Coming of Age on Zoloft (18 page)

On my own I found the gym and the grocery store, went to a departmental party, and tracked down the academic adviser I’d been assigned to, a woman whose facial features I no longer remember, whose office was at the end of a serpentine hallway in the Grecian building that housed the English Department. She helped me with forms. Taking care of business was rewarding in a way, but the feelings of disconnection and guilt that had broken free near the end of my time in New York were stubborn; they sat on my shoulders like birds and cawed into my ears. “This isn’t actually my life,” I wrote on a long document I’d started on my computer to keep track of my thoughts, in plain contradiction of fact.

A few days after arriving in town, I met my downstairs neighbor, Casey, who was a librarian at Cornell’s labor school and liked to play Scrabble. Through him I met
his
friends. I wrote in letters to my mom that I’d gotten to know a librarian, a chicken farmer, a coffee shop employee, and a filmmaker. Making friends helped immensely, but my thoughts and feelings were still all tangled up. I missed New York. Ithaca seemed so small and remote and countrified. Being at school—in a funded program, no less—was an honor, but I couldn’t seem to get excited about it, and that lack of enthusiasm made me feel appalled with myself. One by one I had made all the choices that got me here, but when I opened my eyes each morning, I felt the panic of someone waking up in an unfamiliar room. The feelings didn’t fade, and after a few weeks I felt worn out by the effort of trying to hide them. One afternoon I walked into the campus medical building and asked directions to the wing for mental health.

The psychiatrist I was assigned to had a difficult-to-pronounce last name, so everyone simply called her “Dr. Barbara.” Dr. Barbara styled her gray hair in a bob and wore sensible, loose long dresses made of jersey knits. She hung Balinese masks on the wall of her office, and her shelves were lined with interesting books. After I began to feel better, I used to try during our appointments to imagine her at home; for some reason, I usually pictured her standing on tiptoe, filling a bird feeder. Dr. Barbara worked methodically, even more so than other prescribers I’d known. At every appointment she took me through the same few sets of questions, noting my responses in a binder. In one of her assessments she would read out statements to which I was to reply: “All of the time,” “Most of the time,” “Some of the time,” or “Never or almost never.” I still remember that one of these statements was: “I feel punished.” I remember it because it was such a perfect evocation of exactly the way I did feel. She asked me practical questions too, about caffeine, alcohol, and sleep. Our appointments were brief, but she had a certain personal warmth, and I liked her and felt that she wished me well.

Dr. Barbara told me that Serzone had been pulled off the market after having been shown to cause liver damage in a few rare cases. She did think that I was depressed, though, and she recommended that I try Prozac. Prozac! Even in my low state, I was a bit excited about getting to try the oldest and most charismatic member of the SSRI family. I had told Dr. Barbara that I was having trouble feeling like getting out of bed in the morning, a symptom she seemed well familiar with and aptly called “dread of the day”; she told me that she wanted me to try Prozac in part because it has a reputation for being activating. I filled her prescription at Wegman’s supermarket, took it home, and tried to think hopeful thoughts.

“ACTIVATING.” BOY, WAS
it ever. After a few days I felt positively wired. I couldn’t sleep. I had to force myself to eat. (Dr. Barbara dutifully wrote “anorexia” in her notes, in her clear hand.) She took me down to a smaller dose and then brought me up again slowly, hoping I’d acclimate.

But I never did. During the Prozac period, I drove to Massachusetts for a party to celebrate my Uncle David’s sixtieth birthday. My parents and David’s children and a couple of my other aunts and uncles were meeting up at David’s small farmhouse in the Berkshires. I liked it out there and was happy to go; I thought that a couple days away from Ithaca might be good for me. What I remember, though, is this: I’m in an upstairs bedroom at David’s, where I’ve been assigned to spend the night. There is a tall four-poster bed fitted with scratchy wool blankets. It’s nighttime, and I think that I might be losing my mind. I feel as if I want to molt my skin, or climb up the walls like a praying mantis and peel the wallpaper into strips with my teeth. I have never been so anxious or so uncomfortable in my entire life; I’m sweating and shaking like a Hollywood representation of someone coming off of hard drugs. I want to wake somebody else up and tell them how insanely wrong I feel, and I’m held back only by the knowledge that they won’t be able to help me, and the fear that the words that would come out of my mouth might not make any sense at all.

