Coming of Age on Zoloft (26 page)

The people I interviewed also reported taking on new activities and having new feelings about old ones. Often they did this consciously, out of a sense that they could try to make up for the effects of medication with modified habits. Many said that exercise had become vital to them, and that it made a difference: Shannon did yoga; Isabel and Abby signed up for gym memberships. “Exercise has helped me a lot,” said David. “This summer I’ve been running, and it’s been amazing. I don’t know what I’m going to do when winter comes.” Quite a few people had used trial and error to arrive at a belief about what kinds of changes made the biggest difference for them. Shannon was trying to eat fewer processed foods, and Alexa said that she’d moved getting enough sleep to the top of her list of priorities. “I have to be really strict about sleep,” she said.

If I don’t get enough sleep, I just start crying all the time. So what I do is I just go to bed early. If I’m out with my friends and it’s midnight, I’m terrified, because I’m thinking, I’m going to get to sleep when it’s 2:00
A.M
. So, needless to say, [I’ve started to prioritize sleep over my] social life, because it makes me happier. And the two hours that I’m at that bar with my friends, that they’re at for eight hours, are going to be better.

And that was a big resistant thing, the sleep thing, at first. Most of my friends, even the very supportive, understanding ones, are like “Really? You’re really going to bed now?” But that’s just what I need to do.

—Alexa, age twenty-three

As it turns out, there is at least some scientific evidence for the influence on mood of changes in all these realms—exercise, sleep, and diet. A number of studies performed over the years suggest that exercise can have a therapeutic effect on depression; the benefits of two to four months of a sustained exercise program can be comparable to the benefits achieved by antidepressants. More vigorous exercise is correlated with greater relief. Moreover, there’s evidence that exercise may have a preventive effect, making people who exercise regularly less likely to get depressed in the first place.
1
Sleep disturbances have been linked with depression too. While insomnia or oversleeping can be effects of depression, there’s evidence that the direction of causality can also go the other way,
2
and that maintaining an erratic sleep schedule and habitually undersleeping can lead to disordered moods.
3
As for diet, though there is an avalanche of studies that have looked at the effect of single foods or nutrients on depression, the study I find most compelling (and, like many compelling studies, commonsensical) is one that tracked thousands of London office workers for years and found that, after adjusting for other factors, a “whole food” dietary pattern emphasizing vegetables, whole grains, fruits, and fish correlated with a lower risk of depression than a “processed food” dietary pattern.
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Not all of the interventions people mentioned were tangible. Meghan, Grace, and Shannon talked about the importance of community. “So much of depression is feeling isolated, and not being able to depend on anyone,” said Meghan. She said that one of her theories about why she was able to stop using medication is that while she was on it, she was able to build up an excellent and supportive network of friends. “Through being on medication and being more happy and confident, I developed a lot of really good friendships. And I think that having a community helped me stay off medication ultimately. Just sort of not feeling like a total freak when I was having a hard time. Like my friends still loved me, and I’m just a person, and I’m having a hard time and that’s okay.” Alexa spoke about community in a slightly different way—she said that after quitting, she needed to regulate who she was spending time with and monitor what kind of effect they were having on her. “I had some very intense friendships and I was like, ‘I’m not going to be friends with you anymore, because I can’t handle it.’ These were people who were a lot further gone than me in the sense of, like, people who had tried to kill themselves way too many times. And I was like, I’m going to surround myself either with no one, because I’m going to sleep at 10:00
P.M
., or just more positive people, which I feel like is a really crummy thing to do, but I needed to do it.”

Those who were in long-term romantic relationships often cited them as a factor contributing to an overall feeling of stability. “Part of what made me feel okay with stopping when I did was being in this sort of stable relationship,” said Dana. Shannon said that her fiancé was a big help in her effort to get off antidepressants.

He’s been exceptionally patient, and very understanding, and he’s helped me work through it. He slowly helped push me out of my comfort zone, especially from an anxiety sense. He’ll help to put me in a situation that would normally trigger my anxiety, usually social stuff, but he’ll be there, and kind of assure me that everything’s going to be okay.

—Shannon, age twenty-six

She also talked about the importance of social contact in general.

I’m the first person to say that if you’re depressed, or if you’re anxious, the last thing you want to do is anything. You don’t want to eat, you don’t want to shower. You definitely don’t want to go out on a hike or go to the mall or something like that. But you have to do something. Once you isolate yourself, that’s when you’ve crossed over to letting it get you. Even if all you do is go for a walk, and say hi to one person that you pass during the walk, that’s an accomplishment.

—Shannon, age twenty-six

Several people described feeling as though they had become better at noticing their own needs and taking action to meet them—a combination of being both more vigilant and more relaxed. “I’ve worked out enough strategies so that I never get to the bottom anymore,” said Isabel.

I used to get into the thing where like, what I want to do is just, like, watch a movie, but that’s bad because I should be trying to be productive, so I would spend the whole day not doing anything, and then end up feeling like I was a waste of a person. But now, I allow myself some, like, “Oh, if you want to chill out, that’s cool, you can just chill out for an hour,” and limit the number of things that I expect myself to do in a day. Which I often exceed. It’s not that I have to struggle through all my days, but lowering my demands on myself has been big.

