Coming of Age on Zoloft (15 page)

Still, Emily’s uneasiness about medication led her to go on and off Prozac a couple of times in high school. During a year spent as an exchange student in Spain, she didn’t take it and felt fine; social life kept her busy, and in a foreign environment, she said, schoolwork didn’t cause so much anxiety. She became more committed to antidepressants in college. “Freshman year I was off it for a while,” she remembered. “And I remember in some kind of writing 101, the most basic writing class, we had to write a paragraph about some essay we’d read. And I stayed up all night writing a hundred words. Just having to be perfect—I can’t even tell you. When I think about that one incident now, I am like, ‘That is insane.’ ” That’s the point at which Emily decided that she had a serious and lasting problem with anxiety around performance-oriented tasks and deadlines, particularly ones involving writing. Since that time, Prozac has been a consistent part of her routine. The medication, she finds, frees her so she can do her work and meet her obligations. She believes it allowed her to finish college without losing her mind, and that it’s what facilitated her eventual choice of career. “I don’t think I’d be able to be a writer without it,” she said.

Even so, Emily thinks frequently about who she would be without Prozac, and whether her life might be better—or worse—if medication had never entered into it. “I do wonder,” she said. “I do think Prozac has helped me a lot. But I wonder, if I’d never gotten antidepressants, who would I be? What would I be like?” She sketched out a couple of possibilities. “For all I know, I wouldn’t be alive,” she said. “But maybe I would also be—I mean, what would Virginia Woolf have been like if she had taken antidepressants, you know? Maybe I would be great in some other way, but I would be unhappy.”

Sometimes, she worries that antidepressants block off an experience of herself that would be more intimate and direct, more “authentic.” The times she quit antidepressants in high school, she said, she was motivated by “a desire to be clear and clean, to just be absolutely myself.” She wonders whether, because of Prozac, she’s less “in touch with my body, and my feelings” than other people. In low moments, she can make herself feel bad by wondering whether her years of antidepressant use might have had a permanent effect: “Maybe I messed with who I really am by changing my body chemistry.”

Even today, Emily says that she’s often beguiled by a wish to leave Prozac behind and get, as she imagines it, back in touch with herself. On the day of our conversation she was even mulling over a plan. “I’ve been thinking,” she said. “Once I finish some articles, at the end of the year, maybe January or February, I need to take some time off work and spend some time, you know, reading, being outdoors or, you know, just to get myself—maybe that would be a time to go off Prozac and just see how it is.”

But the idea of taking a medication holiday is easier said than done for Emily. Taking antidepressants, she believes, is what allows her to pursue her chosen livelihood. Writing is how Emily supports herself. Being a writer is also her identity, one she’s worked hard for and that she values. “At this point, I literally feed and clothe and house myself one hundred percent through my writing,” she said. “So when I think about experimenting with going off medication, the chance of writing anxiety is more worrisome to me than the depression. Even on the best days, I don’t find writing to be easy. Can I really risk making it harder?” Or would she want to? Emily
feels
like a writer. It isn’t just what she does; it’s what she is. “I mean, I think about not writing,” she continued. “But then I’m like, what would I
do
? And not even just the money. Can I really not write anymore? It feels kind of like a dead end.”

Emily thinks that she could get by without antidepressants, but that to do so she’d have to reorganize her life and probably sacrifice her profession. She told me she’s read about people who have “structured their lives to avoid any kind of stress,” and she said, “I have to think that would work. If I were doing something completely different, that didn’t require the sorts of tasks that usually cause problems for me, I think I could be fine without medication.” As an example, she thinks back to that exchange-student year in Spain. The fantasy of remaking her life into one of less-challenging work and no medication can be tempting, an incursion of the romantic critique of antidepressants into Emily’s inner dialogue about herself and her choices. “So I think about that sometimes,” she continued. “Maybe if I just worked in a café and made that my life. Maybe that’s the answer.”

