Coming of Age on Zoloft (16 page)

One of the ways that teens can incorporate using antidepressants into their developing identities is to internalize the idea that they’re sick. Honos-Webb has noticed this phenomenon in her practice. “I think what’s tragic, and I think this is what a lot of psychiatrists really miss, is that the diagnosis and the medication have a serious risk that a teenager will define themselves as fundamentally flawed and lacking,” she told me. “I have seen teenagers directly say, ‘Why should I try, if I’m already handicapped in some way?’ ” And though that isn’t the message that anyone would want a young person to take away from treatment, I talked to a number of people who remember hearing it that way.

Natalie, twenty-four, started taking antidepressants at age thirteen, followed quickly by stimulant medications for ADHD. She said that she was having real trouble and that her parents wanted to help. “But when you put someone on a drug that early, it automatically puts in the kid’s head, and it put in my head, that there was something
wrong
with me,” she told me.

And so it just caused me to feel like I didn’t belong, or that I was mentally unstable. They kept telling me that, and after a while you start to believe it, and you’re all fucked-up. And you know, you can’t hang out with people because you think you’re too fucked-up.

—Natalie, age twenty-four

Alexa said she believes that taking antidepressants in middle school made her self-define as a sad person to such an extent that she actually avoided developing her identity in other areas. Her comment reminded me of something else that Honos-Webb told me—that though antidepressants are effective at managing negative emotions, they don’t in themselves provide the sense of meaning and direction that a person equally needs in order to find her way in life. Alexa thinks that in her own case, medication made that direction harder to find. “I think that one of my criticisms is really [of prescribing] antidepressants for kids,” Alexa said.

Just because your identity isn’t formed yet, and to a certain extent I feel like you have to play catch-up. Because even if you grow up and become an adult like everyone else, if you go off them, there’s just this cloud of wonder about “What am I really like?” Those are the cheesy questions that you ask yourself when you’re a teenager. And I didn’t really ask myself those questions. I was just like “Oh, I’m someone who’s sad, because I’m on these drugs.” And so for me, I feel like it limited me. Like I didn’t really explore myself.

—Alexa, age twenty-three

On the other hand, not everyone who took antidepressants felt that it had a negative impact on their identity. Dana, now thirty-one, grew up in Boulder, Colorado. Her parents divorced when she was ten, and she started going to therapy around that time. She described herself as a moderately depressed high-school student: “I always maintained functionality,” she said. “My grades weren’t dropping. I was always a solid student and a solid member of my family. But I was definitely showing signs of depression. I was definitely hurting, and seeking something to make me not feel the way I felt.” At fifteen, she asked to be examined by a psychiatrist. She was hoping to get a prescription for medication, both to feel better, and because something about the idea of being on medication appealed to her. “One of my best friends at the time had ended up on Prozac,” she said, “and I remember starting to feel a little jealous, like it sort of legitimized her experience a bit more than mine. There wasn’t no reason for me to consider it—I was certainly a sad, alienated kid—but she sparked the idea.” Dana saw a psychiatrist through her mother’s health plan, had “the really brief diagnostic interview,” and came away with her own prescription for Prozac.

Perhaps in part because she had pushed to do it, Dana said, she never felt uneasy about taking antidepressants. She also couldn’t relate to friends on antidepressants who used to worry about whether the pills would change who they were. “I couldn’t really empathize with that,” she told me. “That hadn’t been a fear of mine, and it hadn’t been my experience. Probably because [taking Prozac] was my idea. Nobody said, ‘You’re too messed up, you need to start taking these pills.’ I kind of asked to do it, and in a way I asked to do it to validate my existence and my experience, so it makes sense to me that I had the opposite reaction. Actually, I felt a little proud of it.” To Dana, being on antidepressants was a way of taking herself seriously and distinguishing herself from other people—marking herself as a certain kind of person in the almost tribal milieu of high school. “I played high school volleyball,” she explained,

and I was definitely not the sort of person you would associate with a volleyball team. And I remember, I have a memory of sort of intentionally taking my Prozac in front of some members of the team, and I think it was a little bit like, “Just to be clear here, I’m not quite like you guys.” There was a little bit of “Yes, what this means about me is that I’m a deeper feeler, and I’m kind of a tortured soul”—you know, whatever a fifteen- or sixteen-year-old might like to own about a depressed persona, I embraced, because it kind of set me apart. Maybe I already felt apart, and it was a way to own it, like “Yeah, fuck you, I
am
different.”

