escitalopram™ jovia 10 mg film-coated tablet
marking my first few days off of anti-depressants
contents
escitalopram oxalate.
description
each tablet contains: escitalopram (as oxalate) 10 mg.
action
pharmacology: escitalopram, the active s-enantiomer of racemic citalopram, is a highly potent and selective inhibitor of the serotonin transporter protein which is responsible for serotonin (5-ht) re-uptake into presynaptic nerve terminals in the central nervous system (cns).
pharmacokinetics: escitalopram's absorption is almost complete and independent of food intake. as with racemic citalopram, the absolute bioavailability of escitalopram is about 80%.
indications/uses
you will get your official diagnosis on the 19th of march 2023, a little over a half-year since you last saw the psychiatrist after [redacted].
she will ask you about your normal day-to-day. how school is, how your friends and family are. you tell her that sometimes, you don’t notice the passing of the days. most times, everything looks and feels the same. that’s how it is when you’re on autopilot, she says. you make it a point to add a list of discontinued hobbies and interests before she moves on to the next set of questions. she purses her lips and lifts her eyebrows. from her arsenal of minimal responses, she chooses “hm, okay.”
she will then ask about suicidal ideation and tendencies. you say—clarify—that you actually don’t want to do the killing-of-the-self on your own but would not object if, hypothetically, a car were to speed into you on an otherwise perfectly normal day.
from that and a few other bits of information lost to your hazy recollection of things, the psychiatrist will say you are now depressed. you were good at hiding it then, she says, but now you can’t. at least not from her. for that, you need to be cured because you are such a young girl full to the brim with potential and it would be a waste to lose all that to an overgrown sadness.
she will ask if you need help telling your mother about it. you say yes, please.
dosage/directions for use
start with a quarter of a pill for two days. drink with lunch. on the third to seventh day, take half a pill. again, drink with lunch. you don’t want an upset stomach. increase to one whole pill—what’s 10 mg of manufactured brain chemicals against persistent depression?—thereafter. you need to be on medication for at least six months. don’t forget lunch.
special precautions
the first thing your mother will tell you is that you cannot drink—not a bottle, not a cup, not a shot—while you’re on meds. she will find out last-minute that your friend’s nighttime birthday party you asked to go to was actually in a bar and warn you against peer pressuring friends. your friends already operate under the assumption that you do not like drinking and coupled with the knowledge of your medically-constrained hedonism, the birthday girl will tell the others in your table that you’re not supposed to drink. you drink anyway, but just a few sips. and maybe two cups. half a year later, you will forget to hide two empty beer bottles from your parents. you will be told off, first by your mother for not heeding medical advice then by your father for drinking two bottles in one go. your correction: the psychiatrist said drinking was okay, and you drank the first and second beers on separate occasions.
the suicidality and anxiety will still come, sometimes more intensely than before your brain had its first contact with synthetic serotonin. there will be days you unconsciously gravitate closer to the oncoming traffic when commuting. your favorite part of the trip home will be the dark alley leading to your subdivision precisely because of its potential for unsafety. the medication will temper your depression at first, but it will plateau and your depression will learn to be better than escitalopram-once-a-day. your psychiatrist and the therapist she recommended will not know, even when they ask you if there’s anything they need to know about your treatment thus far.
so, you will be tempted to drop the medication altogether because they’re getting expensive and you aren’t getting any better on it, anyway. taking the daily pill will slip your mind and you will forget to renew prescriptions on time. in august of 2023, you will go three full days without medication only to come begging for it again. you will suffer through a week’s worth of headaches and nausea. you will not be able to sleep however much you want to and the world will be distorted, taking the shape of all your greatest fears. you, however, are still of the belief that your medication does not work against whatever it was that you were diagnosed with, but the withdrawal experience will be enough to keep you on the treatment plan in the next half year.
adverse reactions
on your first month on escitalopram, you will decide to drop out of the fencing team. although your psychiatrist spoke highly of escitalopram (jovia)’s energy-restoring properties in the defeated and lethargic, you spend much of the initial weeks—then later months—on it camping out in your home org’s room and snoozing in between classes. you find that you can sleep through anything, from your friends’ chatter to the blaring live music of the musicians’ pool next door. nothing bothers you while asleep on the beanbags. day less-than-five into the medication, you show up to the university gym and make sure that the coach sees you taking the pill. he notices, but does not ask about it. you do not change into your usual training clothes and explain why. you say you are on medication that is making you tired. you still choose to show up out of respect, but in decreasing durations. training is from 4 to 7. you stay 4 to 6, then only until 5, then 4:30 before you stop showing up entirely. you will disappear from the face of the fencing hall for an entire semester and a half.
it has been a few months since your recent return. you are in the group chat, invited to an out-of-town team-building. you are in the official team photo taken by the school paper’s sports arm. but, you still cannot figure out how to belong.
come the fourth month, you will forego your life-long plan of taking a term abroad. this was supposed to be the compromise following your parents’—mainly your mother’s—refusal to let you take a whole undergraduate program in nyu abu dhabi or even somewhere in nearby singapore. in august of 2023, you will be matched with sciences po rennes, france, and another applicant will ask you for your slot when she notices that you have yet to settle the confirmation fee. you have no good reason to refuse. people wonder why you won’t be in france come january 2024 and they will get one of two scripted responses: “france is too far,” or “i’m just not into western politics.”
junior term abroad-ers will begin posting photos of whichever corner of the world they got flung to by the end of the year and the irreversibility of your decision to stay will lodge itself in your throat. you unfollow one batchmate on instagram out of a sad envy and will be tempted to do it a second time when another boasts of an opportunity that could have been yours. but france is still too far and you really still aren’t into western politics, although you will try to make yourself feel better with the idea of taking a master’s degree in qatar.
on the last month of taking escitalopram, after your psychiatrist’s congratulations have worn off, you will begin to doubt the life you have shaped for your future self. you want out of the need to take medication that when missed would give you massive headaches, but you worry that you will regret all the choices you have made thus far once you come off of it and so you try to make the homestretch last longer by skipping a dose or two. you worry a lot. you are scared.
but, people will congratulate you for being in remission. they will recount how far you have come and use your case as yet another testament to the benefits of seeking help early. you will receive well wishes and prayers of continued healing. you pray for the same.
