell you? I’ve been feeling extremely worn down lately and I don’t have as much to give as I used to. But I’m still alive.

Fall head-first into the agony of it. Live through it. Whatever it takes. Maybe that’s what I did. Maybe you can do it too. The main thing is don’t kill yourself. It isn’t you, remember; it’s the damn Paxil withdrawal.

I’ve always been able to deal with the emotional symptoms (e.g., the suicidal feelings) easier than the other symptoms (e.g., the electrical surges). The electrical sensations just about drive me insane. More than any of the other symptoms, they’ve made it impossible to be me and to do what I love to do.

I have felt on-and-off suicidal since my first cold turkey experience in early July. I still haven’t completely shaken the feeling, but I can tell you that it subsides to the point where it’s just a faint echo of what you’re feeling now. You’ll remember it, and in a sense it’ll still be there, but you won’t feel any urge to go through with it.

The only way to get through now it is don’t kill yourself (simple, right?). Your body and your brain are going through one serious motherload of a neurochemical adaptation. You have to give yourself a chance to get through it and to go through it. As you know, there are some sudden benefits to getting off the Paxil — I’d say focus on those right now and enjoy them as much as you can. And the next thing you know, you’ll be feeling crappy, but you won’t be feeling suicidal. And that’s progress. And gradually everything gets better. That’s the only thing I can say with some confidence.

It’s been a long dragged out experience, but a little tiny bit at a time, I’ve gotten better. So don’t kill yourself and you will too. And don’t forget to take plenty of B Complex.

First response:

I am so excited that I can hear from people who are having similar experiences. Five days ago I decided to quit taking 20mg of Paxil. I did minimal weaning, but I had no medical guidance because I have been stealing Paxil from my mother. Anyway, I attend a prestigious university which is very demanding and I cannot, in no way, get any studying done. I’ve only been taking the drug for about four months and after feeling like an emotional zombie, decided I had enough.

However, these tremors and vertigo accompanied with fits of crying is making me nuts. My roommates and supposedly closest friends have no idea how bad this feels. All I wanted was someone to talk to who could relate to my experience at school and they instead turn their heads and go out for a night on the town. They are mad at me for taking the Paxil without a prescription, but where were they a year ago when I sank into my interminable depression? Where were they when they could have stood up for me in my terrible circumstance?

Thus, I’ve come home (thankfully close to school) and I’ve been bedridden for about three days. My parents think I’m lazy and I lash out at them with a newly acquired temper. No one understands! When are the symptoms going to end, and is this paranoia a result of the withdrawal or is there truth in my perceptions? I don’t know. I’m just rambling to pass time during these periods of insomnia.

Second response:

Yes! I remember that the one and only suicidal thought in my life happened after I accidentally went cold turkey off the Paxil. It is right back there as a faint memory but a very unpleasant one. I was at the sink washing some dishes and it felt like my brain was swelling and then the thought that I should get a gun and shoot myself in the head came and it wouldn’t go away, and then I began fighting with myself, wondering what was real and what wasn’t. That is the day I ran to the drugstore and got a refill on my Paxil only because I couldn’t really figure what else it was from.

This past year of my life hasn’t been measured in months or days. Not even the beating of my heart, as Kazantzakis might contend. Misery and numbness is more like it.

I don’t think it’s right that a human being should be allowed to live through as much as I have. I should be dead.

The whole lobby was empty. It smelled like fifty million dead cigars. It really did. I wasn’t sleepy or anything, but I was feeling sort of lousy. Depressed and all. I almost wished I was dead.

That’s one way to measure my life from this past year, in dead cigars and cigarettes. That’s exactly the description I’d give my life: fifty million dead cigarettes. Excuse me if I’m feeling a little lousy.

Sunday, November 5th, 2000 (5th day off Paxil). A journal entry:

…the effects of the cold turkey Paxil withdrawal were totally unexpected and disturbing. Debilitating and nearly constant electrical surges in my brain; they wiped me out. Unable to take any more of it (I gave it a week, a week where every day it got progressively worse), I started taking the pills again. The symptoms went away, but, in a sense, something else went away. And I haven’t been myself since.

A couple weeks after my cold turkey withdrawal, I was driving alone down a long stretch of highway and I pulled over to the side. I reached down into a bag on the floor of the passenger side, looked over my shoulder to make sure I wasn’t about to be ploughed into the ditch by an 18-wheeler, pulled out my notebook and scribbled down a thought that had just occured to me.

The car was still running. I don’t know how long it took me write down the words, probably no more than five minutes. I looked at what I’d written to make sure my handwriting was at least semi-legible. It was. I then got the car going down the shoulder of the highway as fast as I could without crashing, turned onto the highway and away I went…

…and I was down here in this bedroom lying on the bed with a knife to my throat, feeling the sharpness of the blade, knowing that I could very well, very efficiently, cut open my throat — I could feel my pulse through the blade — and that would be the end of it. I’d be done. I had tried and tried, and had loved and cared as much as I could, and I had come to a life that I didn’t want anymore. The desire was gone. I didn’t want to be witness to the things I’d been living with, to this depth of suffering and total loneliness. And I didn’t care what else there was, and what else there might be. I’d had enough and felt like I had good reason quit.

