Coming of Age on Zoloft (10 page)

When I got my diagnosis, I felt absolutely relieved. Finally I wasn’t just
crazy
. I had something literally physically wrong with me. And more than that, I had hope that it would go away, or at least get better.

—Teresa, age twenty-five

To tell you the truth, I think it was probably very comforting. Having depression was kind of saying you belong to a group. I mean, everybody’s alone in their sadness, but [to be diagnosed was] to say that you’re not necessarily alone-alone in your sadness. At the time, though, I didn’t know that there were any other people my age who were having that. But calling it depression was comforting, yes.

—Abby, age twenty-eight

I didn’t get a proper diagnosis until college. I think I was so relieved actually. And I think it’s really because, when you get hit with mental illness, you do not know what you are hit with. And it’s the mystery of the illness that is terrifying. With mental illness, there are horrible things happening to you and you don’t know what it is, and first getting diagnosed or first getting help is the best thing, because from there on, you’re aware that, like—“What is this thing? Let me pick it apart, and let me deal with it.” And when you pick it apart, it’s not that bad.

—Heather, age thirty-nine

But an equally large and vociferous group had an almost completely opposite reaction. These people told me that getting a diagnosis made them feel “broken.” They focused not on how the diagnosis removed blame, but on how it reified the problem, making it seem big, real, scary, and totally beyond their control. Ben, who developed depression and agoraphobia in high school, said:

In general, I did feel that taking antidepressants was a stigma. To me, I guess it was more evidence that I just wasn’t right. That something was fundamentally wrong with me. I already had some feelings along those lines, and this was another example of why. And so taking the medication, while in some senses it was probably a relief, to be given something that was going to help me, I think that by and large the feeling was probably, “Of course, I’m going to have to take this, because this is what people who can’t get on in the world take.”

—Ben, age thirty-nine

Do you remember what it felt like to get your diagnosis [at age fourteen]?

Yeah. It felt—it was just so sad. I just felt like a freak. I felt weak. I felt ashamed, just, that I needed this, and that even when I was on them I wasn’t normal.

—Alexa, age twenty-three

Others reported feeling dehumanized by their diagnosis, as though it meant that other people would no longer take them or their feelings seriously. “The message I got when I was nineteen,” said Leah, remembering the time she was hospitalized and diagnosed with bipolar disorder after her first manic break, “was that I was a mood disorder with legs.” Elizabeth’s story was more prosaic—she started taking antidepressants for panic and depression in middle school, and has been on them since—but she too felt that her “label” marked her and her problem as different in a way that let others keep her at arm’s length.

It was always seen as something wrong with me. And you know, that’s not just with my parents, [but also] my teachers and other adults in my life, and other people my age too saw that kind of thing as just “Oh my god, you’re broken, and I don’t know why.”

—Elizabeth, age twenty-five

The way people react to their diagnoses has to do with the question of personal agency. People who welcomed a diagnosis felt that the idea of having a “real” disorder was liberating and that it put them in greater control of their lives. Heather mentioned that having a diagnosis gave her a way to fight back against the “mystery” of the disease. And Teresa explained in a note: “In what some may think is an ironic turn, taking medication has made me feel more in control of my life and my body. My brain was literally trying to kill me before, and now it’s not.” People who had negative feelings about their diagnosis, on the other hand, usually experienced it as a removal of agency, something that would interfere with their ability to be self-sufficient. Elizabeth said that the idea of having a real mental disease was “disempowering, because it makes you feel like there is nothing you can do.”

I avoided diagnosing myself as depressed for a really long time, because I wanted to be someone who could fix her own problems. And to me, taking antidepressants just seemed to say “no,” I couldn’t fix my own problems.

—Elizabeth, age twenty-five

Laura, age twenty-three, said, “I wrestle with the fact that I need Zoloft to function. This makes me feel extremely guilty. I think this is the biggest drawback for me—do I have to have a pill in order to operate in this world?”

