Coming of Age on Zoloft (11 page)

After getting out of the hospital, the individual therapist I had, I went to see her mentor who she had studied under. I saw that woman for six years I think. This is the woman who should have been able to tell what was wrong with me. They were coming up with stuff like, “Oh, your father molested you,” all these things, and it was like “No, I’m fucking depressed!”

They wanted there to be this reason for it.

I know, and it was chemical. Is chemical.

—Heather, age thirty-nine.

Most of the people I talked to accepted the idea of having a real illness more gradually, and with more ambivalence. When antidepressants were first suggested to her in high school, Rachel wrote in an e-mail,

I was really against [the idea] and quite terrified, but I was backed into a corner by my mother and my psychiatrist, and I hated feeling the way I was feeling and I was in some sense at rock bottom so I didn’t care what happened to me. I heard metaphors about bathtubs whose drains suck up water faster than it can come out of the faucet—the water being the serotonin that my brain is not producing fast enough—and I thought they were such bullshit but I was also just too weak and crumpled to really put up enough of a fight.

—Rachel, age twenty-eight

But she did start taking medication, and the experience of feeling better on it slowly started to change her views. “Now I feel like a poster child for antidepressants,” she said, “because unless I’m in a bad situation, I can function almost as normal. I used to believe that medication was almost never a good idea, but now I believe that there is definitely a place for it.” She told me that being on antidepressants had affected her sense of herself in complex ways. After thirteen years on them, she is used to feeling well—that’s part of her identity now. At the same time, taking medication for so long has also solidified her sense of having an illness. When I asked Rachel whether she thought that using antidepressants had changed her, she paused and thought. “I don’t think that medication has affected me inasmuch as medication shifted my brain chemistry and thus who I am,” she said. “But more like I was told that I was depressed and anxious and this and that, and
that
kind of confused me about who I am, more. So that’s always there in the background when I think about quitting. Like—maybe I am this crazy person, but the medicine’s working.”

Other people took medication and found that it helped their symptoms, but they still raged against the conclusion that they were “really” ill. Laura, twenty-three, wrote to me about getting back on Zoloft the previous spring, after she graduated from college. She said the Zoloft was working “very well” but confided that “I hesitated for months about going back on it.” Like many people I spoke to, she wanted to resist the feeling that she “needed” a pill, and she fantasized about a future when she might be able to get by without it: “I am still waiting for a moment in my life where everything is a bit more settled, and then perhaps I can get off.”

Sometimes a reluctance to settle into the illness identity suggested by antidepressants led people to try going off their medication. A number of people quit for this reason, only to be rewarded with repeat episodes of depression. Some people became long-term users of antidepressants only after cycling through several such trials and failures. Christine, from Denmark, had a story like that:

I always had a lot of ups and downs. And that was kind of taken away by Celexa. But the downs were taken away too, and that was helpful. And then every time I stopped, I tried to come off, I fell into a depression, and started back on them again.

What made you stop to begin with?

I guess I’ve never seen myself as really mentally ill, or really depressed. I’ve never had like a sick period where I’ve just been lying in bed, I’ve never had to stay home from school or work or anything. I’ve never been
crazy
-crazy, I’ve always been affluent and gone to good schools and held great jobs, and managed a lot of things, I guess. So I thought, why should I be on medication when I’m not crazy? So then I try to stop, but there’s this whole falling into a big depression, is not great either. So, it’s not good.

—Christine, age thirty-six

And I was the same way.

By spring semester of freshman year, I felt well, happy, back to normal. I had great friends, classes were exciting, and I was in love with Jeff. I started to wonder whether I really needed anti-depressants anymore. So I decided to test the premise by stopping. There were still things about taking them that bothered me, and quitting seemed like the easiest way of sweeping the whole mess aside.

