It has been long enough since the most recent Zoloft dosage increase to evaluate its efficacy. There was at some point, very briefly, a barely perceptible improvement, and now I have begun to backslide.
It is a little complex because different symptoms are taking different paths. Part of what comes with my depression and/or anxiety is irritability and paranoia, basically taking everything that is said or done in the worst way and over-reacting. Thankfully, this cluster of symptoms has consistently been disappearing over the course of my treatment with Zoloft. As of now, bouts of reactionary jackassery are very infrequent, usually extremely brief, and I usually figure out what is going on (or more to the point not going on) and make amends in time to salvage what remains of the interaction. As a result, my illness is perceived as improved by others because I am getting along better with others. There is an internal component to this, of course. I'm simply more philosophical about how I perceive, contemplate, and respond to stimuli. I find it easier to put things in a perspective that make them smaller rather than bigger.
My internal life is not going as well as that. Part of how I deescalate perceived negative stimuli is through a kind of fatalism, realizing that things will be as they are and I am powerless to change them, so why bother getting upset? I also internalize a lot of perceived negative stimuli through a belief that I deserve it, that I brought it on myself, so once again, what point is there in reacting in a way that can only make it worse? Finally, and most importantly, I realize that most of the negative stimuli that I perceive is simply manufactured in my own malfunctioning mind.
So while I am being less of an overt asshole, I am still being passively upsetting to others by simply not performing the few simple duties I have in life well, consistently, or in some cases, at all. I do a lot of sleeping, or trying and failing to sleep, and other forms of doing nothing but letting time pass.
So, that is how I am doing, or not doing, in terms of my effect on the lives of others, but what about selfish me? How am I doing? Very not well is the short answer, and getting worse rapidly.
Shortly after starting Zoloft, I found myself able to resume in-person public interaction with old friends and acquaintances, and through those connections accumulated a few new associations. I was meeting with a group of people at "Karaoke From Hell", a recurring show at Dante's, once or twice a month. Singing has always been important to me, and I once again was able to convince myself that I could sing well enough at least to enjoy it, even if I couldn't perform as well as I believed had been able to about 10 years ago.
Abruptly, the last two monthly attempts started well enough, but I found myself feeling out-of-place, foolish, and painfully aware of my vocal shortcomings, well before the evening was over. I went home both times feeling depressed and convinced that not only could I no longer sing well, but that the belief that I had once been a moderately good singer was a delusion. I was also acutely aware of the age difference between myself and most of the other people present, and could not imagine that my presence could be as welcome as they pretended it to be. They were being kind to a pitiful and foolish old man.
Most of my time since my life sort of collapsed, first in 2000, and further in 2003, has been spent on a myriad of pointless digital projects, mostly playing around with reworking other people's existing music and films. Now I am finding that I am performing poorly at even these indulgent diversions. It takes me longer and longer to make progress. I context switch between projects too often, and don't document my process so I often am at a loss as to where I left off when I return to a project. I do a lot of tossing out untold hours of work and starting over. And remember, this is stuff I am doing purely for my own interest, contributing nothing to the lives of others. Self-indulgent obsessions which rob time from my household duties. I can't even live up to my own standards of goofing off.
My cognitive function seems very inconsistent and degrading. A vague but heavy malaise drags me down and saps my energy. I am overwhelmed with thoughts of many things I was sure I was going to do someday, many of which have been started and lay unfinished, will never be done. I don't know how much time life has left for me, and everything I do is going slower and not well. Even relatively trivial goals I now realize are beyond what is left of me.
I am rapidly approaching the state of mind I was in when I started Zoloft, a feeling best described with the single word "done".
I'm at 150mg of Zoloft. The clinical limit is 200mg. I'm trying to hold out and delay asking for that final increase for as long as possible because after that, there is literally nowhere to go. If it doesn't work, or if it works and then gradually starts failing, I have nowhere else to go. True hopelessness. As for anxiety, a lot of old symptoms are coming back, but I am not quite in the hell hole I was in before I started Clonazepam. But I know I will be back there at some point, I feel myself descending towards it, and there is nowhere to go there. The 4mg daily dosage I am on already would be considered by many clinicians to be absurdly high.
Before I once again declare myself "done"of my own volition, it seems likely that life and medicine will have decided for me. I'm sorry to be so absorbed in self pity in a world full of people enduring real suffering beyond my imagining. I have cheated death so many times in so many ways, but it seems that the world, evolution, the universe and God all agree that I was not meant to live. If I had been born very few years earlier, many of the medications and surgeries that have saved my life would not have existed. Television and other media are filled with heartwarming and inspiring stories of people living meaningful, purposeful lives bravely overcoming illnesses and injuries far worse that my poorly wired brain and poorly plumbed circulatory system. There will never be such a story about me because I am a selfish, self-pitying, self-loathing weakling who will continue whining and complaining until my bitter end.