Taking Prozac became part of her identity, but it was a part she actively welcomed.

Even so, when Dana looks back, she does believe that antidepressants reinforced her sense of herself as a depressed person, and she sometimes wonders whether that reinforcement strengthened what depressive tendencies she did have—whether those tendencies would have weakened or worked themselves out in time. “I don’t question the feelings that I had as a teenager,” she said. “But I don’t know if I needed meds at the time, or if someone could have said to me, ‘Hey, why do you think you need Prozac?’ and that could have been a different kind of conversation.” She continued: “I felt that [Prozac] maybe solidified my depression a little bit, made it something more reified and substantial, rather than letting it fall away.”

Some young people who take antidepressants dwell on their inability to know whether what they are feeling is “real.” Adults experience this too—“Is it me or my meds?” is a common-enough question-complaint at any age—but young adults, who have less experience telling depressed thoughts apart from nondepressed ones, and comparing the way they feel on medication to the way they feel off it, often mull over the question with special intensity.

Aaron told me that in his very affluent suburban middle school in Connecticut, psychotropic drug use was so common that “it would get to where I’d be in my school cafeteria and everyone was sort of talking about what they were on. To the point where if you weren’t on something, it was just weird.” So he didn’t feel socially judged or outcast when he started taking an antidepressant at age twelve. But he did describe a persistent sense of uncertainty around his own emotions, which he associates with medication. “I’ve been raised on the idea that there is a chemical imbalance in my brain,” he said, “and that it’s also a genetic thing, because both my mother and my grandmother have been on some kind of antidepressant at certain stages of their lives.” By now, he said, he’s used to the idea. “But also,” he continued,

“It’s only chemical” is a really uncomfortable thing, because you tend to distrust your own thoughts at a certain point. Because you’re not aware of whether what you’re feeling is a product of a chemical imbalance, or an actual thing. So I’m a little bit—I’m uncomfortable treating it purely as a chemical thing.

—Aaron, age twenty-two

Aaron is familiar with the idea that his illness consists of a chemical imbalance that affects his consciousness, but he doesn’t like the way the belief leads him to continually second-guess whether any given feeling he has is an “actual thing” or a product of his disease. Antidepressants, he said, just compound matters. Rather than making him trust his thoughts more, they add one more layer of complexity to the system: when he takes them, he wonders whether his feelings are “real,” disordered, influenced by medication, or some combination of all three. In this culture, we’re supposed to be aware of our true feelings and use them as a guide to action. Aaron doesn’t believe he’s able to do that in a straightforward way, and the thought pains him. “For a long time, I looked into ‘anything but pills,’ ” he said, explaining that he was motivated by his wish to avoid the question that medications always raise for him: “How can I really know whether what I’m feeling is genuine?”

Sophia began to take antidepressants after being diagnosed with anorexia at age thirteen. The medication, along with a therapy program for teenagers with eating disorders, seemed to help, but Sophia resented having to be on medication—not least because it made her feel as though she couldn’t know who she would be or what she would be feeling without it.

I went through high school with very frequent treatments. I was at doctors three times a week; it was my main extracurricular activity. Much to my resentment at the time. All through high school I was on the drugs, and I couldn’t tell whether they were doing anything, but I was on a high enough dose that I was scared to go off. I didn’t know what my personality would be, really, if I didn’t have them, because I’d grown up with them.

—Sophia, age twenty

Now a junior in college, Sophia still takes antidepressants. She made an attempt at quitting after her freshman year but restarted a year later when another anorexic crisis forced her to take a temporary break from school. Despite the appearance that she benefits from medication, Sophia says that she still struggles with her inability to know exactly what antidepressants are doing for her, and the impossibility of prizing apart how they fit into the bigger picture of her personality and her moods.

