’d stopped taking my medication only a few days earlier. It had just seemed crazy to be taking antidepressants in Italy. How could I be depressed here?

I’d never wanted to be on the medication in the first place. I’d fought taking it for so long, mainly because of a long list of personal objections (e.g.: Americans are overmedicated; we don’t know the long-term effects of this stuff yet on the human brain; it’s a crime that even American children are on antidepressants these days; we are treating the symptoms and not the causes of a national mental health emergency . . .). Still, during the last few years of my life, there was no question that I was in grave trouble and that this trouble was not lifting quickly. As my marriage dissolved and my drama with David evolved, I’d come to have all the symptoms of a major depression—loss of sleep, appetite and libido, uncontrollable weeping, chronic backaches and stomachaches, alienation and despair, trouble concentrating on work, inability to even get upset that the Republicans had just stolen a presidential election . . . it went on and on.

When you’re lost in those woods, it sometimes takes you a while to realize that you are lost. For the longest time, you can convince yourself that you’ve just wandered a few feet off the path, that you’ll find your way back to the trailhead any moment now. Then night falls again and again, and you still have no idea where you are, and it’s time to admit that you have bewildered yourself so far off the path that you don’t even know from which direction the sun rises anymore.

I took on my depression like it was the fight of my life, which, of course, it was. I became a student of my own depressed experience, trying to unthread its causes. What was the root of all this despair? Was it psychological? (Mom and Dad’s fault?) Was it just temporal, a “bad time” in my life?(When the divorce ends, will the depression end with it?) Was it genetic?(Melancholy, called by many names, has run through my family for generations, along with its sad bride, Alcoholism.) Was it cultural? (Is this just the fallout of a post feminist American career girl trying to find balance in an increasingly stressful and alienating urban world?) Was it astrological?(Am I so sad because I’m a thin-skinned Cancer whose major signs are all ruled by unstable Gemini?) Was it artistic? (Don’t creative people always suffer from depression because we’re so supersensitive and special?) Was it evolutionary? (Do I carry in me the residual panic that comes after millennia of my species’ attempting to survive a brutal world?) Was it karmic? (Are all these spasms of grief just the consequences of bad behavior in previous lifetimes, the last obstacles before liberation?) Was it hormonal? Dietary? Philosophical? Seasonal? Environmental? Was I tapping into a universal yearning for God? Did I have a chemical imbalance? Or did I just need to get laid?

What a large number of factors constitute a single human being! How very many layers we operate on, and how very many influences we receive from our minds, our bodies, our histories, our families, our cities, our souls and our lunches! I came to feel that my depression was probably some ever-shifting assortment of all those factors, and probably also included some stuff I couldn’t name or claim. So I faced the fight at every level. I bought all those embarrassingly titled self-help books (always being certain to wrap up the books in the latest issue of Hustler, so that strangers wouldn’t know what I was really reading). I commenced to getting professional help with a therapist who was as kind as she was insightful. I prayed liked a novice nun. I stopped eating meat (for a short time, anyway) after someone told me that I was “eating the fear of the animal at the moment of its death.” Some spacey new age massage therapist told me I should wear orange-colored panties, to rebalance my sexual chakras, and, brother—I actually did it. I drank enough of that damn Saint-John’s-wort tea to cheer up whole a Russian gulag, to no noticeable effect. I exercised. I exposed myself to the uplifting arts and carefully protected myself from sad movies, books and songs (if anyone even mentioned the words Leonard and Cohen in the same sentence, I would have to leave the room).

I tried so hard to fight the endless sobbing. I remember asking myself one night, while I was curled up in the same old corner of my same old couch in tears yet again over the same old repetition of sorrowful thoughts, “Is there anything about this scene you can change, Liz?” And all I could think to do was stand up, while still sobbing, and try to balance on one foot in the middle of my living room. Just to prove that—while I couldn’t stop the tears or change my dismal interior dialogue—I was not yet totally out of control: at least I could cry hysterically while balanced on one foot. Hey, it was a start.

I crossed the street to walk in the sunshine. I leaned on my support network, cherishing my family and cultivating my most enlightening friendships. And when those officious women’s magazines kept telling me that my low self-esteem wasn’t helping depression matters at all, I got myself a pretty haircut, bought some fancy makeup and a nice dress. (When a friend complimented my new look, all I could say, grimly, was, “Operation Self-Esteem—Day Fucking One.”)

