While Dr. Fitzgerald is busy with her computer, entering notes or data or maybe she is catching up on her email, Bunny is brushing the bits of wet tissue from her lap to the floor. After a few minutes, or maybe closer to fifty-five minutes, the doctor asks Bunny, “What medications are you currently taking?”
“Wellbutrin,” Bunny says, which is not a lie insofar as it is the medication she took most recently. Most recently is near enough to currently to be more or less true.
“Would you say it’s been effective?”
To keep herself from saying what she wants to say, which is, “What the fuck kind of stupid question is that? Would I be here if it were effective?” Bunny keeps her jaw clenched and shakes her head.
The doctor asks about other medication. “Other than Wellbutrin?”
Bunny neglects to mention the Lexapro; perhaps she’s forgotten about it, as it, too, obviously, hasn’t done her any good, and it’s been who knows how long since she quit bothering with it. However, she does own up to the Ambien, although not the Lunesta.
“And prior to Wellbutrin,” Dr. Fitzgerald asks, “which antidepressants have you tried?”
“All of them,” Bunny says.
“All of them?” Dr. Fitzgerald is skeptical. “Which ones exactly?”
“I don’t remember, but all of them.”
“Do you drink?” the doctor asks.
Bunny takes a fresh tissue from the box. “Not much. Wine with dinner. A drink at a party.” And although Dr. Fitzgerald doesn’t ask, Bunny volunteers, “I smoke.”
“You know you can get Nicorette at the nurse’s station? But this might be a good time to quit, don’t you think?”
No. No, Bunny doesn’t think this is a good time to quit. If anything, this is the worst time imaginable to quit, and even that is to assume Bunny wants to quit smoking, which she most definitely does not.
Dr. Fitzgerald’s plan of action, the road map to a sound mind, begins with first weaning Bunny off Wellbutrin. “We’ll cut your dose in half for two days, then halve that for two days more. Then,” Dr. Fitzgerald says, “I want to put you on a course of paroxetine with an adjunctive treatment of aripiprazole.”
Paroxetine? Aripiprazole? A doctor who speaks to you in a language they know you don’t understand is not unlike a snooty waiter who recites the dinner specials in French, except Bunny is fluent in French whereas she is not fluent in the vehicular language of medicine. However, she does have a working knowledge of psychopharmacologic terminology. Paroxetine is generic for Paxil. Bunny’s time with Paxil was interminable, four months that dragged on into an eternity of lethargy, but aripiprazole she did not know. “What is that?” she asks.
Dr. Fitzgerald fiddles with the gold earring on her left ear, and says, “It’s an atypical antipsychotic.”
Delusional melancholia can’t be ruled out when it comes to major depressive disorder, but psychotic? “I’m psychotic?” Bunny asks.
Bunny is not psychotic, but this classification of antipsychotics has been proven very effective in treating depression. Dr. Fitzgerald tells her that Abilify augmented with Paxil has yielded excellent results.
Aripiprazole might’ve been new to her, but when she learns the brand name, Abilify, Bunny says, “No.” Abilify is legendary.
“No?” Dr. Fitzgerald sounds as if that—no—was a word she’s never heard before. “No? What do you mean?”
“I mean no. No Abilify,” Bunny says. “And no Paxil, either.”
Dr. Fitzgerald asks, “Why not?”
Why not? Dr. Fitzgerald has got to know why not, but nonetheless Bunny tells her, “Because of the side effects.”
“Every drug has side effects.” For a psychiatrist, Dr. Fitzgerald is short on patience and slim on insight.
Yes, every drug has side effects, but side effects such as dry mouth or the possibility of an erection that lasts for more than four hours is not the same as a side effect that can result in death or hair loss. The side effects that Bunny experienced with Paxil—lethargy that bordered on narcolepsy, and a loss of libido that left her with the sexual desire of a desk lamp—were identical to symptoms that ail her now, and Abilify? Abilify is a drug that brings on significant weight gain, along with uncontrollable twitching and chances are you’ll turn into a bed-wetter, too. How is that a cure for a person afflicted with depression? No one in their right mind, or even someone not in their right mind, would call that a better life.
“Not everyone experiences all the side effects,” Dr. Fitzgerald says. “And some people experience none.”
Bunny continues to shake her head well beyond a single no.
“You need to listen to me,” Dr. Fitzgerald says. “I’m trying to help you.”
For the duration of an instant, Bunny goes blind. Everything is black, tar-black and deep purple, which is then followed by a ring of light, a crisp and sharply edged light framed by fire, and the glow bores through the darkness. This is how Bunny sees rage. Slow and measured, she says, “No, you need to listen to me.”