Coming of Age on Zoloft (14 page)

These two drives—on the one hand, to succeed; on the other hand, to be who you really are inside—often come into tension. Getting ahead in life is of no value if you lose yourself in the process, as any reader of
The Picture of Dorian Gray
or
A Christmas Carol
has been well advised. The possible contradiction between achieving outward success and staying true to yourself partly explains why Americans feel ambivalent about enhancement technologies, antidepressants included.

When it comes to antidepressants in particular, there’s one more rumple: the American attitude about happiness. In this country, happiness is another ideal that carries nearly the weight of a moral imperative; as Elliott observes, there is an unspoken expectation in America that people should feel and act happy most of the time. Travelers to the United States often remark that in America, more than other places, cheerfulness is viewed as a default state, and that there’s considerable pressure to present oneself as upbeat. There’s also a peculiarly American belief that authenticity and happiness stand in a causal relationship to each other—that
really being oneself
will lead to happiness every time. Elliott thinks that this belief evolved from a loose interpretation of Freud, who taught that unhappiness was caused by repressions of various kinds: by that logic, the least repressed, most fully realized self would be the most happy. Americans possess, says Elliott, a naive trust that achieving perfect personal authenticity, a feat summed up in the popular phrase “self-actualization,” will result in the deepest possible contentment.

So: Americans are supposed to be authentic,
and
we’re supposed to be happy. When happiness comes easily, this is not a problem. But for people who aren’t feeling happy and are contemplating antidepressants, it can make for tough choices. Is it better to take antidepressants and be happy (but maybe inauthentic, if you believe that antidepressants can temper the self)? Or is it better to press on, authentic but not happy? Either way, you’ll be failing to fulfill the script that American lore has laid out for you: be who you are, and happiness will surely and naturally follow.

There’s only one way out of this bind, and it’s to believe that antidepressants make you more, not less, authentic. As it happens, this is precisely the claim that Elliott finds people make about a wide variety of enhancement technologies: people use a technique to alter a certain thing about themselves, and then speak about the alteration as something that makes them into, or expresses, who they really were inside all along. (For example, recipients of sex-change operations often describe them as a way to bring the physical body in line with a deeper reality.
I always felt like a woman, and now I am one.
) In short, people who use personal enhancements often speak like Tess did when she told Peter Kramer that, off Prozac, “I am not myself.”

IN FACT, THAT
move is precisely the one that most direct-to-consumer advertisements for antidepressants make. Drug companies have used personal authenticity as a selling point in antidepressant advertisements ever since the first commercials for Prozac began to run in professional journals. These ads are designed to allay doctors’ and patients’ fears that taking antidepressants will tamper with the user’s unique personhood—while still maximizing the appeal of the drugs’ effects.

Typically, the imagery of a direct-to-consumer antidepressant advertisement depicts people (post-treatment people, that is) enjoying a state of high effectiveness, bouncing through their everyday routines with a joie de vivre that would be the envy of anyone, clinically depressed or not. The Paxil ad at the beginning of this chapter, in which successfully treated adults hug, grin, accept graduate degrees, and speak in public with apparent calm enjoyment, is just the tip of the iceberg. Print advertisements for antidepressants from the 1990s and 2000s depict a cavalcade of mothers dandling babies, grown sons slapping fathers on the back, happy couples dancing barefoot in the grass, everyone flashing an openmouthed smile. Were these people enjoying the fruits of cosmetic psychopharmacology? It seemed likely. Thanks to Paxil (or Prozac, or Lexapro, or Effexor) they were feeling appropriately American levels of happiness, getting ahead, excelling at work and in their relationships at home.

But the language of those same ads drove home a very different point. If the images were consonant with the idea of cosmetic psychopharmacology and/or personal enhancement, the ads’ wording bludgeoned us over the head with the idea that the medications were precisely
not
doing what Kramer had said they could: they weren’t altering people, that is, but rather bringing them back to normal. To this day, ad campaign after ad campaign is designed to drive home the message that to take an antidepressant is to be not changed but, more precisely,
restored
. Antidepressants, the argument goes, turn you back into the person you really were all along. In other words, they don’t tamper with personal authenticity; they enhance it.

The claim that antidepressants can make you more like yourself has been around for a long time. In the year 2000, an ad campaign for Prozac targeted at psychiatrists (it ran in the
American Journal of Psychiatry
) aimed to preempt any
Brave New World
associations with the product by prominently featuring a series of riffs on the phrase “Just like normal.” As in: “Barb’s golfing again . . . just like normal,”
30
and “Sue’s playing with her kids again . . . just like normal.”
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(As if that wasn’t enough on the theme of normalcy, in smaller print below a cartoon depicting the activity in question, the text continued: “Your patients count on you to help them feel normal again. You can count on Prozac to help restore normal functioning.”) In other words, take a deep breath. No one is in danger of becoming the toasted-marshmallow-head figure on the cover of
Listening to Prozac
.

The association between antidepressants and normality abounds in direct-to-consumer ads too. The late-2000s motto of GlaxoSmithKline’s Paxil CR was “Get Back to Feeling Like You Again.” In a recent TV ad for the antidepressant Cymbalta, a voice-over accompanying a montage of exhausted-looking people intones, “Depression can turn you into a person you don’t recognize. Unlike the person you used to be. Someone your kids don’t understand.”
32
The message is clear: to be depressed is to be not quite oneself. Taking an antidepressant can turn you back into who you really are. Doctors have been known to say the same thing to reluctant patients. Harold Koplewicz, a well-known child and adolescent psychiatrist, told me that when teenagers in his practice tell him that they don’t know whether the person they are on antidepressants is really them or not, “My answer is always, ‘It’s always you, but it’s the you you’re supposed to be.’ ”

