One year on Lexapro
I would like to have a candid discussion about mental health
Note: In this essay, I address my struggles with suicidal ideation. I think it’s important to be candid about the issue, but if you think this topic will be too upsetting, I suggest skipping this post.
My friend Danni and I were hiking through a ponderosa forest above Zion Canyon when I admitted my most shameful secret — out loud — for the first time. It was November 2021 and I’d had a rough year. The lingering isolation of the pandemic, the panic attacks that erupted in February, the difficulty when Beat broke his clavicle, the death of my father in June, the soul-crushing summer in Utah while trying to help my mom navigate her new life, and then a truck driver hit me with his side-view mirror while I was riding my bike in October. A month later, it was clear the lingering effects of this collision would be more impactful than I hoped. My back muscles spasmed with pain as I walked.
Danni was justifiably worried about me, and I needed to assure her that, no, really, I was okay. I was more at peace than I had been all year. Since I couldn’t vocalize the reasons for this — as they were mostly unknown to me — I told her the truth.
“I know I’m okay because I’ve stopped thinking about killing myself.”
I’d never admitted these thoughts to anyone — not to my husband or my sisters or my mom. I’d never even talked about suicidal ideation with my therapist, whom I started working with remotely in April 2020 when I was filled with pandemic anxiety. I never could quite muster a trusting relationship with the therapist and eventually cut contact after my dad died. But when it finally came out, the confession sounded so nonchalant, as though I was describing how I finally got rid of a wart I’d had for years. Even more perplexing was Danni’s reaction. She didn’t seem surprised.
Coming to better understand suicidal ideation has been one of the most perplexing challenges of my mental health journey. I feel extremely vulnerable writing about it, but I also believe it’s an important part of my story. When I searched for answers during my lower points, I hoped to find stories from others like me: People who were genuinely happy with their lives, who had good relationships with their families and loving partners, who were physically active, who were reasonably healthy, who were free to pursue their passions, who enjoyed massive privileges … and yet still found life too painful to bear at times. These sorts of stories aren’t easy to find. While depression and anxiety are rampant in modern life and not nearly the stigmatizing condition they used to be, there’s still a sense of shame associated with carrying these burdens when they aren’t “earned.” So I want to tell my story. I hope it can help somebody else.
Anxiety is part of who I am. It always has been. I had terrible separation anxiety as a small child. The anxiety became more generalized during my grade school years. I would feel random spurts of terror that had no origin, so I tended to project my fear onto current events I’d watched on the 6 o’clock news. (I’ve always been a hopeless news junkie.) As a teen, anxiety manifested as the usual adolescent angst with a streak of existential despair. In my early 20s, the anxiety surged and I started having panic attacks. I was determined to confront it directly by seeking out situations that frightened me — but also excited me. Which is how I found my way to winter endurance racing. I decided that as long as I could overcome terrifying situations, I was cured. The thing is — one can never combat anxiety by feigning fearlessness. Anxiety is not fear. Anxiety has no origin and thus no end. It is ephemeral and omnipresent. Even during my “strong” years, anxiety was always there, lurking beneath the surface and waiting for moments of vulnerability to strike.
It was easier to ignore these infrequent “slip-ups” during my strong years. I dismissed the occasional anxiety attack as a quirk — “Isn’t funny how I froze up and cried when we went sea kayaking on Mendenhall Lake even though paddling was my idea, haha.” I don’t remember when I finally accepted that anxiety was a problem that I couldn’t just wish away with lots of exercise and badassery. The random panic attacks didn’t return until 2018. But well before that, in 2016, suicidal ideation seeped into my head for the first time. It had been a rough few months. My physical health was in steep decline. A year of asthma treatments had done seemingly nothing for my breathing difficulties, which were getting worse. No matter how hard I pushed myself, I only became weaker and less fit. Muscles were atrophying. My resting heart rate topped 90 bpm. I experienced alarming memory lapses and became convinced I was facing early-onset dementia or cardiac arrest or something of that ilk, something that would certainly take me out 40 years too soon.
What I had was Graves Disease. I didn’t know it at the time. Amid this rapid decline came the 2016 election. The outcome of the election burst my ideological bubble to irretrievable shreds. I didn’t understand the nation I called home and I didn’t understand this old woman I was becoming. Laying awake with insomnia, I began self-soothing with thoughts of death. Initially, the thoughts reminded me that if I did have a heart attack, at least I wouldn’t have to witness nuclear annihilation or civil war or other authoritarian storylines that I had no desire to be a part of. But soon the thoughts of death became more visceral, envisioning how I might expedite the process if early-onset dementia was indeed part of my near future. (The brain fog of Graves Disease is deeply disturbing.)