Personally, I was squarely in the second group. Zoloft did make me feel better, but the
idea
of having depression was like a fish bone that stuck uncomfortably in my throat. There was something ironic at play. As a kid, I’d often felt shy and strange and out of sync with other people. As I got older these feelings had lessened, but they’d never entirely gone away. Getting a diagnosis and beginning to take Zoloft interacted with them interestingly. On the one hand, the medication
did
make me feel more gregarious and relaxed, more unreflectively a part of things, in a way I’d always wanted. But the diagnosis itself worked in the opposite direction. Having a label seemed like official confirmation of my oldest fears: that I really was different, that I didn’t belong. In a way, the therapeutic effects of the medicine seemed trumped by the fact of taking them. It didn’t matter if I felt better, I thought to myself, in a certain mood; the salient thing was that I needed medication in the first place.

A label also felt like something to hide, a ticklish fact that might cause other people to write me off if they knew about it. A month or two after I started to take Zoloft, I met a tall, laconic freshman named Jeff, who quickly became my much-beloved boyfriend. I eventually told Jeff that I was taking antidepressants, and he seemed okay with it, though it was hard to tell what he really thought—he came from a stoic family of farmers in Texas who didn’t
do
depression, let alone take pills for it. My secret out, I lived with the fear that Jeff saw or would come to see me as crazy, and that this would give him good reason to reject me if he wanted to.

FOR MOST OF
the people I talked to, medication worked, at least to some degree. A few described their medication experiences as near miraculous. “Going on Prozac was literally going from black and white to color,” said Mark. When he first started medication as a law student in his early twenties, he’d felt overwhelmed by depression and anxiety for most of his life. Mark has been on an antidepressant regimen for fifteen years now, but I could still hear the excitement, relief, and even joy in his voice when he remembered first finding effective treatment.

Not everyone has such a powerfully transformative experience, of course. But the majority of people I talked to said they found antidepressants helpful with the problems they started to take them for.

My therapist suggested that I go to a psychiatrist for screening. I’d been trying a lot to bolster my mood by working out more and by, I dunno, thinking about it, and it was rough. So I went and the psychiatrist put me on an SSRI. And it really helped. Within a couple weeks I felt like I was me again, and I hadn’t been me for a long time.

—Claire, age thirty-two

[Zoloft] helps me not feel despair. I guess that’s kind of vague, but when despair actually feels tangible, then there’s nothing vague about it, you know.

—Paul, age twenty-six

Within a few weeks [of starting Prozac at sixteen], I felt a really big difference. You know, life was still filled with problems. But suddenly it was just, they were problems, not this overbearing force. Right now, I’m taking 40 milligrams of Celexa. I went down to 10 at one point, and it’s very interesting to me; it’s so clear when things aren’t working, within a few days everything is wrong, I’m very anxious. It’s been surprising how cut and dried it is.
—Lindsay, age twenty-six

I started taking [Lexapro], and within a week, I felt like a human being again. I could feel something changing inside of me. I could feel this different kind of light, this support, this capability that I didn’t have before. It was very supportive. It was kind of like someone was holding my hand the entire time.

—Shannon, age twenty-six

There’s no question that antidepressants help. Before I started taking Lexapro this last time, I couldn’t fall asleep or eat unless I was drunk first. I couldn’t maintain normal affect long enough to sit through class and had to leave to cry in the bathroom once or more every session. I couldn’t interact with my friends normally. I felt like I had absolutely zero control over my actions and my mouth. All of these things got better, within a matter of weeks, once I started taking Lexapro. Everything didn’t get wonderful, but it became resoundingly, blessedly okay.