Back in Ithaca, I called Dr. Barbara as soon as I could. She told me that it was the Prozac that had made me feel that way; that in fact it was Prozac that had had me feeling anxious and creepy-crawly for the past few weeks. The formal name for the state is akathisia, she said, and it can occur in some people who take SSRIs. This explained some of my diary entries. Looking back over recent ones, I read: “Prozac seems to make me jumpy, confused, more anxious rather than less”; a few days later I’d noted, “I feel like I am losing my shit.” At David’s house I’d written that on the drive out I felt “so fucked-up . . . so discombobulated it’s almost frightening.” Things were “too intense, cycling fast between okay and unbearable.” On October 19, 2003: “I feel worlds better since the end of the Prozac adventure,” and am happy to be out of “Prozac hell.”

The next year, a series of emotionally-charged hearings in Congress about whether or not SSRIs can cause suicidal thoughts and behaviors in children would hinge on those drugs’ ability to cause an agitated state. After analyzing the data available from clinical trials, the FDA concluded that youth on SSRIs appeared to be about twice as likely to become suicidal as those treated with placebos.
1
SSRI suicidality (which includes both “suicidal ideation” and actual attempts) occurred in about 4 percent of children and adolescents treated with the drugs,
2
while other adverse reactions, including agitation and erratic behavior, were about six times that common.
3
In 2004, the FDA required drug makers to place a “black box” warning label on SSRI antidepressants, indicating that the medications may increase the risk of suicidal thoughts and actions in children and adolescents. In 2006, it expanded the warning to include young adults up to age twenty-five.

Despite the FDA’s mandate, the answer to the question of whether the SSRIs can cause suicide is still not entirely clear; the amount of data is finite, and what exists is difficult to interpret.
4
At the very least, any claims about the drugs’ harmful effects have to be balanced against the fact that antidepressants do a great deal of good for many people who are or are at risk of becoming suicidal. Still, I felt rattled by my Prozac experience. No antidepressant had ever made me feel jumpy before, and I was surprised that they could, and how marked those feelings could be. I hadn’t become suicidal, but the sensations the drug had given me were scary. It wasn’t hard for me to imagine that if the discomfort had been worse or gone on for longer, or if my depression had had a more self-destructive cast to begin with, those feelings could have helped nudge me to do something I didn’t mean to do.

Dr. Barbara took me off of Prozac immediately, and I felt better within a couple of days. Only when withdrawing from it did I get a glimpse of Prozac “working” as it left my system. For a day or two I felt like a bird that’s caught a pocket of good air and is able to glide a little. The fear machine quieted down, and I was able to feel myself in the here and now: the hot coffee in the cup, the edge of the Scrabble tiles, the powdery pages of a library book.

Around Halloween, Dr. Barbara got me started on a different SSRI called Lexapro. Aware of the problem we’d had with Prozac, she instructed me to take tiny amounts: a quarter of a pill, or an eighth. Still, I couldn’t eat in the mornings. My jeans began to float away from my waist, an outcome I wasn’t totally unsatisfied with, although the whole experience was beginning to make me feel a bit like a science experiment. I developed headaches that Dr. Barbara sent me to a different doctor to treat. I began to resent her a little. In late November, she declared that I “wouldn’t tolerate” Lexapro and wanted to try me on Paxil, but I couldn’t take it anymore. I told her I wanted plain old Zoloft again, and she wrote me a prescription.

But I decided to wait some time before having it filled. As the weeks went by, life did become more manageable. I went home for winter break, wrote the papers I needed to write, returned to school, and threw a party with my neighbor Casey, an upstairs-downstairs party in both of our apartments. I made an appetizer out of roasted red peppers and smoked trout, and we served sparkling wine. My tiny apartment bustled with warm bodies, eating and laughing. After everyone went home I had a final drink with Casey at my kitchen table, and we hashed over the night: who’d come, what they’d said, who’d flirted with whom. I felt a wave of gratitude wash over me:
I came here with nothing a semester ago. And look at all this now. I have friends, I have a life.