I didn’t tell anyone in the Health Center about my decision. I just tapered down my dosage as I’d read you should. Within a few weeks I was pill free and feeling fine. A little of the anxiety that had departed the semester before returned, but it was nothing I couldn’t handle. As people began making their arrangements to return home for the summer, though, I started to wobble. The prospect of saying good-bye to Jeff felt particularly traumatic. We had plans to visit once or twice over the break, and of course there would be next year. But it didn’t matter. When I thought about parting even for a little while, I felt a wave of irrational but intense dread. On our last night in town together Jeff and I saw a movie at a local second-run theater and then stopped for pancakes at the Waffle House near the highway. I snuffed back tears all through the meal. Jeff held my hand and said sensible things like “It’s only for a summer,” while I hated myself for my show of vulnerability.

Back at home in Arlington I tried to pull myself together, but the summer seemed to have gotten off on an awkward footing. I missed my college friends and the structure afforded by classes, papers, and deadlines. My sister was busy with her own friends, and while I saw Sarah and other members of my high school crowd occasionally, it felt as if we were drifting apart. Eventually I landed an internship at the National Museum of Natural History on the Mall in Washington, which I had applied for months earlier. I was to spend six weeks in the arctic anthropology department, taking photographs of a collection of Neolithic stone artifacts that were on loan from a university in Canada. For most of the day, I worked by myself in a cold room filled from floor to vaulted ceiling with taxidermic birds. I had always loved the museum, and it felt amazing to be able to enter my key code each morning and slip through an inconspicuous door tucked behind a fiberglass diorama of a South Sea island, and into a warren of hallways lined with greenish wood shelves stuffed with every manner of specimen—including an alarming number of human skeletons in drawers whose yellowed labels still bore the loops of perfect Victorian penmanship. I took lunch breaks on the steps outside, in the shadow of the big pieces of petrified wood that guard the museum’s front entrance. In the gritty summer heat of Washington I watched pigeons peck at pretzel crumbs and listened to the happy-tired-cranky din of families on vacation, but the contrast between that bustle and my cold, silent work environment made me feel even lonelier. Everyone else seemed to be doing something that made sense, I thought, while I felt lost and flailing.

Like it had the summer before, my mood drifted out to sea. I cried in the bathroom of the telemarketing office where I moonlighted for extra money. I cried on the steps of the United States Supreme Court, where I sat one day, killing time before work. I cried in the exquisite marble bathroom of the Arctic Anthropology wing of the National Museum of Natural History. I cried at Cold Spring Harbor Laboratories, in Long Island, New York, where I went to visit Jeff at his fancy summer biochemistry internship. I cried on the gently sloping lawn of the tasteful Cape Cod house on the grounds of the Labs, where James Watson, codiscoverer of the DNA double helix, lived with his wife. Seeing Jeff helped, but only temporarily; I spent the visit dreading the moment I would step into the taxi that would carry me back to the Long Island Railroad station and the rest of my life.

I didn’t have any good theories about what had unhinged me, but this time, the words to describe it (“depressed, again”) and the action to take were closer at hand. On a sweltering D.C.-area day, I drove out to the “behavioral health clinic” where my mother’s HMO provided mental health ser-vices. The doctor there sat with me for even less time than Sam had, but it didn’t surprise me anymore. I came home with a bottle of fiery orange Wellbutrin.

This was the point at which I became committed to medication. After crashing a second time, it was harder to see what was happening to me as a fluke. I still didn’t want to use antidepressants, but I started to grudgingly accept it as preferable to what was beginning to seem like the alternative, and the new pills traveled back to school with me. My mother’s HMO managed the prescription for the rest of college, fielding refill requests over their automated phone system, sending giant, geriatric-size bottles of pills from Virginia to Oregon in tough plastic mailers.

On the one hand, it seemed like the evidence was piling up that I did have a chemical imbalance—whatever that really meant. But though I found it ever harder to reject the story about me suggested by medication, I never really accepted it either. Unlike Mark, who saw in his childhood the beginnings of a disease he wanted no part of, and unlike Heather, who saw in her childhood a whole kid that bipolar disorder later obscured, I harbored more personal feelings about my “it.” Christine told me that when she was little, she’d felt fragile but also sensitive and perceptive. I had similar mixed feelings about my own young self: she seemed skittish, intense, prone to get lost in thoughts she couldn’t explain. But even though I’d hated this difference, I’d also loved it. And for no especially defensible reason except that it was what I believed, I was afraid that antidepressants were going to sweep away those private feelings, spell the end of the strange, mystical kid I’d been.

