Coming of Age on Zoloft (30 page)

Like Mia, Anastasia has also wondered how to square the fact that she benefits from medication with the fact that she often feels critical of mainstream psychiatry, and especially doesn’t like diagnostic labels. For one thing, her symptoms, while sometimes severe, never fit neatly into a DSM category. For another thing, she has read widely in sociology and is inclined to be skeptical about the validity of such divisions. “Part of me struggles a little bit with the whole categorization process,” she said, talking about support group meetings in which she’s felt pressured to identify with a particular label, like unipolar or bipolar, and articulate an understanding of herself as a person who has a disease. “I have really mixed feelings about the utility of those kinds of labels for people, and their process of surviving,” she said. “I think that sometimes a notion of being ill can be helpful, but I also think it can be harmful.” When I asked her to frame her understanding of her own problems, she told me that she thinks they are related to an inborn excess of sensitivity, a “capacity for feeling deeply and for feeling pain” that can be problematic, but also beneficial in the right context. “I’ve always avoided practitioners who are really interested in understanding things in terms of illness and labels,” she said. “I’ve shied away from that model.”

Even so, Anastasia has found a way to feel comfortable with her own use of medication, and she gently but firmly disagrees with those who suggest that she doesn’t need it. When we talked, she’d been seeing a psychiatrist who had recently wanted to get her off everything; she described him as “a Buddhist” and said “whatever, it’s nice that he thinks that,” but she insisted that now is not a good time for her to try stopping. She described her attitude toward medication as utilitarian; like Denise and Elizabeth, she understands medication as a tool she wields to get the results she needs. “Sometimes people I know, who are not on medication themselves, but have depression issues,” she said,

will talk to me and get on their high horse about not being on medication, or how I don’t need to be, or will talk to me about how I’m getting fucked by the pharmaceutical industry, and I take that argument only so far. I mean, I think that pharmaceutical companies are very interested in fucking people; I don’t believe that they’re these benevolent forces. On the other hand, I’m looking out for myself and I’m looking out for how to function, and if my goal is to function, then I’m going to use what I can from them to the best of my ability. So I just view it in terms of utility, whether it’s working for me. And for me I just feel that unless I were in treatment all the time, or in a cozy, you know,
farmhouse
—I often feel like the world is too much for me, and this provides me some kind of protection.

Over time, Anastasia has come to see medication as a balancing act. A good medication regimen is one that allows her to feel like herself while also affording her the degree of protection that she feels like she needs. To illustrate the point, she told me about her recent time on Abilify, another atypical antipsychotic that a psychiatrist recently tried adding to her treatment. “Abilify was
amazing
in terms of my mood,” she said. “Like, unbelievable. I was so nondepressed. I’ve never
been
so nondepressed. Normally, there’s always part of me that’s dragging my heels, and just wants to curl up in bed; the world often feels, at least on a small level, exhausting to me. But when I was taking Abilify I was like, ‘I’m gonna take three subways to go work out! I’m gonna go dig a ditch fifty feet long and fifty feet deep!’ ” There were only two problems. One was physical; she could hardly sleep. But the other was more personal and aesthetic. Anastasia felt like she couldn’t relate to the person she was on Abilify. She confided to her therapist that when she was on Abilify, she “almost didn’t remember what it felt like to feel bad. I really could not even
imagine
what depression felt like anymore. Which sounds like, ‘Well, that’s weird, why would you care?’ But thinking about those things has become so much a part of my identity—I couldn’t recognize myself in a certain kind of way.” Anastasia said that it was “liberating to feel so functional,” but the change was too much. She told her therapist that being able to at least
empathize
with someone with depression was important to her, and she asked to be put on a different drug. The medications she is on now, she said, strike the balance she needs; they let her feel “pretty much myself but just less, the really thin-skinned-ness or the kind of—I think without medication I feel almost too sensitive to live in the world. And I feel that with these things I’m a little protected from the world, but not so covered up that I feel nonhuman.”

IN THIS CHAPTER,
I told the stories of people who went from feeling lukewarm or worse about using medication, to feeling confident and comfortable with the role that it plays in their lives. In the beginning, James, Denise, and Anastasia felt as if they weren’t in control of their choices around medication, and the associations it carried for them were mostly negative. James, as a teenager, was afraid of being judged by other people; to him, taking Prozac symbolized being crazy. Denise wasn’t happy with how her G.P. handled her, didn’t feel well listened to, and wasn’t sure that the antidepressant he gave her really helped. Anastasia resented the sense that she had to use Zoloft to handle a job that she hated in the first place.

Then something happened to each that made them reevaluate their situation. James had another suicide attempt. Denise, shaken by her breakup, decided she’d been minimizing her dark feelings for long enough. Anastasia left the job she’d hated, but her depression didn’t improve, it got worse. Each person made a return to medication and had a markedly better experience the second time around. They sought stronger relationships with doctors and found more effective drugs. They also began to assign more hopeful meanings to medication and to feel personally in charge of their decisions to use them. James began to see medication as, potentially, not just a palliative but also a key to the life he wanted; this committed him to keep searching for the right drugs, even when the search proved difficult. To Denise and Anastasia, medication started to symbolize a personal determination to take good care of themselves in a sometimes bruising world.