And yet, and yet. There are two strains that run though our conversation, like different instrument sections in an orchestra, balancing each other out. As much as Emily wonders who she’d be without medication—and clearly these questions are very active for her—she also defends the authenticity and the validity of the person she has become. This second voice talks against the first voice, and against the voices of people in her life who call Emily’s antidepressant use into question. “Sometimes I have this feeling like I failed,” she said. “I have this one friend who says things to me like, ‘You’ve just never learned to deal with your problems.’ And most of the time I don’t agree with that, but there are times when I think, ‘God, maybe he’s right. Maybe instead of really dealing with the problems, I’ve chosen to go the weaker route.’ ” She nudged a crust of French toast around her plate with her fork. “But then again, it seems to me like maybe medication
is
a way of dealing with it. It’s a way of making what can be a tough choice. I could choose not to take it and have living without it be what I focus on, but in the end I stay on it because there are other things in my life, there are other problems and issues where I’d rather concentrate my energy.”

At twenty-eight, Emily still asks herself regularly how fourteen years on antidepressants have affected the person she’s become. There is much she doesn’t know. Would she be a better, if more tortured, writer without medication? Would a simpler life without Prozac, if she could achieve it, have more meaning? Who
is
she, really: the adult she’s made herself into, or the unmedicated person she’s only met a few times since adolescence? Or is that distinction an illusion? There are also some things that she does feel certain about, such as that medication keeps her perfectionism to a manageable level, lets her live the life she’s used to and do work that she values. Tentatively, she’s answered her ambivalence about antidepressants by affirming that the identity that she’s created on them, and which they support, is more real and more valuable than the hypothetical identities she imagines she might have if she were not taking antidepressants.

But her struggle has been an active one, and the existential questions that antidepressants raise for her are still there in the background, occasionally demanding reconsideration. With Emily, as for many people who have grown up on antidepressants, these questions—sharp and uncomfortable at some moments, barely perceptible at others—are now woven tightly into the fabric of her life.

THOSE EXISTENTIAL QUESTIONS
are felt more keenly by some people than by others. One thing that causes variance is a person’s sense of how ill they are. People who strongly and viscerally believe in their own need for medication are less likely to spend time and energy second-guessing about the self that might have been. Emily, for example, believes that she’d be able to get along without antidepressants in a life rinsed of professional stress. So from time to time, she feels compelled to weigh the value of the career she has built for herself against the strength of her desire to live without medications. For other people, the questions break down very differently. Those who believe that antidepressants literally have life-saving power often find it easier to accept antidepressants as, on balance, an element of good in their lives, and move on.

This is the equation that Claire makes. Now thirty-four, Claire went through periods of depression in high school, and then again after dropping out of college. When she was in her early twenties, a psychiatrist put her on an SSRI, and she found it helpful. Six months later, Claire’s brother, who had been suffering from undiagnosed mental illness, killed himself. After his death, stories of other mental illness in the family began to come out. “That gave me a really different perspective on taking antidepressants,” Claire said. “Since then, I have tried to take my mental health very seriously,” a commitment that has included staying on medication, out of a sense that she is at high genetic risk. Once in a while, Claire wonders whether she really needs antidepressants. When we talked, she was in the process of finalizing a divorce. She said she was managing well, but had speculated about whether antidepressants were preventing her from digesting the experience: “Am I numbing myself by taking medication?” she asked. “Would I process things more quickly if I were feeling them on a deeper level?” But when she thinks about quitting, she always remembers her brother, her perception of her own vulnerability, and her feeling that over the years, medication has helped her a lot. She told me that while she doesn’t agree with the analogy comparing depression to a physical disease in every case, she does think it applies in her own. “For me, okay, my brother killed himself,” she said. “The issue is pretty cut-and-dried. It’s probably safer to medicate.”

The matter is even clearer for Josh. Of all the people I spoke to for this book, Josh corresponded most closely to my preconceptions about what a person with clinical depression might sound like. His voice on the phone line had a flatness to it that I desperately wanted to cheer up. Josh, who is thirty-two, told me that his father had committed suicide when Josh was four. One of his uncles also committed suicide, and his mother and both his brothers suffer from depression. Josh made a suicide attempt of his own when he was fourteen, an event that led to his first prescription for an antidepressant. He told me matter-of-factly that he remembers feeling “disappointed” that his attempt hadn’t succeeded, but that after it, he became “resigned to living.” Josh did start feeling better on medication, and has continued to take it since. He said that while he still doesn’t consider himself to be remarkably happy, he knows that antidepressants keep him out of the depths of depression. “I’m confident that I’m not going to kill myself,” he said, adding, “I’m very aware of how it feels to be a survivor of suicide. I didn’t want to put my family through that again.”

