This piece was originally published in Slate on June 18, 2006.
I dread public speaking. I get nervous on first dates. I hate to be called on in classes or meetings. In short, I’m shy. Not debilitatingly so. I’m guessing many of you are no different.
I’ve often wondered what it’s like to be outgoing—a social butterfly, an extrovert. That’s why TV ads for Paxil caught my eye. You’ve seen them: They promise ease in a pill. An end to social anxiety. Does my degree of shyness warrant medication? It was enough to make me want to see what life was like without being shy. I wondered what Paxil could do for me. Was a smoother, suaver Seth just 20 milligrams away?
Skimming my insurance company’s list, I found a nearby general practitioner and made an appointment.
I. The Transformation
Day 1: After taking my blood pressure, the doc sits me down and asks a few questions. Am I shy? Yes, I’m uncomfortable speaking in groups. Have I suffered from depression? I’ve been blue but nothing serious. I tell him I’ve taken the self-test at Paxil.com (example: “I avoid having to give speeches—Not at all, A little bit, Somewhat, Very much, or Extremely”) and it said, “Your score suggests that you may be experiencing the symptoms of social anxiety disorder.” Of course, it wouldn’t surprise me if it always said that.
He lists Paxil’s side effects—headache, nausea, tremor, etc. “The most universal side effect,” he says, “is delayed orgasm. For some people, that’s a good thing.” I nod. He explains a little about the drug itself (it’s a Prozac-type antidepressant that later got approved for social anxiety treatment) but concludes, “No matter what anyone says, we basically have no clue how this works.” And that’s that. He writes out the prescription, for 20 milligrams a day. “If you’d like, we’ve got some counselors upstairs you can talk to, but it sounds like you just want the drug,” he says, and hands over the slip. “It could take a couple of weeks to kick in. Be patient.”
I walk around the corner to CVS. Boom: Fifteen minutes with a doctor, $15 at the pharmacy, and I’ve scored a month’s supply of a powerful, mood-altering substance. Back home, I pop my first pill and wait.
Day 2: I’m lying on the couch, wrapped in a blanket, staring at the wall. My head is buzzing. My eyes won’t focus. My stomach hurts and I’m shaking. I feel like a slo-mo version of Dr. Jekyll’s violent transformation.
I do not feel outgoing.
Day 3: Ditto.
Day 4: No longer confined to the couch, but head still buzzing. Feeling totally detached from my surroundings. There’s a constant lump in my throat (apparently a common side effect), and the shaking is getting worse. Eating cereal, I spill milk from the spoon before it reaches my mouth. When the doc said tremor, I thought it could be cool—give me a little Katharine Hepburn style. Turns out tremors are not so cool.
Day 8: Delayed orgasm, beyond a reasonable point, is not a good thing. I will say nothing further about this.
Day 11: Side effects have mostly faded out, save for the orgasm thing, which is in for the long haul. I’m not seeing any personality changes, though. At a party a few nights ago (among good friends, so not a worthy testing ground), I did notice one thing: After a few drinks, I began to discourse freely on my Paxil experience.
Generally, talking about myself, even with close friends, is my least favorite thing to do (writing about myself is clearly a different [2,000-word] story). So this was odd. But was it the Paxil? The alcohol? Or just that, for a change, I had something to talk about?
II. The Unexamined Life
Day 16: Still no visible change. However, I can’t get a lick of work done. Unfinished articles are lying around, waiting for my attention. Motivation has dried up. Coincidence?
Day 25: A pattern is emerging. Since starting on Paxil, I’ve been drinking like a fish. For some reason, vitamin P combines incredibly well with alcohol. It’s more fun to drink than it was before. I want to be drunk every night. I don’t get hung over now, and I remain pretty lucid even when sloshed.
Day 27: Paxil is messing with my livelihood. I’m still not getting any work done. Could it be Paxil’s antidepressant effects? Perhaps I’m too content to be motivated. Do I require bile and unhappiness to write? I could clearly go the rest of my life on this stuff and never feel down again.
Another scary part: Before Paxil, while working on stories, turns of phrase would pop into my head, fully formed. Lying awake at night, or riding on the subway, poof—a neat arrangement of words would appear from nowhere. And would often show up in the article. It’s part of what makes writing fun and surprising. On Paxil, it’s gone. The words just aren’t coming.
Also, the last few days I’ve considered cutting down on free-lancing and getting a regular job—consulting or something. Previously, I couldn’t imagine a job like this. Regular hours and no creative outlet sounded like a nightmare. All wrong for me. But now, stability, routine, and boredom sounds A-OK. Pleasant, even. An easy way to make a buck and just live my life.
Day 29: A literati book party. My first real test, and it’s basically a failure. Upon meeting a gaggle of strangers, I still sprout flop sweat all over my torso, just like before. I still can’t introduce myself to people I’d like to meet. I still don’t know how to talk in big groups.