As I thought about the stories of James, Denise, and Anastasia—and also Dan from chapter 7—I found myself being guided to a theory. I don’t think it’s a coincidence that they all arrived at a feeling of greater security and greater positivity about their relationships with antidepressants as they moved into the second half of their twenties. In the last chapter, I wrote about how people who decided to stop using medication often felt that being a little older had made them more stable. But James, Denise, and Anastasia were also talking about the benefits of age. As I listened to their stories, it struck me that the existential worries that are front and center in younger people’s antidepressant tales—the fears that medication might change their inmost natures—are no longer a major presence. This makes sense. As we age, the questions of identity that are a constant in adolescence begin to lose their keening insistency, not because we find the one diamond-hard answer we think we’ve been looking for, but because we settle into an intuitive sense of ourselves. “The older you get, the more secure you become in who you are,” said Rachel, twenty-eight, explaining that she feels less torn about taking Effexor now than she did when she started as a young teenager, “and the more empathy you have for yourself too, and the more acceptance and self-esteem. I don’t know why, but it just happens that way, as your ego kind of coalesces.”

An e-mail I received from a twenty-six-year-old teacher named Debbie perfectly summed up the several kinds of evolution that make people who continue on medication tend to feel more comfortable about the decision as they mature.

When I first started taking Zoloft, at thirteen, I oscillated between being appalled at the idea and really wanting to take them. I wanted to take them because I felt like it somehow removed the blame from me. On the other hand, I was not super thrilled with the idea of needing to be on anything, and I was definitely concerned about the way in which it would change me. I’d been depressed for as long as I could remember, and when I first started Zoloft I didn’t know what it would feel like, and if I would act differently. It was hard to imagine a me who was cheerful. I also found (or at least claimed to find) cheerfulness insipid and I mistrusted good weather and people who seemed happy. They felt really artificial, and I felt like I was being artificial as well by taking antidepressants. I worried that I was putting up a buffer between myself and the world, and that I was dulling all of the input (the fact that I read
Brave New World
when I was fourteen did not help this).

I feel a lot better about taking them now. I think this is partially that I’m (fortunately) significantly more mature than I was when I was thirteen, and also that I don’t think about it as much anymore. I’ve been on and off antidepressants for the past thirteen (!) years, so it’s pretty much a habit. I’ve also learned that unexpected people take antidepressants as well, so I feel less alone. What they really do is help me live a normal life; I’ve found that, unfortunately, I can barely function without medicine. When I’m off my medicine, I get home at the end of the day and lie on the couch in my pajamas and can’t do anything, I just sob and eventually go to bed. At this point, I have a responsibility to my husband as well as my parents and younger brother to stay on my medicine, or it becomes really difficult to deal with me, and that’s not fair to them. I’ve tried to go off medicine before, and over time I’ve accepted that I will be on
something
probably for the rest of my life. It’s still always in my mind somewhere, but ultimately I think I’m quite grateful that there are options to help me live a fairly normal life.

In Debbie’s story, as in the other stories in this chapter, the central drama has shifted from “Who am I?” to “What do I need?” Debbie’s choice to use medication is leveraged by her knowledge that she doesn’t function well without it, but she doesn’t speak of a sense of being forced into something that she doesn’t want to do. What she does describe is what so many people feel as they grow into their adult selves: a greater sense of knowledge about what she needs and wants, and a greater willingness to reach out and grab it—to insist on it for herself, with ever-lessening amounts of conflict or doubt.

10
| The Next Generation

I
n an accelerated culture, fifteen years is a long time. And it had been, I realized last spring when a cream-colored envelope arrived in my mailbox to announce preparations for my class’s tenth college reunion, nearly that long since my experience with antidepressants began.

I knew that a lot must have changed in the interim. My peers and I were at college during the first wave of the SSRI revolution. During our midteen years, antidepressants weren’t everywhere, and then suddenly they were; a spike in the number of students diagnosed with ADHD began just as we were graduating. People born in the 1990s were raised in a very different world. They had never known a time before Prozac, could scarcely remember when advertisements for prescription medication hadn’t peered out from bus shelters and blared from TV. Did psychiatric medication mean something different to this generation than it had to mine?

At around the time that the invitation to my own tenth reunion arrived in the mail, I had been feeling curious about what had changed on college campuses since I last set foot on one. My interest was piqued by two sensational-sounding but widely reported stories in the news. One story proclaimed a remarkable recent deterioration in the mental health levels of college students. A 2010 survey of incoming college freshmen found that the self-reported mental well-being of incoming freshmen had fallen to its lowest level in twenty-five years, since the survey began collecting that information.
1
Another major survey found that 46 percent of college students had “felt things were hopeless” at some point in the previous year, while 30 percent had felt “so depressed that it was difficult to function.”
2
Almost 95 percent of college and university mental health center directors in a national poll said that the number of students with “serious mental health problems” was “a growing concern” on their campus.
3
School mental health staffs found themselves dealing with an unprecedented volume of requests, and also with far more emergencies.
4
The number of students using medication had risen too; the University of California reported in 2006 that one in four students who arrived to seek counseling within the U.C. system was already taking a psychotropic medication that they had been prescribed elsewhere—a finding in keeping, the university noted, with a “stark increase” in medication use among student bodies nationwide.
5

The second story reported on a precipitous rise in the amount of academic stress faced by college students. Undergraduate admissions had grown more competitive across the board in the past decade, as the children of baby boomers formed a miniboom of their own. Today’s students were applying to more schools, facing more rejection, and living their pre-college lives ever more attuned to the need to work hard enough to vie for available spots.
6
Once admitted, according to longtime educators, students seemed apt to approach college as though it were a professional job, rather than a time for exploration and experimentation. One college president lamented that the “moments of woolgathering, dreaming, improvisation” that were seen as part and parcel of a liberal arts education a generation ago had become a hard sell for today’s brand of highly driven student.
7
Experts agreed that undergraduates were in a bigger hurry than ever before, expected by teachers, parents, and themselves to produce more work, of a higher quality, in the same finite amount of time. Sometimes the stress story was linked to the mental-illness story, under the implication that a new generation of youth raised on pills and pushed to succeed were literally working themselves sick.
8