I asked Josh whether he ever wrestled with feeling that antidepressants might prevent him from knowing who he really is, and he says that hardly matters to him. “I can understand that,” he said. “I felt that a little bit. But, yeah, it doesn’t really enter into it. I’ve probably been off them about four times, and when I do, my life will slowly slide into just, I’m just miserable. The last time, when I was represcribed them, they said that the more times you have to go back on—they just said that I might be one of those people who needs to be on it, and I agreed.” He told me he has an ex-girlfriend who once wondered “if medication was affecting my ability to feel love. And I don’t know. But it’s not—it’s not a choice of being in love or—I mean, I need to be on it. I can’t go off it to figure out if I can bond more strongly without them.” When you need the pills the way he does, says Josh, the question of personal authenticity “becomes kind of moot.” Josh is pretty sure that antidepressants are what keep him alive. At this point, taking them “is just kind of part of who I am.”

There is also a sizable group of people for whom antidepressants simply
don’t
raise troubling questions about personhood. David Ramirez, a psychologist and the director of counseling and psychological ser-vices at Swarthmore College, says that the young adults he sees in his practice reliably break down into two groups. “For some people, it’s like ‘Whatever, it’s like a vitamin, I just take it,’ ” he said. Others brood. “For other people, it’s like, ‘I am this person who’s also on this medication, but maybe there’s this other person I could be, who I don’t know who that is. I don’t know who I would be if I wasn’t on this.’ Some people feel more realized on medication, and that’s nice,” he said. “Other people feel unrealized.” Ramirez thinks that these responses are rooted in differences of character: some people are just inclined to feel that taking an antidepressant is a philosophical dilemma, and some aren’t.

Perhaps not surprisingly, a majority of the people who answered my call for interviews were the brooding type—at least to a degree. But some of those I talked to contrasted themselves with people they’ve known who have taken antidepressants without angst:

I was in a relationship for a while with a guy who was also on antidepressants. But he wasn’t in therapy or anything, never had been. He just woke up and took a pill every day. It drove me crazy—how can you not want to know what’s really going on? But he just didn’t care to think about it. And that was certainly his choice. But it wasn’t one I could have made.

—Vivian, age twenty-four

I have a friend who’s been on Prozac since she was really little, and she has always said “No, there’s just this chemical thing in my brain, and I take my happy pills and I’m good.” And her depression really has been helped by taking medication, so she doesn’t think there’s anything behind it except maybe a genetic tendency to some sort of brain malfunction.

—Elizabeth, age twenty-five

By a similar token, Teresa, the twenty-five-year-old in Iowa, wrote of feeling so certain that her depression was “other” that she never doubted that antidepressants reveal her authentic self. “For me, I always felt like the
depression
hid who I really was,” she wrote. “My therapist commented earlier today on how much I’d changed since she started working with me, and I was confused. To me, I haven’t changed at all. I’ve just shed the tremendous weight of depression and anxiety that was stifling my actual personality.”

BUT MOST OF
the people I talked to did wonder, sometimes with a fair amount of torment, how antidepressants had impacted who they are, and how they experience the world and themselves in it. It makes sense that they did: developmental psychologists agree that establishing an identity is the main developmental task of adolescence (a stage that spans, roughly, the ages eleven to nineteen years), and adolescents who are already actively reflecting on questions of identity are likely to fold medication into the process. “Teenagers tend to incorporate their use of medication into their identity and reflect on its meaning more than adults,” said Lara Honos-Webb, a Walnut Creek, California–based clinical psychologist. “Because teens are presented with the question of ‘Who am I?,’ being a person who takes medication gets included in that quest.” Sharing some of their comments can illuminate what this kind of wondering sounds and feels like.