Wednesday, 22 January 2014 at 11:45 AM *[14 Noble Ave, Yonkers, NY, United States](https://www.google.com/maps/search/?api=1&query=14+Noble+Ave,+Yonkers,+NY,+United+States&map_action=map&basemap=satellite)* # Climbing Out of the Hole Thank you for your patience. For the past month, I have been adjusting to a new medication to treat my depression and my anxiety. The drug is called Cymbalta, and it's a combination serotonin- and norepinephrine-reuptake inhibitor. It was prescribed by a doctor I found when I realized I was drinking more than one bottle of bourbon a week without sharing it with anyone. Knowing that there was a history of alcoholism in my family, I decided that was the final warning sign that I needed real professional assistance. The problem with my outlook, I discovered, was not cognitive. My rational faculty has always been hyperactive, and, logically speaking, I had no reason to feel dissatisfied, pessimistic, worthless or lonely. In fact, I have very good reasons to feel the contrary, the least of which being that I have loving parents, a stable and enjoyable job, a place to live, food to eat, and some of the best friendships humanity has ever afforded. In the few years I've been employed by the same company, I have achieved each of my career goals except for one, and that last objective gets closer every day. In 2014, I will celebrate ten years of priceless friendship with two men who can almost claim as much credit for who I am today as my own parents can. I have no financial debt, except for a couple of years remaining on a car payment. The revelation came to me when I was at work. I had been tweaking a project until it met my discriminating standards for quality when it hit me that my method of design was starting with something I hated and carving away at it until I didn't hate it anymore. I would lay something out, decide that it disgusted me, then break it down into individual components that rubbed me the wrong way. Systematically, I would remove or alter those elements until what I was looking at was no longer appalling. My moment of clarity arrived when I tried to think about how someone else would approach this project, maybe someone more design-oriented. I realized that another person may approach it the same way, but armed with a tool I didn't have: they would feel good about the elements they liked. See, I was only cutting and changing things I didn't like until they didn't piss me off anymore, a kind of negative reinforcement of good aesthetics. But another person, I posited, would probably have positive reinforcement to go on too. They would look at their progress and see both things they liked and things they didn't like. When they changed something, they would feel a sense of progress and be able to ride that wave to redesigning the whole piece. That feeling of accomplishment, or success, or even just progress, is tied up with the chemical reward system in your brain. You do something well, either something you wanted to do or something that is evolutionarily advantageous to you, and your brain releases chemicals to reinforce that behavior. It actually sets off a chain reaction of activity that sets you on the path to more action, with the resulting possibility of more reward. What phenomenally complex creatures we are! Anyway, I realized that it made much more sense for a mind to both like and hate things, and for progress to be both a matter of stripping away the negatives and enhancing the positives. I ventured so far as to suggest that such a mind should be the norm. But my mind did not work that way. I never felt a sense of accomplishment or progress with my work, and the same could be said about my hobbies or activities outside of work. Everything has been done at the mandate of duty, without joy or excitement or satisfaction. Thanks to a rigorous Liberal Arts education, I've been to function at a relatively high level despite this impediment, but I finally had an explanation for that feeling of emptiness and aimlessness. Now, I am taking a daily therapeutic dose of 60mg duloxetine, and am pleased to report that I get excited by things now. I look forward to seeing my coworkers, or my family, whom I was fortunate enough to visit with over this past week. When I tell a joke or make a meal, or even just write a few pages of my book, I feel a genuine sense of accomplishment and progress, like I'm building toward something and that something is good. I don't think I've ever spoken at length about my anxiety attacks, but they were common at work, at the grocery store, and navigating the streets of New York. Since I've started taking this medication, I have had only one moment of anxiety, and that was reflecting on the shortening lifespan of my now eighteen-year-old cat whom I raised from a kitten. That's valid. The climb out of depression and anxiety isn't over, but the issue with my chemistry has been addressed and it leaves me optimistic. For those of you who are curious about the mechanism of SNRIs, I would be glad to describe the process in a future post. --- Wednesday, January 22, 2014 in [Day One](dayone://open?date=2014-01-22) #dailynote ```query file:20140122 ```