—Anne, age twenty-five

A significant minority, however, had mixed or negative reactions. Some people complained about the difficulty of finding the right pill. Because getting started on a drug, giving it time to work, and then tapering down takes weeks or months, finding the right medication can be time-consuming—and, if the side effects are significant, very disruptive. Even people who ended up sticking with medication struggled with side effects. “Each new drug I tried—because I would get immune to them—each one had these terrible side effects,” said Alexa. “I got night sweats. I’d wake up, drenched in sweat, and then be cold, so I was basically always sick, which is pretty bad.” Certain drugs, notably the SNRI Effexor, cause many people to have hugely uncomfortable symptoms if they miss a dose. “I ran out [of Effexor] over the weekend one time,” said Elizabeth, “and that was horrible. You get nightmares that you can’t wake up from. You lose the distinction between being awake and asleep.” (Effexor, and to some extent Paxil, among other antidepressants, gained notoriety in the 2000s for their ability to cause “discontinuation syndrome”—a pattern of withdrawal symptoms that can last for weeks or months, and may make getting off the drugs difficult.
2
)

Others reported just never being sure whether the drugs were having any effect at all.

The psychiatrist gave me some medicine. I don’t remember the order, but at one point I was on Paxil, Zoloft, Remeron, one at a time. And everything had side effects that made it not possible to continue. The last med that she put me on was Effexor XR. And that had crazy side effects at first, but there was this encouragement to stay with it. And at that time I was leaving for college. I don’t know if the medication really worked or if going to college worked or if I got older, and that worked. I would still get really low and really anxious, and have other symptoms that started in college, but I guess it worked better than the other ones.

—Rachel, age twenty-eight

I sometimes hoped that the drugs would do something. Like that as I raised the dose, I’d suddenly start to feel better. I was told that you’re supposed to get a very marked reaction the first time it starts to kick in. But I never felt that in a way that could be attributed to the medication, rather than the placebo effect or other things going on in my life. So honestly I was never sure whether they were working.

—Elizabeth, age twenty-five

After a crisis, after help-seeking and diagnosis and treatment with medication, after the medication works or doesn’t work, and things stabilize again, people begin to integrate their stories and assign meaning to everything that happened. This is the point at which childhoods are revised, where a problem that was once an “it” is solidified into a whole narrative.

A few pages back, I wrote that getting a diagnosis and, especially, taking a medication entail a forceful encounter with a biomedical interpretation of one’s suffering. People who encounter this explanation need to accept or reject it as part of their own personal story. Some accept it easily, others do so only with reservations or after the passage of time, and others never quite accept it at all—though if medications work for them, this can lead them to have to do some mental acrobatics: when you find relief from a drug, it’s hard to cling to the premise that your problems weren’t in some way chemical.

Mark, the former law student, took to a biomedical narrative comfortably and easily. Partly this was because Prozac worked so well for him. Partly it was because the story suggested by Prozac seemed succinctly to explain a lot about his early life. “I’d been, in many respects, as I look back on it, depressed since I was a child, and certainly anxious,” Mark told me. But at the time, “I wasn’t really that aware of it to say that there was something wrong.” He cited one of his earliest memories: “I was two and a half, I guess. Christmas at my father’s workplace. It was Santa Claus, and all the little kids were there. And my mother was like, ‘You wanna go out?’ And I was like, ‘Mm-mmm, no!’ I was just afraid, to tears, of these people. I was scared to death of it. It was like
Lord of the Flies
.” Mark had always known he felt bad. “Depression” was a story that made his early experiences make sense. It snapped his past life into focus, dignified his present, and made him able to believe in a better future. “The idea that depression is a medical illness was just unbelievably empowering, and very important for me,” he said. “It took away some of the shame, and gave some hope. And for society, it had a similar effect. It’s a potent story that, thankfully, has changed many people’s understanding toward people with depression.”

Heather, who developed bipolar disorder as a teenager, had never felt depressed in childhood, but she too gravitated toward a chemical explanation for her problem. In fact, she fought for it. (Like Mark, Heather was at the older end of my sample, which might help explain why they both feel so passionate about the medical paradigm. Each mentioned feeling as if they grew up in a climate of awareness where their difficulties either went unrecognized or weren’t interpreted correctly.) “The care I got in the 1980s was horrific,” said Heather.