The last thing I tried, after about two years of fighting this sorrow, was medication. If I may impose my opinions here, I think it should always be the last thing you try. For me, the decision to go the route of “Vitamin P” happened after a night when I’d sat on the floor of my bedroom for many hours, trying very hard to talk myself out of cutting into my arm with a kitchen knife. I won the argument against the knife that night, but barely. I had some other good ideas around that time—about how jumping off a building or blowing my brains out with a gun might stop the suffering. But something about spending a night with a knife in my hand did it.

The next morning I called my friend Susan as the sun came up, begged her to help me. I don’t think a woman in the whole history of my family had ever done that before, had ever sat down in the middle of the road like that and said, in the middle of her life, “I cannot walk another step further—somebody has to help me.” It wouldn’t have served those women to have stopped walking. Nobody would have, or could have, helped them. The only thing that would’ve happened was that they and their families would have starved. I couldn’t stop thinking about those women.

And I will never forget Susan’s face when she rushed into my apartment about an hour after my emergency phone call and saw me in a heap on the couch. The image of my pain mirrored back at me through her visible fear for my life is still one of the scariest memories for me out of all those scary years. I huddled in a ball while Susan made the phone calls and found me a psychiatrist who would give me a consultation that very day, to discuss the possibility of prescribing antidepressants. I listened to Susan’s one-sided conversation with the doctor, listened to her say, “I’m afraid my friend is going to seriously hurt herself.” I was afraid, too.

When I went to see the psychiatrist that afternoon, he asked me what had taken me so long to get help—as if I hadn’t been trying to help myself already for so long. I told him my objections and reservations about antidepressants. I laid copies of the three books I’d already published on his desk, and I said, “I’m a writer. Please don’t do anything to harm my brain.” He said, “If you had a kidney disease, you wouldn’t hesitate to take medication for it—why are you hesitating with this?” But, see, that only shows how ignorant he was about my family; a Gilbert might very well not medicate a kidney disease, seeing that we’re a family who regard any sickness as a sign of personal, ethical, moral failure.

He put me on a few different drugs—Xanax, Zoloft, Wellbutrin, Busperin—until we found the combination that didn’t make me nauseated or turn my libido into a dim and distant memory. Quickly, in less than a week, I could feel an extra inch of daylight opening in my mind. Also, I could finally sleep. And this was the real gift, because when you cannot sleep, you cannot get yourself out of the ditch—there’s not a chance. The pills gave me those recuperative night hours back, and also stopped my hands from shaking and released the vise grip around my chest and the panic alert button from inside my heart.

Still, I never relaxed into taking those drugs, though they helped immediately. It never mattered who told me these medications were a good idea and perfectly safe; I always felt conflicted about it. Those drugs were part of my bridge to the other side, there’s no question about it, but I wanted to be off them as soon as possible. I’d started taking the medication in January of 2003. By May, I was already diminishing my dosage significantly. Those had been the toughest months, anyhow—the last months of the divorce, the last ragged months with David. Could I have endured that time without the drugs, if I’d just held out a little longer? Could I have survived myself, by myself? I don’t know. That’s the thing about a human life—there’s no control group, no way to ever know how any of us would have turned out if any variables had been changed.

I do know these drugs made my misery feel less catastrophic. So I’m grateful for that. But I’m still deeply ambivalent about mood-altering medications. I’m awed by their power, but concerned by their prevalence. I think they need to be prescribed and used with much more re-straint in this country, and never without the parallel treatment of psychological counseling. Medicating the symptom of any illness without exploring its root cause is just a classically hare-brained Western way to think that anyone could ever get truly better. Those pills might have saved my life, but they did so only in conjunction with about twenty other efforts I was making simultaneously during that same period to rescue myself, and I hope to never have to take such drugs again. Though one doctor did suggest that I might have to go on and off antidepressants many times in my life because of my “tendency toward melancholy.” I hope to God he’s wrong. I intend to do everything I can to prove him wrong, or at least to fight that melancholic tendency with every tool in the shed. Whether this makes me self-defeatingly stubborn, or self-preservingly stubborn, I cannot say.

But there I am.