Paragraphs 8 & 9 read: "Tikhanina can't let go of the fact that Silverstein's chronic depression - his life-long companion - took on a renewed and rotten power shortly before his death in July, before his suicide. She thinks she knows why. The answer is broad, and it is a warning. It involves an entire medical system, a system of patient care, a type of prescription drug - even a brand of drug."

"'At this point, I'm back to my senses as much as I can be,' she said, sighing. 'And basically, I can give you one word: Effexor.'"

http://www.jacksonville.com/tu-online/stories/102107/lif_210044760.shtml

Originally created 102107

An artist's pain

The death of a gifted artist and JU professor leaves his widow with lingering questions about the medical treatment of depression

By KONRAD MARSHALL, The Times-Union

Heat rash flushed the skin on the widow's neck and shoulders and face, and especially her chest, where the wedding band of her late husband hung from a silver necklace.

Mariana Tikhanina sat in front of the Jacksonville University gallery where Brad Silverstein's retrospective was in full swing, and spoke in her measured Russian accent to say she didn't want to discuss the details of his death. Not yet.

Tikhanina, a slender 32-year-old with searching eyes and a prominent nose, was still trying to make sense of Silverstein's passing.

She, and the mourners inside the exhibition, were still trying to understand how the young man whose quiet grace and humor had touched so many here so profoundly, in so short a time, could feel - as his medical records indicated - "Hopeless. Helpless. Worthless."

"You could see in him greatness," said Bill Hill, Dean of the College of Fine Arts, the man who hired Silverstein earlier this year - over 300 other candidates - to build a painting program for the school. "You know that he would have impacted everything he touched in a very subtle, steady way. It wasn't like he would come in and be this flashy guy who would consume all the air in the room. He was somebody who would come in and bring air with him, and make things grow around him, even if you didn't know he was there."

Silverstein is no longer there, but things are still growing around him - pieces of music composed in his honor, artworks painted in his memory, poems crafted to tackle his sudden departure from the creative life of the institution.

But Tikhanina can't move on to tributes. Not yet.

Tikhanina can't let go of the fact that Silverstein's chronic depression - his life-long companion - took on a renewed and rotten power shortly before his death in July, before his suicide. She thinks she knows why. The answer is broad, and it is a warning. It involves an entire medical system, a system of patient care, a type of prescription drug - even a brand of drug.

"At this point, I'm back to my senses as much as I can be," she said, sighing. "And basically, I can give you one word: Effexor."

- - -

A few more words about Brad Silverstein.

Pittsburgh. Hog hair bristled brushes. Talent.

Carnegie Mellon. Old masters. Ragged sketch books.

Design. Depression. Dedication.

Kibbutz. University of Haifa. Ogilvy & Mather.

Fulbright. Norway. Odd Nerdrum.

Scrubbing floors. University of Oslo. Europe.

San Francisco. MFA. Teaching.

Love. Mariana. Marriage.

Jacksonville University. Professorship. Riverside.

But those are just words. They don't speak to the character of Silverstein, a 32-year-old who quickly made friends, crossed departments and disciplines, and found his way into local artistic posses by way of dry wit and a skewed outlook.

"I think he really would have changed the direction of the department in a very meaningful way," said Jack Turnock, an art professor at JU, attaching a label to one of his works on the gallery wall. "And oh, so funny."

Colleagues and students spoke of Silverstein as a sensitive presence, an art instructor who would compliment first, critique later, who would ask "May I show you? Do you mind?" so subtly that you didn't know you were being taught. A Silverstein lesson was an interaction, and it started with his eyes. Big, bright, light blue, Silverstein's eyes were like fake color contacts, like the water in a Hockney.

Jordan Brown stayed up all night painting those eyes - the fey sparkle in his mournful mug.

"I've never done a portrait where the expression was so important," Brown said. "It's a sad smirk. I don't know what else I would call it. A hint of opposites, perhaps."

The portrait was one of a dozen tribute pieces in the retrospective for Silverstein that also included a few dozen pieces of his work, painted in the way of the old masters - with diligent attention to mood and space - but with a modern sensibility. Portraits of past lives, or pictures of doughnuts, half-eaten muffins and turkey legs. Kentucky Fried Vermeer.

"I hadn't seen a lot of them," Turnock said. "To actually see them, you want to sit there and talk to him about it, and you can't, you know?"

Laura Heckt, a student in Silverstein's class, told the audience she would leave her most recent work unfinished, lest she cover up her teacher's guiding brush strokes.

Then came the music. Between muffled teary gulps, people closed their eyes to drink in the notes. Some drank wine instead. Then, into their open palms, sank shaking heads.

Piano professor Scott Watkins, before playing a piece by Shostakovich, said he hoped the notes would reflect the regret and anxiety many of Silverstein's cohort felt.

But it would end on a high note, a light of illumination.

- - -

For Tikhanina, the words tumble out now, illuminating the path she hopes no one else will go down.

Silverstein first took Effexor in May, but he was no stranger to antidepressants. Though he had always been bothered by the side effects of the drugs, he found them manageable for the decade he'd been on them.

However, this year - with a new city, a new job and new worries - Zoloft and Lamictal weren't cutting it.

Silverstein came to psychiatrist Atul Shah's Arlington office complaining of panic attacks, nearly fainting, mood swings, difficulty concentrating. Effexor was prescribed. The powerful agent would act on both serotonin and norepinephrine, controlling both mood-regulating neurotransmitters at once.

The side effects were obvious to Tikhanina right away.

"He couldn't focus on his work. It was hard for him to even write an e-mail," she said. "His memory was not that good, and he was anxious. Sometimes I could see him tremble."

Silverstein recorded his own daily notes on how the drug made him feel, from "choking up mixture of sweet and raw melancholy" to "almost crying like a 3-year-old."

