Coming of Age on Zoloft (12 page)

THE COMMERCIAL AND
cultural antidepressant bonanza got off to a good start in the year 1990, when President George H. W. Bush issued a proclamation naming the 1990s the “Decade of the Brain.” He called upon Americans “to observe that decade with appropriate programs, ceremonies, and activities.”
2
Two of those activities, whether he intended it or not, included acquiring a taste for Prozac and cultivating a new, particularly 1990s-inflected awareness of mental illness. Though Americans had always had their psychological complaints—remember the crazes for Miltown and Valium—during the 1990s those problems were translated out of the thorny psychoanalytic language of previous decades and into the bland, biomedical terminology of the DSM
.
Under the influence of that new vocabulary, the 1990s saw what Carina Chocano, writing for
Salon
, called “sudden syndrome proliferation syndrome.”
3
It seemed like every day, some strangely named ailment that appeared to describe familiar behavior in new terms—social anxiety disorder, premenstrual dysphoric disorder, seasonal affective disorder—was turning out to be biological in nature and treatable with medication.

How did it happen? Almost from the start, the SSRIs seemed uniquely able to capture the public’s imagination. They were the center of a highly appealing story of scientific progress: a new, magic-bullet solution for a once-intractable problem. Prozac made the cover of
Time
magazine twice during the 1990s. In 1992, in a cover package introducing many Americans for the first time to the idea of chemical treatments for mental illness,
Time
considered questions like “Is Freud Finished?,” noting that “with the advent of new drug therapies, Freudian analysis has become almost irrelevant to the treatment of severe depression and schizophrenia.”
4
Neuroscientists, the articles explained, were enjoying the bounty of “a burst of new ideas about how the mind works,” including the idea that many mental disorders “are at their core disruptions of normal brain chemistry and can often be treated as such.”
5
Readers were told of practical solutions for the treatment of depression, which was now presented as being both common (like depressive neurosis), and biological in origin (like endogenous depression), as if these two older categories had been merged into one new one. “It is the treatment of ordinary depression—the crushing despondency that strikes more than twelve million Americans each year,” the
Time
article continued, “that represents mental health’s greatest success story.” Thanks to “a crop of new, highly specific antidepressant drugs,” treatment of depression was becoming fast and easy: “Today depression can be treated—quickly and effectively—in seven cases out of ten. If a second round of treatment is required, the cure rate jumps to 90 percent.”
6

Before long, presidential proclamations and breathless cover-age in the press were joined by another stream of media that had great power to make antidepressants visible and shape the way that people thought about them—and about depression itself. In August 1997, the FDA changed a regulation that had prevented drug companies from advertising prescription drugs to the public.
†
These companies had long been allowed to promote their products to doctors through advertisements in medical journals, and by sending company reps, or “detailers,” to doctors’ offices to deliver free samples, pens, note cubes, and information about the benefits of particular products. But direct-to-consumer advertising opened up a whole new world.

Soon after that decision in 1997, television commercials for prescription-only drugs became a commonplace. Many people found them funny, and they were, for their strange juxtaposition of typically cheesy advertising images with frank and highly unsexy language about conditions and side effects. (When was the last time you’d heard the word
sweating
in a commercial for anything, antiperspirant included?) Some of the ailments for which treatments were advertised themselves sounded outlandish: thanks to prescription drug advertising, millions of TV viewers had the chance to raise an eyebrow at the idea of a condition called “restless leg syndrome.” The mandated side-effect list readouts, too, often veered into bizarre territory: “Tell your doctor if you experience new or increased gambling urges, increased sexual urges, or other intense urges while taking rasagiline.”
7