As it is, my body is still alive. As for the rest… I’m wondering if this feeling will ever leave me. Will I always know this? “Is this something I’ll have for the rest of my days?” Can I yell that one up to the skies? What is this knowledge doing to me? How am I going to live with this?

My notebook has been kicking around for a while now. I’ve been meaning to find a place for it. Cleaning up this bedroom, I nearly threw it out a few times. I’ve probably thrown away other things. Maybe it’s okay to hold on to death, to write about it like this, especially when it’s so personal. I don’t like the thought of this being true, but maybe this is all I have. Maybe this blog is me holding on to life. Here’s the unedited version of what I wrote on the side of the highway that day:

Suicide is almost a natural reaction to a trauma. In a physical trauma, such as a car accident, survivors often have no memory of the accident. The brain automatically blocks it out — it removes the trauma and the unpleasantness from your consciousness. Suicidal thoughts are the same thing, only your mind wants to block out your life, your entire living.

That’s the unrefined thought of it. There’s a lot I could add to it. And from where I’m standing, it seems to make a whole lot of sense. It doesn’t seem unreasonable at all. Pretty scary shit, ah?

P.S. (Sept. 2006): The day I had that knife to my throat was a day everything changed. I’ve never gotten over it. This is one crazy journal entry. It’s not difficult to see how close to the edge I was at the time — which was pretty much the whole time I was going through withdrawal. I’m amazed at how civilized I was during the whole thing. I was so close to the edge of my sanity, over the edge really, it’s a miracle I didn’t completely lose it and commit violence against myself or someone else. This might not make sense to most people, but under the extreme conditions of Paxil withdrawal, it seems insane NOT to go nuts and lose it. Who wouldn’t want to go nuts and let it all out? Many times I thought I would have been much better off if I’d simply had permission to say, “F**k being civilized! Put me in a sound-proof padded room and let me get it out of my system — now!” Except for places like paxilprogress.org, there is practically no outlet for the psychological trauma of Paxil withdrawal. Staying civilized in the midst of all that is a miracle. And I know the questions I asked sound crazy — What is this knowledge doing to me? How am I going to live with this? — but they’re still real. I’m not sure what kind of knowledge it is. A knowledge of my death. A knowledge that if I’m ever in that place again, in all likelihood I would kill myself. That knowledge scares the hell out of me, but maybe that’s a good sign. (I still sound crazy, don’t I? But trust me, you would too.)

Right now I don’t know if I’ll be alive by Xmas.

I’m feeling better today. I was going to say much better, but that’s probably pushing it. I got up at 7:30 this morning to help a friend move some things into a new office. I haven’t been sleeping lately, so I was expecting to be tired, grumpy and out of sorts when I got up, and I was. Never too hungry that early in the morning, I had a slice of toast with honey, my usual handful of vitamin supplements, a bottle of water and off I went — hit the road in the pickup truck (someone else driving).

I immediately got dizzy and off balance lifting things and walking up and down the stairs. I wasn’t long popping my first Xanax (electrical sensations were beginning to stir behind my eyes). It took a couple hours to do the work, then I had soup and a bun from doughnut shop. By the time I got home about an hour or so later, I felt good. Not nearly as lousy as I’ve been feeling for the past few weeks, on-and-off suicidal and all that.

This wanting to live stuff is tricky business.

In a previous message I mentioned feeling suicidal at times. I know that’s the kind of thing that scares people off, but most people who go through this kind of thing eventually get around to feeling something like it. The problem with actually admitting it out loud is that people think you’re crazy — and nobody listens to crazy people, right? (Right.)

But the fact that I can say it out loud demonstrates, I hope, that I’m probably more healthy than the people who don’t say it out loud. And the last thing I’m going to do is smile and pretend everything is a.o.k. when it isn’t. I see people every day like that who are living in Disneyland and it’s a way of life for them. (And between you and me and that wall over there, these are the people who are nuts. Seriously.)

Despite all the depressing things I’ve experienced because of the Paxil, I am not depressed. Believe me, I know depression, and this isn’t it. This stuff is a headache, and there’s no joy to be found in any of it, but my personality is still relatively intact, and I’m not depressed.

When I’m genuinely depressed (which I don’t think I have been for a long time), I don’t want to do anything (that’s one of the things about it). What I’m experiencing from the withdrawal may be similar in that I’m not exactly animated — in the run of my day I do pretty much nothing. I try to read and I try to write as much as I can, but otherwise, I’m a walking turnip; I’m useless. (I’m also lucky to be in a position where my responsibilities are minimal. Yes, I admit it, I’ve had to move in with my parents who are nowhere close to rich but who have a big house and who feed me well and pay all the bills. I know how lucky I am to have them at this time.) But I think most of what I’m experiencing now is the withdrawal, not depression.