I never wanted to feel the way I had felt over the summer again, and if antidepressants were the price to pay not to have to, I would take them. But I felt angry that the choice had come to that, and I wasn’t quite ready to embrace the idea that what I had was really a sickness. Like Laura, I never stopped cherishing the idea of some future day when I’d be able to live without medication.

Most of the time, though, I dealt with the cognitive dissonance by ignoring it. Taking pills quickly becomes a habit, and there was plenty to distract me. College rolled on, in its demanding and engaging way. Jeff dropped out after our sophomore year and moved back to Texas, to my shock and sadness, but I weathered his leaving. Eventually there were other boyfriends, new friendships, a series of run-down student apartments that all seemed wonderful in their own way. I switched majors, started going to the gym, made Phi Beta Kappa at last. I worked summer jobs and turned myself into a student to contend with. I wore nylon vests, got an old road bike, and started to blend in with the Pacific Northwest. It’s not that I never felt bad; some months and semesters were better than others. But I didn’t crash again the way I had those two times. And while I never did get to like the idea of taking antidepressants, it often became the sort of habit that you can forget about, in the loud rush of life.

4
| Decade of the Brain

“
Thank You
. On behalf of your patients, thank you for helping to make Prozac one of Fortune magazine’s “Products of the Century.”

—
Eli Lilly & Company, advertisement in the
American Journal of Psychiatry
, January 2000

T
he commercial started out just like any other. There was the big house, the sunlit yard, the pretty lady, all in the soft focus of a suburban daydream. You might have assumed it was an ad for—dish soap? Diamonds? Something grown-ups like to have for breakfast? But after a few seconds, you’d have noticed something that was unlike other ads. It was an aura of gloom. Inside the house the lady, a brunette, stood too close to the window. The dim light around her contrasted with the brightness outside, where children played and cheerful voices called out. The woman inclined her head and fingers toward the glass in an attitude of worried longing; she looked like Betty Crocker playing the role of Boo Radley. There was a party going on out there, but she was stuck, indoors, behind this wall of glass. Was it a yeast infection? Then the voice-over came in.

Over light piano music, a woman spoke:

“Doctors define social anxiety disorder as an intense, persistent fear and avoidance of social situations. Has overwhelming anxiety significantly impaired your work or social life? Paxil offers new hope.”

In the second half of the commercial, warm gold light had replaced the cold blue tones. The curtains parted. Beyond them, grown-ups with sweaters tied around their shoulders, preppie-style, embraced politely beside tables spread for a garden party. The voice continued, faster now: “Side effects may include decreased appetite, dry mouth, sweating, nausea, constipation, sexual side effects in men and women, yawn, tremor, and sleepiness.” Two guys roughhoused with a kid in a football jersey. A man in a dark suit rose to accept a professional award. The piano tinkled a last few poignant notes.

“Will you ask your doctor for more information about Paxil? Do it today. Your life is waiting.”
1

WHILE I WAS
trying to get used to the idea of having a chemical imbalance, the culture at large was busy developing a wholesale fascination with SSRIs. Between the early 1990s and the early 2000s, representations of antidepressants in the media abounded. These were the years when it began to seem that you couldn’t open a newspaper or magazine, set foot in a bookstore, or turn on the television without being assailed by a laudatory or hand-wringing statement about antidepressants—or a straight-up sales pitch. One reason why SSRIs carried such force as a topic of discussion was that we were ambivalent about them, in the true sense: not indifferent, but simultaneously attracted and repelled. Antidepressants spoke to some of our deepest desires while activating some of our deepest fears; they appealed to certain cherished cultural values while threatening to violate others. And it was our collective inability to come down conclusively on one side or the other that helped keep Prozac
*
in the spotlight almost continuously. The two-minded attitudes about antidepressants that we forged during the SSRIs’ first decade persist to this day. Because the tensions that made antidepressants interesting then still inform the way people think and talk about their own medication use, it’s worth taking a closer look at what those tensions are and how they came to be.