My first novel, Please Give, follows a woman named Beth who second-guesses almost everything she does, both at work and at home. Even the most innocuous sentence is subject to debriefing in Beth’s mind, and she constantly worries she’s said the wrong thing to her roommate, her friends, her boyfriend, and especially her higher-ups.

When Evelyn, my editor, sent the manuscript back to me, she praised the way I’d written a character suffering from anxiety and depression. She wrote, “Unusual in contemporary fiction, Beth’s anxiety is an innate character trait, one that helps and hurts her, and one that isn’t magically ‘fixed’ by finding love or a new job prospect. It occurs to me that it’s possible you didn’t set out to write a character with anxiety and depression — that that’s just who Beth is, and you wrote her as you saw her.”

Evelyn was 99% right — I didn’t set out to write a character with anxiety. However, I wrote Beth as I saw her because in my mind, the way Beth acted every day — the second guessing, the panic, the apologies, and the agony that came with it all — was normal.

*

I have always been a nervous person. When I was four or five years old, I accidentally ripped my mom’s pink beer coozie. My father and brother joked that I’d get in trouble. It was nothing malicious and nothing that would’ve upset an average child. I, however, broke down in tears. I panicked that I would be in trouble and that I’d hurt my mother’s feelings, having destroyed something she loved. I sobbed and told my mom that I was sorry that I’d ripped her coozie.

Reactions like this were normal to me, and panic became normalized in my mind. Being worried was normal and okay. It was okay to break down and cry at my desk when I got a D on my math test in 6th grade. It was okay to convince myself in 8th grade that a girl who heard me say something mean about her was going to shoot me on the last day of school. The girl never threatened me, never did anything except be rightfully upset at what I said (because it was mean), but hey, it was going to happen, and I was so convinced that when my dad told me he couldn’t wait for me to see our new house in North Carolina, I thought to myself, Too bad I won’t get to see it.

When it didn’t happen, I was relieved. I could set it aside beneath my regular worries about grades and friends and my weight. I’d gotten through it so easily that it was nothing at all when, in 11th grade, I overheard a senior boy who didn’t like me say that on the last day of school, he’d punch me in the mouth. In my mind, the last day of school meant he would shoot me. After exams, I walked outside, steeling myself for yet another imagined death. Nothing happened. I shrugged it off and saw Finding Nemo with my friends, as we’d planned. Everything was normal.

*

When I was in high school, anti-depressants were spoken of for just that: depression. If someone had anxiety, it was in the form of mental breakdowns, suicide attempts, or being institutionalized. It wasn’t crying over grades or imagining ways one would die, and it certainly wasn’t someone like me who could worry and still do things. I could still graduate with honors, still get into graduate school on a scholarship, still work jobs and receive praise for my swiftness and attention to detail.

People loved how thorough I was. People still do. My eagle eye, honed by reading code and emails three or four times before pressing Send with a racing pulse, is a point of pride. My memory and organization skills, honed by thinking the same worried thoughts and remembering the same terrible mistakes over and over into a never-ending spiral, have been called iron-clad. A gigabyte of memory — viruses and all.

I’m smart. I like to read. I’m organized and I work fast. I can hyper-focus on things like writing and produce, produce, produce. These are things I do whether or not I’m worrying, but they’ve been perfected by my worried state of being. Why would I do anything to temper that perfection?

*

As I spent more time on social media, I noticed more people talking about anxiety. It was usually stories of people who couldn’t speak, people who couldn’t get out of bed because they were so scared, people who’d had breakdowns and gone to the hospital. I wasn’t this person. I wasn’t suicidal, I wasn’t trembling or unable to function. I worked, I loved, I socialized. My worries were just what people experience every day. Everyone panics when they get an email, any email, from their coworkers. Everyone reads things over and over and nearly breaks out in sweat whenever they do their daily tasks.

Slowly, the conversation on anxiety turned to things I was familiar with. Circular thinking. Thinking about past transgressions and panicking about them years later. Consistent worry.

This coincided with my return to writing, and the deep dive that was writing Please Give. I often wrote 2000 or 3000 words a day — usually after work — and spent a lot of that time worrying what potential readers would think of it. I figured that was normal, as was the constant imagining of how its reception would spiral out of my control, and the headaches and stomachaches that came with it. Writers are always a little nervous, right?

This was especially the case as I waited for Evelyn’s edits. She was the first full reader, and had heard me talk about it for months before I sent her the manuscript. I was so fixated on what she thought that I had a dream that she sent me a drill sergeant to tell me everything I needed to fix, along with a manuscript covered in red ink. When I got my edits, mostly on clarifying Beth’s character and intentions, I panicked as I wondered how I’d do this while still making a salvageable book. I’d think about how to do this constantly. I still remember thinking about this as I got ready for work, and how I started to cry as I put on my shoes.

All part of the writing process, I thought. Comes with the territory.

*

In November 2017, my husband got sick. Falling in love with him has been the best thing to happen to me, and it also gave me new ways to panic. I was convinced that having something so good in my life meant that it would be taken away. I especially thought this in winter, when icy sidewalks led to me constantly thinking he’d slip and fall and crack his head (this was a popular circular thought the winter before we got married).

Now, something bad had actually happened. However, I went into gear to help — driving to appointments, being there for comfort, telling friends and family.

When my mother came up to visit and help, we had some alone time at my husband’s and my apartment. I told her how I’d started to think about how I worry so much and that I might need help. She suggested I talk to my doctor about medicine.

I’d heard about medicine before, especially online. I’d also started to hear direct recommendations from friends, who mentioned antidepressants casually to me — as if I were already on them, or already thinking about them. I saw my worry as a natural state. They saw treatment of my worry as a natural response.