Strangely, these ideations usually involved drowning. At age 21, I endured a near-drowning experience during a whitewater rafting trip. Moving water remains my most pronounced phobia. I still have vivid nightmares in which I relive being trapped under the boat. I don’t swim because I can’t even put my face in the water without sparking a panic. Would my brain, even at its most diseased, ever choose to put me through a drowning scenario on purpose? I sincerely doubted it. And yet, daydreaming about drowning brought unsettling — yet undeniable — relief. Whenever I had a breathing attack or political jitters or unbearable insomnia, I’d imagine the icy black water of my daydreams and gain a sense of calm.
Being human can be such an infuriatingly confounding experience. Why does my brain self-soothe with one of its deepest fears? During the rough months straddling 2016 and 2017, I came to believe these ideations were a simple tactic to ease the pain. Of course, I had no desire to leave this world; I just wanted to escape the emotions that were impossible to pinpoint and yet hurt as viscerally as if I had been stabbed in the gut. Since I couldn’t turn them off at their source, I could at least take comfort in the thought of shutting the whole thing down. Even if I had no intention to do so — and I didn’t. This is why the drowning part made sense. The reality of such an act was so repellent that I didn’t need to worry about a more dangerous desire to execute those plans.
In February 2017, I was diagnosed with Graves Disease, which sent me down a path of sharpened focus on becoming well again. My mental health improved even before my physical health. But it has been a rollercoaster ever since. I’ll pull myself onto a rise, far out of the water, where I can see the distant horizon and marvel at how beautiful the world is. Then something will knock me down and I’ll be back at the surface, where the sea monster that is my anxiety lurks. It will find me there and pull me into the depths until I can no longer bear the darkness and just want to get it over with — which is when the suicidal ideation returns. Then something real — sometimes a good life development, but also bad ones like a chronic illness diagnosis or being hit by a truck — will jolt me back to the surface. There I can see the light and distant beauty, and I’ll start climbing again.
Being stuck on this rollercoaster was an exhausting way to live, but I was still largely focused on getting my physical health back, and still assuming the mental illness was part of it. I dealt with periods of strong paranoia and anxiety attacks that would almost push me to finally seek outside help, but then a good stretch would return and I’d convince myself the problem was solved. And I always knew when the problem was “solved” because it would occur to me that a week or more had passed since I last thought about drowning.
The 2020 pandemic hit me like a brick wall. I wasn’t in a good place to brace myself for the upheaval. I’d spent six months single-mindedly focused on the goal of hiking the full Iditarod Trail — the arduous thousand miles from Knik to Nome — in 30 days. I convinced myself that this feat of strength would solve everything: the mid-life crisis that was roiling at age 40, the physical decline I’d continued to grapple with since Graves Disease, and the mental rollercoaster this hormone imbalance seemed to set me on.
Amid the worst weather I’ve experienced in Alaska, I gave the attempt everything I had. I pushed through long, sleepless days filled with terrifying conditions and complete physical exhaustion. The mental effort drained my reserves so completely that I stopped feeling human. I felt like a broken animal, straining against an invisible whip, begging to be free of this Sisyphean imprisonment. In rare moments of clarity, I remembered that what I was doing was a choice. But I couldn’t just stop. I still had to get myself to safety. I spent a night in my bivy sack at 45 below, writhing in a dreamlike state of exhaustion. Upon waking in the early morning, I realized just how far gone I’d been. The fact that I’d lost control in such dangerous conditions filled me with fear — not anxiety, but genuine fear. I quit the race the moment I made it to the village McGrath.
This is where I was when the pandemic blew up on March 10, 2020. From this point, I had to make my way home, wait for my husband to return from an even more remote part of Alaska, and figure out what came next. Like many, I spent the next few months avoiding all other humans while counting all of the calories in my pantry just in case society collapsed. My mind held onto the deeply affecting fear I absorbed in Alaska and projected it onto all things pandemic. I was a knotted ball of paranoia.
2020 is when I finally started seeing a therapist — not a great one for me, it turned out, but I was trying. I finally accepted that I was not well and needed to do something different than what I’d always done. I launched a meditation practice. I accepted that endurance racing wasn’t going to solve all or even any of my problems. I was on a path to better mental health. Or so I thought.
Grief is a pain unlike any I’ve known. I’ve had frostbite, which felt like someone was holding a blowtorch over my foot for hours, and I would choose to experience that pain all over again rather than live through even a moment of raw grief. I always said that frostbite is forever, but no, frostbite only burns us in this life. Grief is forever.
