Coming of Age on Zoloft (17 page)

Sexual side effects from SSRIs haven’t been widely discussed in the context of teenagers, possibly out of a cultural ambivalence about whether adolescents should be sexually active or not. But because SSRIs influence not just performance but also a person’s thoughts and desires, these side effects are relevant for teens who aren’t having sex as well as for those who are. In the article in which he described his patient Julie, Richard Friedman mentioned a woman in her mid-twenties who came to him complaining that she often felt pressured by her boyfriend for sex. “I’ve always had a low sex drive,” she explained. Friedman pointed out that the young woman had been taking an SSRI since her mid-teens; she had “understandably mistaken the side effect of the drug for her ‘normal’ sexual desire and was shocked when I explained it,” he wrote. Timothy Dugan, a child and adolescent psychiatrist at Harvard’s Cambridge Hospital, told me he thinks that the question of SSRIs’ effects on young adult sexuality deserves consideration, especially in light of the importance that sexuality plays in psychological theories of development. “If Freud’s right, then sexuality should drive development, and drive connections with other people,” he said. “If you’ve taken the edge off [with a medication], then what’s that about? There are real side effects that have, in my mind, real or potential developmental impact.”

When I started to ask people about their experiences, I found many who said or suspected that medication had influenced their sexuality, though a number of them didn’t make this connection until later—and some still aren’t completely certain. Laura, a twenty-three-year-old graphic designer who took Zoloft as a teenager, said: “I was an arty senior in a big suburban high school.” When it came to sex, “I just wasn’t interested. I thought it was the Zoloft. But, again, I wasn’t sure.” Alexa said she didn’t really blossom sexually until after she quit medication at twenty. “On those drugs,” she said, “I had no sexual—I didn’t even know if I was straight!” Aaron also says he experienced sexual side effects from medication. “Now that I think about it,” he wrote in an e-mail, “there may be a correlation between [the times during college] when I was on medication, and when I wasn’t getting laid. I wouldn’t have much of a sex drive on medication, and there were times when I just didn’t have the ability to perform.” And Emily told me in our conversation that “the sex thing” is definitely part of her occasional desire to go off antidepressants. When I asked her to explain, she said, “I think that I have a really healthy sex drive, but it’s impossible for me to know. Even if I do go off it, my brain has formed around these chemicals now for that last half of my life. I mean, I started having sex when I was taking antidepressants! So I’m never going to be clear on what the difference would have been.”

Others had a clearer sense of what was happening. Dana, who started taking Prozac at fifteen, was aware of some sexual side effects at sixteen, and then lost her ability to have an orgasm the following year. The situation was “frustrating, and depressing in its own right,” but she understood the reasons for it. She shared her concerns with her psychiatrist, who switched her to Wellbutrin, a non-SSRI antidepressant with a lower incidence of sexual side effects. Dana dealt with the problem well—and increased awareness may help more teenagers and young adults to do the same—but others may remain too embarrassed to ask for help, or will lack a basis to notice the difference the drugs are making.

NOT ALL, BUT
a considerable number of adolescents who take psychiatric medications find that these medications impact their search for an identity. They feel that the drugs make the question “Who am I?” more complicated to answer. They may struggle with the feeling that the answer to the question could be something negative: “I’m someone who’s sick, because I take these drugs.” Or they worry that the medication alienates them from their real emotions: “How can I really know if what I’m feeling is genuine?” Over time, they may come to feel that the selves they know are not, somehow, their real selves, or not the selves they might have been: “I didn’t know what my personality would be without it, really, because I’d grown up on it.” Even people who end up affirming their choice to take medication live with these questions, and can feel a need to reconsider them from time to time: “I do wonder. If I’d never gotten antidepressants, who would I be? What would I be like?”

