About five years ago, at the age of 44, I discovered that my tear ducts seemed to be broken.
It was after an office squabble, the kind of terse, pointed exchange with a coworker that in the past might have brought hot tears to my eyes.
Yet I remained dry-eyed and unfazed, and later it hit me: I haven't cried in forever.
At the time, I was taking 40 milligrams a day of Paxil, a selective serotonin reuptake inhibitor, or SSRI, that was one of the most prescribed antidepressants in the U.S. It was my fourth attempt to find a medication that would tame the anxiety and depression that had shadowed me since 1969, the year my father, a navy pilot, died in Vietnam, leaving my family adrift.
I had several serious depressive episodes over the next three decades; I simply could not envision happiness.
In the mid-1980s, the panic attacks began. My heart would race and my breathing turn shallow; sometimes I'd spend hours lying on my office floor in Manhattan, paralyzed, a taste like pennies in my mouth. After 9/11, I refused to leave my house. I saw a commercial for Paxil and asked my psychiatrist for it by name.
Most SSRIs are thought to work by increasing the amount of serotonin that is taken up by the neurons. This neurotransmitter performs all sorts of vital functions, including regulating anxiety levels.
Yet in some cases, too much serotonin may make the user emotionally numb. My tear ducts felt paralyzed, as if injected with Botox. Weddings, sad movies, novels with heartbreaking plot twists -- nothing affected me.
I didn't mind; I told myself I'd cried enough in my life. Besides, I adored Paxil; it cut the gloom and fear and got me back to the world. It changed my life, or so I thought.
But Paxil worked a little too well. Whenever I felt stressed, I'd ask my psychiatrist -- who calls Paxil the "What, me worry?" drug -- to up my dosage. She controlled the supply, but I controlled the spigot, regulating the flow of serotonin as I saw fit.
In January 2008, when my older brother, Mark, called to tell me he'd been diagnosed with Stage 4 non-Hodgkin's lymphoma, I cranked the spigot up to 50 mg a day.
Mark battled the disease with great courage and dignity for 18 months. While he fought for his life, I popped a pill every day to blunt the heartache. We lived on opposite coasts, and I flew out to California as often as I could to see him.
In August 2009 he entered the same Orange County hospital where our mother had died eight years earlier. I was at his bedside, along with his two kids and our younger sister, as he took his last breath. He was only 51.
Yet later, my equanimity struck me as totally not okay. I hadn't felt the true, necessary grief that my brother deserved, and this was wrong.
I began to question my reliance on Paxil. By the time a woman reaches 50, she ought to have a pretty good idea of who she's become, yet I didn't know where the drug ended and I began. I'd also begun experiencing some unpleasant side effects, particularly nausea and light-headedness.
So last spring, after 20 years of antidepressants and talk therapy, I said to myself, It's time for a change.
Going cold turkey was not an option. Of all the antidepressants, SSRIs are arguably the hardest to discontinue abruptly. Many people stay on the drug simply because the symptoms of suddenly stopping -- nausea, dizziness, diarrhea, electrical brain zaps, insomnia, mood swings, confusion -- can be so hellish.
With my doctor's help, I would taper off, slowly reducing my daily dose to zero or close. "You have a good chance of being medication-free," she said, "but you have to reach the point where you can tolerate emotion." She handed me scrips for lower doses, along with the advice to learn new strategies for coping in a more holistic way.
"All I need," I told my ever-supportive husband, "is a guru."
Kelly Larson calls herself a "transformational consultant." Her business, Breathe into Balance, is based in the Boston area. Larson helps clients make life changes using yoga, meditation, and yogic breathing techniques, along with spiritual guidance if they so choose.
Something of a change scholar, she has studied the dynamics of personal transformation for the past decade, including receiving a master's in integral transformation from Arizona's Prescott University. But what attracted me was her evidence-based approach, in which she incorporates yoga postures that have been shown, in published studies, to help stabilize mood.
I explained to Larson that I wanted to go off my mood meds and learn to embrace my feelings, not fear them. Her reply was startling in its simplicity. "You can let your sensitivity serve you, not control you. The same part of you that cries easily can also let you be struck by beauty and open to love."
Two weeks later I drove from New York City to her office in Cambridge. The session began when Larson filled a tub with warm water, lavender oil, and Epsom salts. She encouraged me to soak my feet as we spoke. Hesitantly, I dipped a toe in.
Eleven beginning yoga students took nine 90-minute classes, with each class focusing on one of the three posture types. The findings suggest that yoga, particularly back bends, increased confidence and decreased negativity.
When I contacted the lead author, David Shapiro, Ph.D., to learn why, he could only speculate. "Back bends open the chest, increasing oxygen flow and circulation to the brain," said Shapiro, noting that further study is needed to understand what, exactly, is behind the mood boost. "Frankly, people who benefit from it don't care why it's happening. They just know it works."
Finding Peace After Pain
I was curious about how Larson had come to the work of helping people transform their lives, and we had dinner together that night. She told me about her childhood on a farm in Iowa.