After my Dad died on June 16, 2021, my entire being was consumed with raw grief. The pandemic had been tough and early 2021 brought my worst bouts of anxiety yet, but those experiences became shadows, nothing at all. I loved my Dad so much, and suddenly that love had nowhere to go. An overwhelming combustion of love and fury and despair roiled inside of me until I felt like I would burst apart. I hoped I would burst apart. Once again, I found comfort in ideations … this time, of falling.
The torrent of grief left little room to feel much of anything about myself. Indifference toward my own life became a genuine concern. Again, I should have talked about this with someone, but I was ashamed. I made plans to keep myself safe. My largest fear during this time was losing somebody else — Beat, or my mom, or my sisters. If this happened, I planned to immediately walk to a neighbor’s house, or my mom’s friend’s house, or even to a stranger’s house if it came to that. I wouldn’t get in my car or take a bike — too risky. No, I would walk and keep walking until I found someone who I could ask to watch over me. I was frightened about what I might do if left alone too long.
Still, I knew in my heart that there was no desire to leave this world. I love life. I would miss out on so much. The good and the bad — it’s all a great adventure. I could never leave the people I love. I was heartened when I started to come back to myself and the ideations subsided. Beat and I visited his parents in Europe and went for gorgeous hikes in the Alps, where I felt as though my dad was walking beside me. I was grateful to learn that I still possessed a debilitating fear of heights. By November, while hiking with Danni and Beat in Zion, I thought, finally, I’m cured. But really, I was just getting back on the rollercoaster.
I don’t remember when my friend Corrine started to suggest trying antidepressants. But it went on for months. By Christmas 2022, Beat joked that she was going to prescribe me some as a gift and get it over with already.
Corrine is a family physician and has seen antidepressants improve the quality of life for many of her patients. She was kind and knowledgeable, but I was resistant. Not just resistant — I was strongly against medication. Sure, meds will work for some people, but not for me. I’m an endurance athlete. Mental toughness is my greatest strength. My only strength. Sure, I have wonky hormones and ratty lungs and thoughts I can’t always control, and sure, I’m staring down the barrel of perimenopause and just hoping it can’t get any worse — but I can bootstrap my way through this. Yes, after everything I’d experienced so far, I still desperately wanted to believe this. I also was admittedly terrified of the side effects of medication: robotic emotions, sexual dysfunction, weight gain, nausea, loss of balance, excess sweating, night terrors (night terrors?!), etc. The list is long.
“There’s no way that anxiety is worse than all of that,” I told Corrine.
The problem was that my rollercoaster was running out of steam, and I was spending much more time in the depths, where depression lurks. The months straddling 2022 and 2023 were so difficult for me. So difficult. I could list the events, but I’ll just say that there were many mornings when it took all my strength to climb out of bed, many nights awake with insomnia, and many days where I came up with excuses so I didn’t have to leave my house — even to go for a run. I spent many waking hours languishing in my “dark hovel” downstairs or under my weighted blanket, letting the tears flow. In a fit of unfocused rage, I took my blog of 17 years offline and had to restrain myself from erasing the entire archive permanently (I later realized that this was a kind of suicidal ideation — indulging in a permanent end to something vital to my sense of self.)
One morning, Beat confessed that my refusal to address my deepening depression was hurting our relationship. This was the kick in the ass I needed, and I started a “New Year New Me” journey with revitalized determination. I found a new therapist (who I still see and who I love.) I joined a gym and hired a personal trainer to help me do the physical work I knew was necessary to regain confidence after the most recent face fall. I tried yoga and restarted meditation. I committed to reducing sugar and cut my caffeine intake by 80%.
I worked hard through January only to arrive at an even worse place by early February. I still had anxiety and depression, and now I had added a bunch of stressful obligations and subtracted the coffee and candy I needed to cope. And yes, I had only been at it for one month. I didn’t give this journey long to convalesce, but I was suffering. On February 13, with the encouragement of my new therapist, the urging of my sister, and the ever-present concerns of Corrine, I went to see my primary care physician. I took a GAD test and scored 16 — severe anxiety. My doctor’s notes included the underlined sentence “Patient appears fidgety and anxious.” She prescribed 10 mg of Lexapro, a common antidepressant.
My first weeks on this drug were awful. I felt nauseated every morning (I took the drug before bed.) I frequently awoke in a T-shirt soaked in sweat and had to change. I had to use extreme caution while running or riding outdoors for several weeks because motion made me feel dizzy. And it seemed that Lexapro was a steroid for my anxiety. Suddenly it was 10 times worse. I could barely function. This trial period with the drug coincided with a weekend trip to Southern Utah to hike The Wave with my mom and sisters. My drive to Kanab ended in an intense meltdown that nearly upended the whole trip. I was so ashamed. So deeply ashamed. But I was grateful that my family was seeing me at my worst. Finally, I was fully exposed. I no longer had to hide.