It’s easy to laugh at the concept of being “genuine,” or roll your eyes at the idea of the real self. In fact, sometimes it’s hard to take these notions with a straight face. Alexa remembered asking herself, “What am I really like?” but she also knowingly referred to it as “one of the cheesy questions you ask yourself when you’re a teenager.” In the academy, scholars have been declaring for decades that the true self is dead. For the last twenty years, the dominant academic theories of personhood have focused not on the idea of essence but on performance and changefulness, the sense that we don and doff identities at will as we move through our lives. Intellectually, we all know that the true self is more of a metaphor than a literal reality—we don’t really believe that there is some perfectly realized version of each of us hovering out there, just waiting to be discovered like a vein of gold.

But no matter how well we understand the academic critique of the essential self, or how much we feel disposed to dismiss “Who am I?” and its ilk as “cheesy questions,” most of us still want to feel, in some way, like ourselves. We may never achieve the highly concrete answer to the question of who we are that we first imagine possible as young teenagers—but a notional sense of self is something that we all rely on from day to day. This sense doesn’t have to be as well-defined as words like
genuine
and
authentic
can make it sound, but we need to be able to trust it intuitively. Such a workaday sense of who we are is a necessary value, one that guides us in our choices and informs our relationships with other people and with our world.

Knowing that many adolescents at least perceive antidepressants as making a reliable sense of self harder to find is important. A feeling of authenticity is, admittedly, an intangible thing to lose—but in a society that still prizes a notion of authentic selfhood, however problematic, it can also be a significant one. The fact that antidepressants can frustrate the adolescent search for identity isn’t a comprehensive argument against their use in youth, of course. Every expert I talked to, from the most bullish on medication to the most conservative, agreed that depression in adolescence can be devastating and that antidepressants are sometimes the best response. (Untreated mental disorder can itself have a negative impact on a young person’s developing identity.) But the sense of uncertainty and self-estrangement that Aaron, Sophie, Emily, Julie, and many others in their situation attribute to medication is powerful. Even when they decided that the benefits of being on antidepressants outweighed the detriments, they often felt that they had lost a direct way of relating to themselves that they imagined other people their age to possess. That sense of loss, they said, is stubborn and real. For many, it is a central and long-lasting feature of the experience of growing up on antidepressants, and it is one that deserves to be taken into account when we are weighing the decision of whether to put young people on psychoactive drugs that they may use and develop with for years.

6
| Two Red Chairs

J
ust about everything I own in the world is bouncing down route 81 in the back of my father’s silver Toyota pickup truck. I’m trailing him in my own Honda Civic, and from time to time I can catch part of my material life—an armchair with red cushions, the mattress we bought this morning at an Ikea in New Jersey—flash into view when the blue tarp tied across the truck bed flaps in the wind. Road conditions are what my high school driver’s ed teacher would have deemed poor. The gray clouds that moved in as we passed through Scranton have begun to shed fat drops of rain that burst on contact like grade-school spitballs. My father is speeding, and I’m driving faster than feels safe to keep up with him, cursing under my breath. The speeding and cursing help distract me from the uncomfortable thought that sinks in a little further with each passing mile:
I’m really doing this. This is really real.

We are headed to Ithaca, New York, where I’m supposed to start my first year as a PhD student in English at Cornell University. But it feels as if I’m driving off the edge of one of those medieval maps of the world, into a void where sea monsters wait to swallow lost sailors.

THAT MORNING IN
Brooklyn, I hugged good-bye to my friend Anna on the strip of grass separating the sidewalk from the street in front of our building. We had graduated from college and moved to the city together nine months before. Anna planned to stay indefinitely, while I’d already applied to schools and expected to be moving on at the end of summer, though I didn’t yet know where. We rented a tiny loft near the river and built denlike bedrooms out of drywall and metal two-by-fours; in honor of my temporary-resident status, I slept on an air mattress for months. During the day I worked at a coffee shop while Anna went to her internship at a record label. In our off times, we explored our wonderful and bewildering new city, or compared notes about it while sitting together in the dusty glory of our first grown-up apartment.