After a little more than a week taking the drug, he returned to Shah's office for an urgent appointment. The doctor introduced mood stabilizers, anti-anxiety medication, and discontinued Effexor.

"When he stopped taking Effexor, it was just crazy," Tikhanina said. "I could see him shivering. His hands would tremble. Every afternoon he would get these panic attacks. His heart would race. He would be all sweaty. It was horrible."

Joseph Glenmullen, a clinical instructor in psychiatry at Harvard Medical School, has followed the tumultuous history of antidepressants for years, writing Prozac Backlash and The Anti-Depressant Solution, and is particularly vehement in his mistrust of Effexor and the side effects it can cause.

"I won't start anybody on Effexor," he said. "It's a very nasty drug. It's by far the worst of the antidepressants."

Gwen Fisher, a spokeswoman for Wyeth Pharmaceuticals, said Effexor has been in existence for 12 years and used by 20 million patients worldwide, often in patients who are believed to be sicker - more depressed - than others.

Roy Perlis, director of pharmacogenetics research at the Depression Clinical and Research Program at Harvard's Massachusetts General Hospital, said anyone who is depressed is at risk of suicide and that antidepressants help many more people than they harm. "The questions is, who are the subset of people for whom that might not be the case?"

Silverstein, said Tikhanina, was so scared by his experience on Effexor that he resolved to get off antidepressants altogether. The side effects on the labels of drug bottles made him fearful. Within three weeks, he was medication free.

Shah said he did not know Silverstein had done this until a final consultation near the end of June, and he advised against it. "We wanted to switch to a different group [of drugs] that would really turn around his depression. The concern is that he did not abide by that at all.

"But he was in therapy with a psychologist, so I allowed him, as long as he knew he could call me if there was a crisis," Shah said. "Then, that was that."

- - -

In the last week of his life, a drug-free Brad Silverstein was busy. He was catching up on preparation for a new semester, and he had to start and finish a piece for a show that weekend.

Tikhanina sat in the spare bedroom of her Post Street apartment, away from the boxes in all other rooms, away from the rubble of an upturned life, a life being moved back to San Francisco, and explained that her husband was usually full of ideas. But he was stuck figuring out how to paint the small amorphous rubber man in front of him. So Tikhanina made a suggestion, and he followed.

"He would never just follow my idea," she said. "He would always transform it in some way, but it seemed he just didn't have the energy."

He shook while he painted. He took frequent cigarette breaks, drawing hard on his Marlboro Lights. Tikhanina would lead him to bed for power naps, to settle his racing heart.

On Friday, Silverstein delivered the completed work, and came home late. On Saturday, he went to the show, and came home late again. That was when he told Tikhanina he had actually gone to the beach, both nights.

He looked relieved, though, and asked her a question: "Have you ever had such an epiphany that you just know in your gut everything will be fine?"

She had, and went to sleep happy, believing - and hoping - he had shaken the anti- depressants, the withdrawal.

An alarm woke her at 7.

"He was gone," she said. "He left a little note that he will be back, that he will be right back, and I haven't . . . I didn't see him after that."

Silverstein's car was found at the beach. Inside, a note apologizing for the pain, and two empty bottles - month-old prescriptions Silverstein had had filled two days earlier, at the Walgreens around the corner from their apartment. His flip-flops were found in the sand.

"He called it an epiphany, but maybe he just decided he could end all his problems, and maybe that gave him huge relief."

A body was found by the Coast Guard in the water near the Atlantic Beach jetties, on Tuesday, July 10, as family arrived and friends gathered. On Friday, the man who had been found in the ocean near Marker 8 was identified as Silverstein.

Tikhanina was left with raw emotion, feelings that have taken shape more recently.

The thought that doctors are too often marionettes of the pharmaceutical companies. The belief that the connection and collaboration between the person prescribing drugs and the person listening to the problems is too often too distant. The knowledge that the odds are stacked against change.

"Every person, every patient, is different, but I think the least I can do is bring up this awareness about this drug and how people should be treated when they are taking this drug, and how people should be monitored and supervised and get plenty of attention, and maybe just in general avoid this drug or ask if there are alternatives," she said.

"I had a feeling that something was wrong, but I didn't understand how profound it was, how deep it went. I don't even know how to describe what I feel, but it's a combination of desperation and rage at the pharmaceutical company and the health care system, and pain and guilt and everything. And at the same time, I realize there's nothing I can do to bring him back."

Shah, for his part, said non-medication is what brought Silverstein down to earth "completely to zero ground."

"It's sad, so sad," he said. "But I think you'll always find diverse opinions about drugs. There are people who think Lithium is a nasty drug, but it is a life-saver. So is Effexor."

- - -

Days after the opening of Brad Silverstein's retrospective, and days before Tikhanina flew back to San Francisco, two dozen people came to the beach where he ended his life, where Cherry Street bottoms out into the Atlantic.

They formed a circle in the sand, dimpled by an afternoon shower and lit candles, one to the next like a relay passing flame. They stabbed the candles into the ground, and drew shapes in the granules - jagged and swirling works of art. The palette of the sky turned from brilliant purple to pink and orange and yellow.

"The sunset is beautiful," Tikhanina said. "I had imagined it this way."

Tikhanina told them Brad had found some comfort and peace here before he died, that he had resolved that things would be better. So people wrote messages, resolutions to themselves. They made their way to the water, alone and in pairs.

They looked out into the blackness that had claimed their friend, listening to waves too far out to be seen.

The candles were extinguished, one by one, each fluttering yellow flame giving way to a static orange wick, piercing the dying light.

konrad.marshall@jacksonville.com,(904) 359-4287

Online: To see some of Brad Silverstein's work, visit www.