The worst weeks passed. Gradually, my brain adjusted to the increase in serotonin. The initial symptoms subsided, and most of the side effects didn’t come to fruition. Almost immediately after the terrible trial period, my sleep improved substantially. Lexapro does hit me with occasional night sweats and frequent, vivid dreams — but these are largely pleasant and joyful dreams, or at worst strange. The are nothing like the terrifying anxiety nightmares that haunted me when I was an insomniac.
For the most part, I still feel like myself. But what’s different is a return of perspective: The views from the rise when I’m far above my lurking sea monster, where I can see the horizon and the beautiful world surrounding me. I’ve regained the ability to feel joy. Sometimes, I’ll be driving around town for tedious errands or even something I’m dreading — like getting my weekly allergy shot — and I’ll think, “What a beautiful day.” And I will feel so excited about the possibilities surrounding this beautiful day. I didn’t have thoughts like this a year ago. I couldn’t appreciate the simple joys. I was too mired in darkness to notice.
Conversely, antidepressants don’t create a state of mindless bliss. I still have my share of anger, fear, sadness, disappointment, disgust, grief, all of it. But I don’t fear my emotions now. I’m grateful for them. The spectrum of human experience is a gift. Anxiety took this away from me. With anxiety suppressed, I can be fully immersed in the moment: the good, the bad, the beautiful, the terrifying. Let it all happen — I am grateful to be alive to witness the story.
I haven’t experienced suicidal ideation in nearly a year. Sometimes I will come across a place that had been a part of these daydreams, and I’ll remember what it was like … to just casually think about death. And yet, now I don’t. And the only thing that’s changed is a chemical component in my brain. A few molecules.
Yes, being human can be such an infuriatingly confounding experience.
I’m not sure how long I will stay on this medication. I was going to give it six months, but admittedly, it’s been working so well that I’m reluctant to let it go. I’m terrified that I’ll be tossed back to where I was in February 2023, and it will be another long and painful slog to climb out of the depths. I’ve sought other perspectives on this matter, but it truly is the kind of thing where everyone has to follow their own path. Still, as reluctant as I was to try, and as skeptical as I remain that this is the only way, I’m grateful that I have this option. I’m grateful that I live in an era when we have tangible means to treat mental illness, just as I’m grateful for my inhalers and thyroid medication.
Some people win the genetic lottery before they’re born and skate through life without assistance. I’m just not one of those people.
And I continue to do the work to maintain my mental health. My therapist has been working with me using eye movement desensitization and reprocessing (EMDR) therapy, which is so intense and exhausting, yet so revealing. I have been making connections to all of my “little” traumas. I can see how they’ve accumulated in my psyche just as surely as scars on my skin, and how I can reprocess these traumas and take back control. I will sing the praises of EMDR and recommend the therapy to anyone, as strange as it may seem (and as intense and upsetting as the process can be.)
I still carry shame about my mental health — for my inability to “tough it out,” for the ways it can hurt the people around me, for my lack of gratitude, at times, for this miracle gift of life I’ve been given. This is the impetus for this essay — that yes, I struggle, and no, I’m not always strong, and yes, I need help. My power comes in acknowledging all of that, getting help, and moving forward. If you are struggling, I hope that you can find this power. I’m here to listen privately if you want to share. My e-mail is jillhomer@gmail.com.
Thank you for listening.
Thank you so much for this article. I just started Lexapro yesterday for my anxiety, during my call with the psychiatrist I kept trying to resist a daily medication - for the reasons you have outlined. I KNOW I'm resilient, I have this figured out, I take such good care of myself, etc. She said, "Let me help you, please trust me." I'm giving this a shot.
Love your blog by the way, Jill. I'm glad I searched and stumbled across it.
So well expressed/written, Jill. My dad died at age 61, when I was only 23. That, along with having a child, divorce, guilt and a myriad of "Life Trials" sank me to the lowest of lows...panic attacks, depression, anxiety, etc.. It was tough because this all happened back in the 70's when seeking help was taboo, especially for men. Long story short, I'm so glad I stuck it out; my senior life is amazing right now @ 73. Yet that will end, too, and I brace for the day coming when I will no longer be physically able to do the things I need to do to keep my head on straight.
Keep writing, as it always helps to express one's feelings openly like you do.
Mark, from Lovely Ouray.