As thrilling as New York could be, the new shape of social life alternately excited and dazed me. In the city we went out a lot, but people seemed to disappear back into their lives more mysteriously; there was no nucleus, no point of reference to understand ourselves in relation to. I missed the way that Portland had felt like a real community. It had been a home to me, while New York City felt like a raucous way station, a wild party in an elevator.

In the first months after college I had ended up applying to graduate schools almost by accident, out of a sense that the real world was too baffling and amorphous to handle. I hadn’t figured out what to do with my life, but I had been good at my major, English, and when one of my professors suggested that I might apply for PhD programs, the thought appealed to me. The implicit praise appealed to me too. All my life I had been a good student, adept at pleasing teachers and used to warming myself by the glow of the approval they gave me. Losing that old system for feeling worthwhile had been the hardest thing about leaving college. Getting back into the academic world, with its reassuring markers of achievement, seemed like a way both to feel good about myself again, and to silence the questions about what to do with my future that had become a monotonous, tormenting chorus inside my head.

So I applied. I did it even though something about the whole process felt rushed and wrong, like a bigger commitment than I was ready for. I drove my unease away with the lockstep of details: I filled out forms, gathered writing samples, and sent packets off to a dozen distant addresses. I was admitted to a couple of programs, and even though my campus visits made me feel crazy with ambivalence, I accepted one, because I didn’t know what else to do and I wanted to make other people proud. And now, in my waning days in New York, every time I thought about it too hard I felt queasy. So I tried my best not to think about it at all.

One night in June, Anna and I went to a party, and once again I noticed that feeling that going out in New York so often gave me, of not gaining
traction
. I was tired of explaining to people I’d just met that I would soon be leaving, tired of trying to sound excited about a step that in truth I felt no excitement about. When we left around midnight, it was pouring rain so we decided to share a taxi home. I had been feeling on edge all night, and as the cab crept slowly through the darkened streets, with thick sheets of water enclosing its windows, the sensation deepened to an unbearable claustrophobia. At a stop sign a few blocks from home I threw some money into Anna’s lap and let myself out into the night. I sprinted home and pounded up the six flights of stairs to the large, flat roof of the building, leaving foot-shaped pools of wetness behind me. Up there, the rain pasted my clothes to my body and then streamed freely through them. I was finally alone, as I had not been alone in New York City in months, and I threw fistfuls of gravel and banged my arms on the metal ladder that led up to the empty water tank, suddenly venting a fury I didn’t know I had been carrying inside. I stayed up there, throwing and shouting and banging, until I was exhausted, and then I knelt on the layer of pointy stones that covered the rooftop and let rivulets of cool water trace small rivers down my skin.

The next morning I awoke on my air mattress. Pale, innocuous sunshine streamed in the window. I felt more truly calm than I had in months. The feeling stayed with me all day, and it was evening before I realized that I had missed my pill the night before. I was still taking Serzone, the antidepressant I had used for most of college. I had been taking it for so long now that I’d lost a sense of what it was doing for me; I only knew that if I missed a dose I would wake up in the middle of the night, overheated and itchy all over.

That evening I skipped it again. By the time I moved away from Brooklyn, two months later, the bottle had grown dusty on the shelf. It was a risky way to quit, but after all, I reasoned, Serzone hadn’t protected me from everything. I felt stuck and out of touch, and I quietly hoped that taking a break from medication might help me regain control of my life. Maybe without it I’d be able to reach back and refind that thing, that sense of purpose I knew I’d had once, but that seemed to have become lost, somewhere, during college and after.

WHEN WE GOT
to Ithaca, my father helped me carry my things up to the apartment I’d rented, sight unseen, a cozy studio on the third floor of a huge Victorian house near the edge of town. The skies were lake-effect gray, but the rain had stopped. He headed off to a motel for the night, and I sat there amid my unassembled Ikea furniture, feeling a sense of despair and a sense of unreality. We had breakfast the next morning at a greasy-spoon café, and then he drove off and left me to settling in.