But I wasn’t there yet. I had other things to do — and besides, my anxiousness wasn’t enough to be called anxiety. People would think I was just trying to get attention, that I was being selfish or dramatic. I just needed to relax. The worry would subside.

When my husband got better, my panic had time to manifest. Follow-ups with the doctor nearly shut me down. I’d feel the blanket of tired anxiety, a lack of panic but a sense of dejected worry that things are bad and you just have to plow through them. The appointment would go well, we’d be happy, and then at the next check-in, it’d start all over again.

One week in May 2018, I couldn’t stop thinking about a moment during my husband’s treatment when he’d been hurt. I remembered every sense — the feel, the sound, the panic — and I’d start to breathe heavily. I had a tendency to do this in the same spot at the same time every day on my walk to work. By the fifth time, I’d had enough. I was still too scared to call my doctor, so I sent an email: I’ve been a worrier all my life, I’d been stuck in a panic spiral all week, and I wanted to discuss going on medication.

*

My doctor prescribed 10 mg of Lexapro to start. I still remember how relieved I felt when she gave me the prescription right away. I thought I’d have to go to the edge to prove how much I needed it. I felt so comforted when I picked it up from CVS.

I noticed its value immediately. The first thing I noticed was that I would walk on the Metro platform and not imagine falling (or being accidentally pushed) onto the tracks. I could also cross the highway near our apartment without imagining I’d trip, twist my ankle, and fall right as an oncoming car appeared.

But a part of me wondered: how would this affect my writing? My nervous drive was drive, after all, and it got things done. I’d also heard all the concern about medication dulling creativity, creating minds that couldn’t dive into the places where artists went and emerged with something great.

What would I emerge with?

*

I wrote the bulk of Without Condition before I was medicated. Experience helped me take a calmer approach to this one than Please Give (though my latent, persistent worries still lingered, of course). I didn’t start to see the effects of treatment on my writing until I did my first full read-through. I read it and didn’t worry over sentences or passages. I thought to myself, “Evelyn can tell me if this needs fixing.” And when I sent it to Evelyn, I didn’t write down a million edits based on what I thought she’d have to say about it. I worked on other stories — including one that became my first acceptance, “Hearts are Just ‘Likes.'”

When I got the manuscript back, I had some things to fix, as I always do. The biggest edit, and one of my favorites to date, was to “add another body or two to Cara’s count.” I didn’t panic when I read her suggestions for structure, even when it meant having to write another chapter and reorder a few existing ones. I saw it as a to-do list that I knew I could manage. I knew this because medication helped that knowledge stay on the surface above my panic, worries, and fears that had led my thinking for so long.

I managed it. I edited it, I sent it to reviewers, and I published it in February. To date, it’s my most popular and best-received book yet.

*

Getting help for my anxiety has been one of the best things to happen to my creativity. I still worry, of course. I’ll always feel a little nervous when I press “Publish,” or when I see a review of my work has gone online, or that someone is reading it. But it doesn’t keep me from producing new work the way my anxiety did when it went unchecked. I was so anxiously obsessed with Please Give that I could barely write when it was out for edits. I spent more time that summer writing pages of notes on how to fix it, and even writing continuations of the story (which, looking back, was essentially rewriting the book) that I only wrote maybe two full stories. This past summer, while Without Condition was out for edits, I wrote almost twenty.

I feel less like I’m juggling ideas or meeting imaginary deadlines. I’m able to set aside work and tell myself that it’ll get done when it’s ready. I’m able to approach editing as a to-do list and not a do-or-die list. I’m able to share my work with a normal amount of panic, one that comes with putting your thoughts and your work out into the world — a sense of worry that’s actually normal.

I still hear artists of all kinds say they fear medication will dull their creativity. Going on medication is a personal decision. However, I would encourage creatives to really think about whether their panic or their sadness is helping their art, or if it’s just another lie that their illness wants to tell them. Ask if it’s really part of the process. Ask if that funny Internet comic talking about writer’s panic is really so funny when you’re feeling so sad and so worried that you erase, rewrite, delete, erase, rewrite, delete one passage so many times that you get a headache and you don’t go to bed (true Please Give story). Is any art worth that — especially when art can still be produced with medical help?

*

There’s an excellent episode of the Netflix sitcom, One Day at a Time, where Penelope wants to go off her antidepressants. She quits, then spirals into a depression so dark that she doesn’t leave bed, cancels her dates, skips work, and eventually records herself sharing suicidal thoughts. She talks to her landlord and friend, Schneider, about how she feels like she shouldn’t need antidepressants to function every day. Schneider points to his glasses and says, “I need these for the rest of my life.” He takes them off, then says pointedly, “Want me to drive?”

This was such an elegant way to describe both mental illness and treatment that may last a lifetime. I may be on Lexapro for the rest of my life. I’m okay with this, because I remember what my life was like without it. I have memories of panic going back as far as when I could first form memories. I have no desire to drive, read, work, love, or write without these 10 mg glasses that I put on every morning at 8 a.m.

*

In her memo for Without Condition, Evelyn wrote, “It was especially exciting to read this novel because I can see how much you absorbed and internalized from the process of writing your first novel and were able to put into action here. As enjoyable and rewarding a read as Please Give was, there’s lots of growth here in the pacing, characters, and dialogue. You should be really proud of how far you’ve come in a short time.”

A lot of that growth has come from experience, as well as working with such a great editor. I also know, though, that part of that growth between the first novel and the second came from taking care of myself. Rather than dull my creativity, that care helped it to flourish. And for that, I’m very proud.

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Learn more about Please Give.

Learn more about Without Condition.

Learn more about Evelyn Duffy.