The claims that antidepressants can turn you back into your old self, or make you into the person you were meant to be, saturate antidepressant advertising, but they are larger than that too; they’ve become part of our cultural discourse about psychiatric medication. Individuals use the language of personal authenticity to talk about their own antidepressant experiences. On a web forum dedicated to personal stories about prescription drug use, a woman in her sixties writes that a few months after starting the antidepressant Celexa, “I am well again, to the extent that I never ever imagined I could get my old self back again.”
33
For individuals, too, the claim that antidepressants restore the self is powerful and useful. It provides a way out of the bind that Carl Elliott’s work points to, squaring the American imperative to be happy with the American imperative to be true to our innermost selves. It is also, in a sense, an unassailable claim: when Tess says that she isn’t quite herself without Prozac, or when a web forum user writes that on medication, “I feel more like myself than I have in a long time,”
34
they’re speaking a personal truth, something that feels deeply and intuitively right. It is difficult to argue—who better than you to say what it is to feel like yourself? Really believing in the comforting conclusion that antidepressants return the self to its former state, though, is often more difficult for younger antidepressant users than for older ones. Not having had time yet to arrive at a clear sense of what it means to “feel like my old self,” young people are apt to worry with particular intensity about how medication may be affecting their developing identities.

5
| I’ve Never Been to Me

I
n April 2008, the
New York Times
ran a column in which the psychiatrist Richard Friedman described the case of “Julie,” a thirty-one-year-old woman who “had been on one antidepressant or another nearly continuously since she was fourteen.” Julie had recently told Friedman that because she’d “grown up on medication,” she didn’t really have a sense of who she would be without it. She wondered but would never be able to gauge how the drugs might have affected her psychological development and her most basic sense of herself. Friedman reported listening with interest. “It was not,” he wrote, “an issue I had seriously considered before.”
1

And yet, he realized, it could hardly be a unique one. Adolescence is the most common time of life for a first occurrence of depression.
2
And though no company or agency keeps data on how long individuals remain on antidepressant medication, we know anecdotally that usage often goes on continuously or nearly continuously for years, even decades. In my own interviews I spoke to a number of people who reported, like Julie, that they’d taken antidepressants throughout more or less their entire adolescence. Understandably, these people often asked themselves how those ten or fifteen years of antidepressant use had affected the people they had become.

Julie’s question to her doctor is difficult if not impossible to answer. Friedman admits that he can’t tell his patient how growing up on antidepressants affected her, except to remind her that the course of untreated serious depression is nothing to be desired. He advised readers that Julie herself, who had endured “several suicide attempts,” credited antidepressants with saving her life. But even when doctor and patient both trust that anti-depressants are the right choice, the existential questions that the medications raise don’t just go away. For many people, they linger or recur from time to time, a significant feature of the overall antidepressant experience.

EMILY WAS TWENTY-EIGHT
years old, and in the outlines of her story, she could have been Julie’s twin. She had started Prozac when she was fourteen and remained on it, with only a few short breaks, ever since. Emily was raised in the Midwest by her mother and older siblings, where she attended private schools and enjoyed what she describes as a comfortable life. After college she moved to New York City and began working as a freelance writer. She has established herself well; it’s entirely possible that you’ve read something with her byline. Her experience exemplifies many of the questions that people who come of age on antidepressants ask themselves—about what the real self is, how medication affects development, and whether or not to stay on medication as adults—as well as the ways that they arrive at personal answers to these questions.

I met Emily on one of the first crisp fall mornings of the year, at a café about halfway in between our respective neighborhoods. In a casual, floppy sweater, with her blond hair pulled back from her face, she looked cute and cool, as if ready to audition for the part of schoolboy crush or loyal best friend. I asked her to tell me how she got started on antidepressants, and she began by describing herself as someone who felt from an early age that there was something a little different about her. “I was always sort of depressed, even as a little kid,” she said. She remembered feeling tense often, “having the same crazy anxiety feeling that I have about things now, but about childhood things.” She smiled self-deprecatingly. “Things that, with hindsight, I think ‘That’s not normal.’ ” In elementary school she could worry all day about the fact that she was going to have to go home and do her chore (at the time, scooping out the cat litter); the feeling of responsibility, however inconsequential, filled her with dread.

The word
paralyzed
came up a lot in Emily’s stories about herself. “I remember having paralyzing nostalgia as a kid,” she said. “Like being eight, and looking at pictures from when I was five, and crying.” She frequently worried herself sick over things that most people go months without giving a passing thought to. In middle school, she could lie in bed and think about the universe expanding, about Earth’s tiny size and relative unimportance, until human life began to feel completely pointless. “I’m saying this now laughing,” she explained, “but back then it was awful. It was completely, paralyzingly scary and also just made me feel like I never wanted to do anything. What was the point of getting up?”

Around fifth grade, Emily’s worries began to center more and more on schoolwork. “I was always good at school,” she said, “but I would come home and spend five hours on homework that probably should have only taken me half an hour. It’s not that it was too hard or anything. It would just overwhelm me, and I would obsess about it, and get really anxious. I would overthink questions until they became, I don’t know, impossible meta-quandaries.”

In ninth grade, Emily had a crisis. “I had mono, and it went undiagnosed for a while,” she explained. “And I think that constant exhaustion, coupled with my anxiety over schoolwork, coupled with my obsession over friends and my mom being volatile—I really just lost it. I got super depressed. I think I stayed out of school for three weeks. I would run to the bathroom crying in the middle of the day.” Emily’s mother took her to a talk therapist, and also to a psychiatrist, who prescribed Prozac. Emily remembers not liking the idea of taking medication at first. “I was fourteen, so I didn’t have a choice of whether to take it or not,” she said. “I remember throwing a fit, and my mother just making me. But I think that as soon as I saw and felt the difference, I became much more okay with it.”