Unlike depression, I have the desire now to move, to do things, to live. The desire is there — underneath all the Paxil withdrawal crap, I can feel it there. But when you’re so wired up waiting for the next electrical brain zap to kick in and wipe you out (and other such wonderful conditions of the Paxil Experience), it’s hard to have enough energy to care about that desire, to give it the attention it deserves, to nurture it and to go with it. It takes energy to care, and to live and to make something substantial of that desire. And for me — stuck in the middle of Paxil withdrawal — that energy isn’t there.

I think my spirit is still intact, but everyone needs some kind of fuel to keep them going, and no matter how good-natured I’m able to be, the fact is this: I’m all out of gas. The Paxil withdrawal is using up all of my fuel. Psychic fuel, spiritual fuel, whatever you want to call it — my tank is empty, and I have Paxil to thank for it. I may be bumping around like zombie half the time running on empty, but that doesn’t mean I’m depressed.

My desire to be alive is well intact. But it’s like a car without any gas. As long as the Paxil withdrawal is burning up the fuel, I can’t expect to get any further than the end of the driveway. That’s not depression, though; it’s an empty tank. (I know, I’m repeating myself again.)

And to belabour this point even further, sometimes when I’m scrounging around for some fuel to burn — and being in the middle of Paxil withdrawal is like walking through a desert — it’s easy to feel like, “Man, I’m a goner. No water to drink to quench my thirst, and no fuel to burn so I can start up my car and get the hell out of this place. I might as well just close my eyes and die. There’s nothing here to save me. I’m already dead.” Those may seem like the words of someone who is depressed and suicidal, but that’s not necessarily so. Crawling through a desert like this, who the hell wouldn’t feel like that every now and then? That’s not crazy — that’s normal. It’s human.

And that’s the important thing to recognize. Without it, I would be depressed and I probably would be suicidal. But I know that ALL OF THIS is from the Paxil withdrawal, not necessarily from some underlying depression. (I’m just speaking for myself, remember.) That’s the knowledge that gets me through all of this crap. There’s withdrawal syndrome and there’s depression.

I’m glad I know which is which.

And just to be on the safe side, I am seeing a doctor once a week to make sure that if I do become depressed and genuinely suicidal (which, under the circumstances, would be understandable, even though I think I have a pretty good handle on it), I’ve got someone looking out for me. But so far so good.

Sorry if this turned into a rant.

First response:

Rant away! I could read your posts all day — you’re hilarious! You sound very healthy and funny. More healthy than a lot of “healthy” folk I know.

Second response:

I understand exactly what you’re saying about the suicidal thoughts not being connected to a depressive state. I went through a few weeks of that also. The scenario would go something like this: Early morning brain zaps, a little vertigo, uh-oh, no milk for coffee. Think I’ll kill myself instead of going to the store. Uh-oh, it’s snowing outside. I don’t feel like leaving the house. Think I’ll kill myself. “You’re making what for dinner? I don’t want pasta. Think I’ll kill myself.” It all seemed perfectly logical to me at the time. My husband had to hide the knives for about a week because I’d be standing at the sink doing dishes and the next thing you know I’d have a 12″ chef’s knife at my jugular and very calmly announce, “I think I’ll kill myself.” It was as though there was this little voice in my head whispering, “Okay, NOW!” It was very frightening, but I knew it was the Paxil, and it did pass — like everything else in life. I spent a lot of time in bed with the covers over my head during that period of withdrawal. I figured the worst that could happen to me is that I’d smother from the down comforter! I laugh about it now, but it wasn’t even remotely funny at the time.

Postscript – February 7th, 2001: Despite the knowledge that almost everything I was feeling was being distorted by the Paxil withdrawal — that it was the Paxil withdrawal and not me — I had moments where that thought wasn’t much of a comfort and, to quote André Gide, “Despite every resolution of optimism, melancholy occasionally wins out…” Just after my first withdrawal experience in July, there was an incident where if there hadn’t been anyone in the house at the time, I may very well have taken my life. (I know how you’re probably reacting to reading this. Note: I’m having the same reaction.) This aspect of my withdrawal experience has, I think, left the greatest impression on me. Having lived through it and survived it, it still scares the hell out of me. Despite my optimism, I probably was suicidal at times. In December 2000, near the end of the weaning process, I was feeling so beaten down by the experience that, despite everything I’d been able to deal with, I felt like I couldn’t take it anymore. A human being can only take so much. Nothing has ever pushed me so close to the edge, and it still scares me to think about it, the recognition that I have a breaking point — the ultimate breaking point where there is simply no will to live. I have survived this experience, but sometimes I have no idea how I did it.