"My parents wanted nothing more than to live a simple, private life with their kids," she began. Gary and Deb had three babies, one after another. In the winter of 1984, Larson was 5, Erik was 4, and baby Jared was 20 months. After a snowstorm, while Larson was at school, her father was noisily plowing snow with his tractor while the boys played in the backyard.
Larson is not sure where her mother, nine months pregnant with baby number four, was. Maybe Deb got distracted and left the boys alone for a few moments. No one saw Jared leave and walk toward the tractor, maybe hoping for a ride. "Whatever the case," Larson told me, "my father didn't see him."
Jared's death was an accident, and while no one blamed Gary, his guilt overwhelmed him. Kurt was born six days later, and a year after that Deb gave birth to another daughter, Trina. But after the accident, the family was forever altered.
"The hardest thing was to see my parents change so much," she said, picking at her food. "I did feel like Jared was in an okay place, but most of the mourning for me was dealing with being in a house full of grieving. It was hard for all of us, but I was particularly sensitive to my parents' pain."
Around age 9, Larson began to get migraines. As she got older, she wrestled with self-esteem and body image issues, and an unshakable depression.
"All I ever wanted was to help people, to please people. Yet nowhere felt safe." In the spring of her junior year of high school, she swallowed a fistful of Tylenol and lay down on her bed to die.
Larson survived, but just barely. She took Prozac for six months and did a stint in the Mayo Clinic psych ward, but ultimately it was embracing meditation and yoga that saved her, she says. "I became more aware of who I was and began to take responsibility for how I felt."
Learning that Larson had lost a brother too was a jolt. I thought, If these practices worked for her, maybe they can work for me. I met Larson for another session.
She calls the "transformational breath" the one to try "if you're looking to make major changes in your life. You're unlocking all the emotional stuff that's stored in the front of your body."
She directed me to start by inhaling into my belly, then to feel the air move through my solar plexus into my chest and finally exhale from the chest back down to the belly.
"Feel the breath go over your heart and all the way up to your collarbones. Let the breath wash over any sensation you feel in your heart. Breathe naturally, and feel your breath in your body. Feel where it goes. In the sweetness of those quiet spaces, you begin to feel your mind rewire a little."
I did my best. I imagined forcing ancient dead air from the bottom of my lungs and out of my body. "Feel the breath go over your heart," she instructed again, and oddly enough, I did.
Suddenly I realized that I'd been holding my breath all my life, waiting for something bad to happen, and that maybe, just maybe, it was time to let those years of sadness and loss leave my body with each and every breath.
Moving Forward by Cutting Back
Larson sees most of her clients once a week. But since I live four hours to the south, we had to improvise. She emailed me photos and descriptions of the depression sequence, which I taped to a bookcase so I could see them from my yoga mat. I did the routine as prescribed, yet I'm an impatient person, easily bored, and the breaths became two, then one.
I realized that if, after 20 years, taking meds to manage my moods had become a way of life, then not taking them would have to be a different way of life: more mindful, less manic.
Larson suggested we do guided meditation every week over the phone. Skeptical at first, I found it quite effective, and not just because it forced me to sit still. She directed me to envision my lower body as a tree trunk, grounding me in the present. Then I was to imagine a ball of light entering my body and clearing out grievances and pain, like a cosmic feather duster, all the while breathing. I came back to earth feeling boneless and light and newly determined.
Meanwhile, I lowered my Paxil dosage by 5 mg a week. I closely monitored my mental state for signs of turmoil yet saw none. I felt almost euphoric, despite the occasional nausea and diarrhea. This isn't so hard, I thought.
By mid-July, I was at 10 mg a day, and that's when things got turbulent. I began to feel lousy: lethargic, cranky, fluish. The old pre-Paxil edginess came back. I breathed as if my life depended on it and returned to the yoga with renewed vigor. But one day my distress was so acute that I had to call for backup.
Larson coached me through. "Breathe into your feelings," she said. "Acknowledge the tension with your breath and then release it. Let it go." I felt as if I was battling not only my brain chemistry, but my skepticism; a part of me wanted to give up and run to the pharmacy, waving my prescription like a white hanky.
Another part of me acknowledged that I was just at the beginning of a long journey to a new way of thinking, and I needed to be patient. A pill couldn't change my life. Only I could change my life.
Later that day I sat on my bed, snapping 10-mg tablets in two. My doctor had given me the prescription at my most recent appointment. She was supportive of my work with Larson and advised me to stay on 5 mg for several weeks, then to skip a day between doses. By the fall I'd be off.
"But you may find you're too uncomfortable," she warned. "You may need a small maintenance dose for the rest of your life." I held 60 days' worth of pill fragments in my hand and hoped for the courage to stay the course.
Afterward I checked my email, and there in my in-box was a message from Mark's daughter. She wrote that a family friend was walking in Mark's memory to raise money for cancer research, and when I clicked on the link to the donation page, I found myself staring into my late brother's eyes.
In the photograph, he is handsome and healthy. He is wearing a white cowboy hat and looking into the camera with his wry, bashful smile. It took my breath away.
I looked at the photo for a long time. I thought about how much I missed him and loved him. I felt a wave of pure sadness wash over me, and I let it hit the shore and recede. And then I felt something tickling one corner of my right eye, the sign I'd been waiting for: a single, extraordinary tear.