Funny or not, direct-to-consumer (DTC) ads worked. Certainly the pharmaceutical industry found them worth investing in. The amount it allocated for ads to consumers quadrupled between 1997 and 2004, to $4.35 billion.
8
,
9
In 2000, every dollar the pharmaceutical industry spent on DTC advertising translated into an additional $4.20 in sales, about four times higher than the rate of return on promotion directly to doctors.
10
The ads changed consumer behavior as well. A 2003 report found that a third of adults had talked to their doctors about a particular medication they had seen advertised. Four out of five who did ended up receiving a prescription, either for the drug they’d asked about or for another drug.
11

Along with proton pump inhibitors for stomach problems, cholesterol-lowering drugs, and pain medications, antidepressants were one of the classes of pharmaceuticals most heavily promoted under the new regulations. When the Paxil commercial I described at the beginning of this chapter aired in 2000,
Advertising Age
noted that it was “the first sixty-second branded spot ever for a central nervous system drug” on television.
12
Campaigns for the three most popular antidepressants of the time, Prozac, Paxil, and Zoloft, had already appeared in national magazines. In the early 2000s, media consumers became familiar with messages urging them to consider whether sadness, low energy, and loss of interest might be signs of depression, generalized anxiety disorder, or one of the handful of other conditions that SSRIs had been approved to treat, and to “ask their doctor” whether a particular antidepressant might be right for them.

WHILE THE MASS
media gushed about the promise of SSRIs in the editorial sections and tried to sell them to us in the advertorial ones, references to Prozac, generally of a more ambiguous nature, abounded in popular culture. In Douglas Coupland’s book
Generation X
, which came out in 1991 and introduced a lot of people (including a young-teenaged me) to the myth of the slacker, a character explains, “I was an impostor, and in the end my situation got so bad that I finally had my Mid-twenties Breakdown. That’s when things got pharmaceutical.”
13
Tank Girl, the brawling, cursing, hedonist heroine of the British comic book series, terrorized the landscape of post-apocalypse Australia, wearing a necklace made of silver-dipped Prozac pills in her eponymous 1995 American movie. (What did it mean? We didn’t know, but it seemed bad-ass.) The following year, Homer Simpson cooked up a batch of “homemade Prozac” in his kitchen in Springfield; the panacea seemed to consist largely of ice cream.
14

Probably the best-known appearance of SSRIs in art during the period occurred in HBO’s
The Sopranos
, which first aired in 1999. The show’s well-known premise is that its protagonist, Tony Soprano, is the don of New Jersey. He’s also a family man, with problems at work and at home, and he’s experiencing panic attacks. Tony’s somewhat reluctant decision to see a psychiatrist is the catalyst that sets the whole show in motion. In the first episode his new shrink, Dr. Melfi, slides a prescription for Prozac across her stylish glass table. “With today’s pharmacology,” she tells him, “nobody needs to suffer with feelings of exhaustion and depression.”
15
Subsequent episodes track Tony’s crime career, his family life, and his progress and lack thereof with medication and talk therapy.

While early trailers for the show mined Tony’s medication use for yuks—look at the tough guy on Prozac!—the show quickly settled into its own kind of realism. The fact that Tony took medication was a tip-off about how widespread antidepressants had become: if he could be using them, anyone could. (Besides depicting a changing reality,
The Sopranos
also helped to shape it. In the Canadian magazine
The Walrus
, Wendy Dennis wrote that “as a result of Tony’s twice-weekly appointments, many therapists have reported an increase in male patients.”
16
) As the seasons rolled on, the show took Tony’s therapy, pharmaco- and otherwise, as an opportunity to ask serious questions. There is a tension throughout the series between Tony’s activities in therapy and his crime career and personal life. Will Prozac make Tony (and by analogy, the rest of us) a better person, or will it just make him
feel
better while he goes on lying and cheating and breaking kneecaps?
The Sopranos
picked up on the fact that Prozac plucked at a very old philosophical conversation about the relationship of being happy to being good.