Now I’m still on Lexapro and kind of freaked-out about going off it, because I don’t know what progress to attribute to it. Because I
am
doing better now. Drugs are very confusing.

Well, you don’t have to go off it.

I know, I don’t have to. But I don’t even know if it’s doing anything, and I don’t know—there’s no objective way to measure it, because if you have a good day, you feel better, and if you have a bad day, you feel worse. And I feel that’s fairly normal. So how does Lexapro play into that? It’s a really bizarre question, when you think about it.

And you don’t like having to wonder that.

Yeah, not at all. I would prefer to know that my mental states just modulate themselves, and by themselves. I’ll never know if I don’t go off the meds. But when I do, if something bad happens—is that because I went off?

Sophia told me that she thinks her attitude toward antidepressants has something to do with the kind of person she is. “Some people I’ve talked to really trust their medications, and believe they work for them wonderfully, and are perfectly happy staying on them forever,” she said. “I am rarely satisfied with my current state, so maybe I’m the kind of person who’s just always going to be worried that something’s not quite as good as it could be, or ‘What if this isn’t real,’ or philosophical crises like that.”

Part of Sophia’s dissatisfaction with antidepressants has to do with her sense that in order to use them, she has to cede some control over her emotions, both to a drug and to the people who prescribe it. “It’s confusing, especially when you’re on and off medications all the time,” she said, “and you’re trying different ones, and people are telling you what to do, and you [ask yourself], ‘Should I trust this psychiatrist who doesn’t know who I am anyway?’ ” She’s not the only person who mentioned that antidepressants make them feel as though they weren’t fully in control of their own thoughts and actions, or confuse them about the degree of control they do have. Alexa told me that once she started to think of herself as depressed, every bad thing that happened began to seem like further confirmation that pills were the only thing standing between her and disaster.

Especially when my best friend tried to kill herself. I was like, “Is that going to happen to me?” I just started losing a sense of my own willpower. In a way, my biggest problem with being on drugs was like this lack of self-esteem, because you don’t really know that you’re in control of your life.

—Alexa, age twenty-three

Still others associate antidepressants with a sense of unknowing that can last even after the medication itself is withdrawn. Jessica, twenty-four, who started antidepressants in fifth grade and took them up through her second year in college, feels less conflicted about her antidepressant use than a number of the other people I talked to. “I’m cool with who I am now, having been on all those things,” she told me. But she voiced a feeling that many of those who started antidepressants at a young age echoed, a simple but touching sense of not being certain how medication contributed to the person she became. During her high school years, Jessica remembered,

people, various friends or boyfriends at the time asked me—because I’ve always been very open about [taking medication]—people have asked me, “Do you think it interferes with your personality, or your ability to know yourself? Is it somehow stopping what would naturally come forward?” And I felt okay at the time. So I kind of said, “No,” but I wasn’t quite sure. And honestly I’m still not sure.

IT WOULDN’T BE
right to end our tour of the topic of antidepressants and the teenage self without mentioning one final, very concrete way in which antidepressants can affect a developing identity, and that’s in the realm of sexuality. SSRIs are well known for causing “sexual side effects,” a catchall term for a broad range of occurrences in both men and women—ranging from loss of interest in sex, to difficulty performing, to delay in orgasm or inability to have an orgasm at all. Sexual side effects were originally touted as rare with the SSRIs, but some studies have shown that they affect over half the people who take the medications.
3
For adults, sexual side effects are undeniably a nuisance; sometimes they can be among the biggest drawbacks of the drugs. For teens, they’re also a nuisance, with one added dimension. Just as teens don’t have a sense of their baseline adult personality with which to judge whether and how antidepressants may be affecting them, teens also lack a baseline impression of their own sexuality. Adults who are familiar with their own sexual norms will have an easy time knowing when those norms have been upset. But for adolescents who are just growing into their sexuality, the picture can be more mysterious.