But then something magical happens. After deciding Paxil is worthless and downing three glasses of wine, I find I want to talk to people. No, it wasn’t the alcohol. I drink at parties all the time—and go from standing alone in the corner to standing drunk and alone in the corner. This time, I’m craving conversation. In fact, I want to talk about myself. And in the midst of a lively monologue delivered to a group of four people (previously unimaginable for me), I recognize the feeling: It’s like being on ecstasy! Relaxed, exceedingly comfortable with strangers, completely open. It makes some sense—both drugs noodle with your serotonin. Paxil, like Prozac and Zoloft, is a selective serotonin reuptake inhibitor. SSRIs block reabsorption of serotonin—a neurotransmitter—by your nerve endings, boosting serotonin levels in your brain. Ecstasy tweaks up your serotonin, too. But instead of paying $20 for a night on E, I paid $15 for a month on P. The catch: I seem to require alcohol as a trigger. Not sure why, and I doubt my doc could explain it.
Day 35: Drinking a lot, several nights a week. Liquor + Paxil = Wow!
Pre-Paxil, I was a social drinker. Now I’m walking a mile in someone else’s brain chemistry. I can see why some of you like to drink so much, maybe even need to drink so much. It’s fun for me now, in a way it just wasn’t before. On liquor and Paxil, strangers mean novelty, not fear. Group conversations are a chance to play raconteur, not a chance to smile weakly and shut up.
And it’s so much better than sobriety. Sober for me these days means extreme detachment. Movies, once a favorite hobby, do nothing for me now. Likewise books—I just don’t connect with the plots or characters. I can’t recall laughing (while sober) in the past couple of weeks. I’m never sad, but never happy. Why wouldn’t I drink?
Day 38: I spent the first semester of my freshman year of college in a haze. During the Southern California evenings, I often played tennis, pulling bong hits between games. I distilled homemade rum in my dorm room, using Sterno cans and plastic tubing. My roommate grew six ounces of weed in our closet. It was more fun than I’d ever had in my life.
The day after I got home for Christmas break, I decided to transfer.
It occurs to me that the past month has been a bit like that semester. I’m living the unexamined life. It’s fantastic. I’m about ready to transfer.
Day 45: I stop my treatment. I had planned elaborate tests for myself—crashing formal parties, giving a dinner toast to a full restaurant, singing jazz standards in subway stations—but I decide these will prove nothing. Also, my lack of engagement with life is freaking out my girlfriend. And my seismic personality shift when drunk is freaking out me.
My day-to-day, sober interactions with people are unchanged by Paxil. A crisis along the lines of a public speaking engagement would still send sweat coursing down my spine (unless I downed a few scotch-and-sodas first). As best I can tell, Paxil works by creating massive detachment from your own emotions. If your social anxiety verges on looniness, detachment from those emotions is a good thing. For me, a milder case, hard-core detachment is just spooky. So, no more pills.
III. The Withdrawal
Day 46: At dinner, I feel the onset of mutation. While staring at a plate of artichoke hearts, my focus suddenly shifts, like the track-out/zoom-in camera trick in Vertigo. My brain is shifting out of Paxil gear and back to normal. It’s like coming down off a hallucinogen. Later in the evening, it happens a few more times.
Day 47: Cannot get out of bed. Pounding headache. Extreme intestinal unhappiness. Dizzy all day.
Day 48: More of the same. I’m exhibiting classic withdrawal, which I’ve read about on some anti-Paxil Web sites. The dizziness and lightheadedness are overwhelming and far scarier than mere stomach distress. I leave the house but have to sit down every 10 minutes for fear of keeling over.
Day 49: Not much better. I can’t describe how awful it is to be lightheaded for 72 straight hours. I try to lift my blood sugar by eating, but it makes no difference. Nothing helps. More alarmingly, the dreaded “zaps” have arrived. I’d read about these on the Paxil Database, a site for self-proclaimed Paxil victims, but I thought they were made up—there are so many hypochondriacs on the web.
Turns out the zaps are for real. They’re hard to describe. Imagine low level electrical shocks all over your head, as though someone removed the top of your skull and dragged a staticky blanket across your brain. Zaps come in waves that last about 15 minutes then go away for a few hours. They do not hurt but are unnerving, to say the least.
Day 50: Zap waves all day. Have now been dizzy and burping for four days.
Day 51: Intestines happier. Dizziness comes and goes. Zaps still there.
Day 52: It’s mercifully over. But a new phenomenon has taken hold. When I get teary-eyed watching a horrid chick-flick on a cross-country flight, I recognize it: feelings. On Paxil, I barely noticed they were gone. Now that they’re back, even overcompensating, I never want to lose them again. Bitterness, anger, jealousy, sadness: They all make me happy.
In retrospect, it was a bad idea to screw with my brain chemistry and possibly inflict lifelong damage just for the sake of experiment. I would not do something like this again. At the height of my withdrawal I was seriously terrified, thought it might never end, and repeatedly cursed my own stupidity. The fact that I considered a wholesale career change under the drug’s effects, and couldn’t complete any work, is alarming. Also, the zaps are for real. Fear them.
At the same time, I admit it was fascinating to try out a different personality. He only came out when I drank, but I caught a glimpse of an alternate me, and he wasn’t such a bad guy—if a little gabby. I think I gained some empathy for other types of folk, and maybe got an idea of how alcohol can mean different things to different people. I also sort of discovered what emotions are for and decided being shy isn’t so bad after all. Thanks, Paxil!