Some of the depictions of antidepressants in the culture were critical or at least skeptical. It was easy to portray Prozac-taking as a habit of poor little rich folks, something people did to stave off the ennui of not living fuller or more meaningful lives. The 1995 Blur album
The Great Escape
explores the theme of alienation in an affluent, consumerist world. Its song “Country House,” which hit number one on the UK charts, paints a portrait of a successful man who moves to the country to escape the pressures of the “rat race.” Once there, he indulges heavily in therapeutic culture, “reading Balzac, [and] knocking back Prozac” in an all-out search for equanimity.
17
But the joke is on the man, whose strenuous efforts (“he doesn’t drink smoke laugh, takes herbal baths”) seem to lead nowhere at all. The end of the song leaves him as self-absorbed and fundamentally dissatisfied as it found him.

“Country House” partakes of the same tradition as the Rolling Stones’ “Mother’s Little Helper,” a song about tranquilizers that appeared exactly thirty years before it. The Stones’ protagonist is a busy woman who feels overworked and underappreciated, and reaches for pharmaceuticals to ease the strain. (“And though she’s not really ill, there’s a little yellow pill/ She goes running for the shelter of a mother’s little helper.”
18
) In both songs, whatever relief our characters find seems like false consciousness: the pills provide a veneer of calm that only masks larger problems. And those problems, it’s implied, are social or existential, not medical. We suspect that the man in the country house is actually suffering from his own navel-gazing disengagement from life, and the housewife, perhaps, with mortality itself, if we take the tip-off in the song’s opening words: “What a drag it is getting old.” Both songs exemplify what I call the romantic critique of psychopharmaceuticals, a view that entails the idea that popping a pill can be a way of turning one’s back on life, numbing psychic pain rather than confronting its real causes.

The romantic critique of antidepressants returns over and over again in art and music. It appears in
Garden State
, the 2004 film in which the protagonist, Andrew, a twentysomething man played by Zach Braff, uses the occasion of a trip home to New Jersey to go off the battery of antidepressants and mood stabilizers that his psychiatrist father has had him taking for years. He reconnects with old friends and forms a relationship with a quirky young woman played by Natalie Portman, connections that are vivifying where his medications merely numbed and stifled him. As the film progresses, Andrew loosens up, finally beginning to smile and laugh. See, the movie says, he doesn’t need pills! He needs
love
! He needs to
feel
! He needs Natalie Portman! The love-conquers-all plot builds up toward a cleansing rainstorm and a literal primal scream at the bottom of a quarry.
19

The romantic critique is easy to grasp and smugly satisfying, but it’s also a little sophomoric. It portrays recovery as being as easy as being willing to look your problems in the eye, a proposition that most serious chroniclers of depression and anxiety have understood just isn’t true. David Foster Wallace gives depression a more nuanced and disquieting treatment in his short story “The Depressed Person,” whose protagonist suffers terribly even as she uses her depression to manipulate others and excuse gross acts of selfishness. Though the story doesn’t mention antidepressants directly, it reads like a scathing indictment of the idea that getting better is as simple as wanting to.

PROZAC CAPTURED THE
popular press and made its way into art, but Peter Kramer might have been its first philosopher. His 1993 book
Listening to Prozac
deserves special mention because it did so much to set the terms of the debate about the SSRIs; the conversations that we still have today about how antidepressants affect the self originated with Kramer’s descriptions of what the drugs do. The book became a phenomenon of its own, climbing into the
New York Times
bestseller list and sticking.

In the book Kramer, who is a psychiatrist in Providence, Rhode Island, describes prescribing the then-new drug Prozac to his patients. He argues that Prozac is unlike any drug he had prescribed before. Not only is it more powerful, but it also appears to be more global, changing his patients’ very personalities. He sketches for us the “rough around the edges” architect who loses his depression but also, unaccountably, his taste for pornography; the administrator who after a lifetime as a shy, self-effacing person becomes assertive and vivacious. Prozac, Kramer concludes—and rightly or wrongly, this has become part of our collective consciousness about SSRIs—goes way beyond the previous antidepressants and subtly alters the self itself.