EVENTUALLY I DID
start taking the Zoloft. It worked as it had before, making me feel calmer, brighter, and stronger. But perhaps in a fit of pique at the profession of psychiatry for the things it had put me through without so much as an “Oops, I’m sorry,” I also did something that was new for me. I decided to call a real, “talk” therapist. Cornell’s mental health coverage was generous and allowed for students to work with private therapists off campus. Dr. Barbara furnished me with a list of people who were accepting new patients, and I decided to pick one on the basis of whose voice I liked best on their answering-machine message. Very late at night, when I was sure no one would pick up the phone, I called every doctor’s office and listened. One sounded abrasive, another sleepy, but there was a third I took a liking to right away. He spoke at the easy pace of someone who is used to choosing his words carefully, and his voice had an ever-so-slightly nasal quality that I immediately found comforting. His name was John, and in the middle of the night, I left my name and number on his machine.

The next day I was eating a lunch of soup at home, watching tiny snowflakes fall out of the gray sky and drift across the traffic light beneath my window that, being close to the edge of town, turned from green to red and back again many times without spying a car, when the phone rang.

“Hello,” said a comforting, slightly nasal voice at the other end. “This is John.” He told me there had been a cancellation that afternoon, and that he could see me in an hour, if I wanted to. I squeaked. John said he would understand if I wasn’t ready to come so soon, since it could take some mental preparation. “But,” he added, “if you’re up to the challenge—”

I’d been preparing to backpedal, but at this mention of challenges my competitive streak lurched awake. “Well,” I found myself saying, “if it’s a
challenge
—okay, why not? I’ll see you in an hour.” Thirty minutes later I was bundled up and walking down Cayuga Street toward the center of town.

John’s office was on the second floor of a brown brick building that had once been a school. Its lowest story holds businesses with the hippie leanings that Ithaca is known for: a health food co-op, a serious bookstore, a shop where you can buy a hammer dulcimer and a rainbow wind sock. At exactly 2:00
P.M
. John opened the door of his little waiting area and invited me into a spacious room with high ceilings, tall windows, a rug, and two dark red armchairs flanked by matching side tables with matching boxes of tissues. We sat down. He was a tall, pleasant-looking man in his forties, with comfortably shaggy brown hair and wide-set, deep blue eyes. His fashion sense ran to blues and browns, button-down shirts and sensible shoes. I liked him as much in person as I had on the phone.

John leaned forward in his chair and looked at me. He brought his hands together and then moved them apart. “So,” he said. “What brings you here?”

In my journal afterward, I wrote that I’d felt like Ally Sheedy’s character in
The Breakfast Club
, in the scene where she opens her enormous handbag and dumps all its contents, which are supposed to provide some glimpse inside her weird life, onto the floor. I was surprised how much can come tumbling out in fifty minutes: my angst about school, but also, unbidden, a story of how I’d made an awkward pass at the chicken farmer and how humiliated I’d felt. There were stories of the things you’d expect, like friends and family and New York, and other details that seemed to come from nowhere. John listened and made a few comments. I told him that I was studying English, and near the end of the hour he said that there was something in common between my chosen discipline and the kind of work that he did with his patients, something about the shared pursuit of narrative. He suggested that whatever made me interested in studying literature might endear me to this process as well. We agreed that I would come again, and after a few sessions, we decided to make maximum use of my insurance for the year by meeting twice a week.

THERAPY MAY BE
about pursuing narratives, but how do you tell a narrative about therapy? Therapy is a trope, like falling in love, that we know from movies, from jokes, from bits of cultural flotsam we’ve encountered all our lives. But like falling in love, the difference between hearing about it and going through it yourself is like the difference between looking at a snapshot of the Grand Canyon and hiking all the way to the bottom.

At the beginning, I felt cautiously interested in John and whatever it was he might have to offer. I liked him, I liked the way his office felt like a little oasis in the too-small town, and I liked talking about myself; if nothing else, meeting with him seemed like a pleasant way to spend time. What I didn’t have any idea of at the beginning was that I was about to encounter a way of understanding myself and my problems that was radically different from the way suggested by antidepressants and the people who had given them to me. I didn’t know that I was going to absorb this way and take it on as my own. And I certainly couldn’t have conceived of the fact that, as much time as I had spent worrying over the years about whether antidepressants were going to alter me, in the end it was therapy that created by far the larger change.