—Isabel, age twenty-seven

Isabel’s comment is in line with the many ways people told me that the passage of time had often acted as a powerful intervention of its own. They talked about seeming to acquire a new resilience as they got older—as if living were a skill that they were improving at with age. Dana said she’d gained perspective. “Over the years, with medications and without, I’ve gotten so much better at not mistaking a negative mood for reality,” she wrote in an e-mail. Alexa claimed she’d gotten better at putting herself first. Describing her sleep routine, she said, “The older I get, the more I’m like, ‘I don’t care if I’m boring, I just want to be healthy.’ ” These observations made perfect sense to me. By my midtwenties, I’d felt the same things: life did feel like it was getting a little easier as the years went by. All the emotions were still there, but even the strong ones weren’t quite as jagged as they used to be.

The sense that life becomes easier to manage as we age hasn’t gone entirely unnoticed by science. I felt tickled when I discovered a study in which psychological researchers who tracked hundreds of university graduates for seven years found that, on average, their subjects enjoyed a robust and significant decrease in depressive symptoms over the decade of their twenties.
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Middle-aged people had even fewer depressive symptoms than twentysomethings, and they expressed less anger as well.
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A psychologist who wasn’t involved in the study hastened to tell me that the results shouldn’t be taken as evidence that we “outgrow” depression, or that you can’t get depressed at any age—and they aren’t. But the study does lend credence to the idea that, old chestnuts about “the best years of your life” notwithstanding, most people begin to feel more calm and stable as they leave adolescence well behind.

Meghan, for one, told me she believes that being older has made life easier to deal with. “Definitely!” she said. “For sure.”

My sister’s in college right now, and she’s a sophomore, and her experience is so similar to mine, and the fact that her capacity to handle stress is so little, or small, and she is having a really hard time, and she freaks out really hard sometimes in this sort of nihilistic way, like “I don’t understand, and there is no point, I can’t do anything,” and it’s really hard to hear her go through this, but I’m, part of me doesn’t worry too much because just by getting older, I was better able to handle these things. So I imagine that she will be able to as well. But it’s really hard! It just breaks your heart.

—Meghan, age twenty-five

WHEN I BEGAN
tapering down on Zoloft in 2006, part of my bargain with myself was that I would abandon the project if I felt that it was necessary—that I was going to try to stay mindful of the difference between normal emotional ups and downs and the extra, grinding sensation of depression, and not force myself to suffer the latter just for the sake of being pill-free. During a spate of gray days in March, about six months after I’d gone off antidepressants completely, I started to wonder whether that time had come. I’d hit a low point at my job. A relationship had ended. We’d lost our lease on the apartment with the lovely cocoa-brown room and had moved to a neighborhood that seemed tougher, colder, farther flung. New York had done that thing that New York can do, whipping around on you, turning from bright and exciting to cruel and strident, like a trap you could get stuck in forever, or a playground bully who won’t let you into the game.

Later that month, I went so far one week as to find a psychiatrist who accepted my new health plan, and steal away to her doily-strewn office on a lunch break. Over the course of a month or more, she tried me on a few things, including, at last, a tricyclic antidepressant that overstimulated me so much that she suggested I buy a bag of clear, empty pill capsules from a health food store, break apart the antidepressant capsules, and sweep a few grains of the powder into the clear caps, as a way of taking an infinitesimal dose. I did as she instructed. It may have helped, I don’t remember. I do remember catching sight of myself a week or so later in the reflection of my darkened bedroom window, hunched over and working away like a pharmacist. I had one of those crystallizing moments. It suddenly felt to me that whatever I was doing, I was doing it prophylactically. I wasn’t at the bottom, I was afraid of getting there. I felt overstimulated, disappointed, and sometimes lonely, I realized, but I didn’t feel
sick
. And while I’d stayed on antidepressants in the past for less, this time I decided to take a bet on myself.

Days piled up, the same for a while, then different. One morning I woke up and instead of feeling dread or self-annoyance, I felt the simple pleasure of being focused on outward things: the touch of clean sheets on my skin; the sight of my new curtains, black and white this time, billowing in the early light. More time passed, and the grounded feeling stayed. I took the psychiatrist’s last prescription out of my wallet and put it deep in a drawer.

Life still wasn’t perfect, but after that, it turned. Whatever it had been—the end of a romance, adjustment to a world past academia, the long New York City winter, or a little bit of each—the cycle came to an end, and one by one the areas of trouble worked their way toward resolution. I remembered what John had said in our therapy sessions the year before about the value of aggression, and I tried my best to take action, go after what I wanted, and change all the bothersome things I could.

In the winter of 2007, I reached the end of a year which, aside from that early-spring flirtation, I’d spent completely without medication. It was the first such year I’d had since I was eighteen. In my journal, I wrote that while it hadn’t been an easy time, it had felt like an empowering one. Realizing that I could feel bad for a while and then recover satisfied me deeply in some way. It increased my confidence to know that the things I’d learned would make me feel better still had an effect, even without the net of antidepressants. Most of all, I felt glad to have finally answered to my own satisfaction that old mystery, the question of what I would be like without medication. If there was an irony, it lay in how non-cataclysmic the answer was. Month in and month out, as far as I can tell, the person I am off antidepressants isn’t so very different from the person I am on them. It may be silly that I had to go to great lengths to accept in my bones what psychiatrists have been saying all along. But I did have to, and the knowledge in my bones feels invaluable.

The hope that getting off of antidepressants would somehow perfect me, that I’d zoom to new heights of creativity, or clarity of thought, or personal charm, were laid to rest. But that’s all right. The fears that I’d completely fall apart were put down too. I wrote at the time that somehow, knowing that the difference antidepressants make is less profound than I had sometimes imagined would make me feel more peaceful about taking them again, if I ever decided to. They wouldn’t challenge my sense of self the way they had when I was in my teens and early twenties.

As my year without antidepressants came to an end, I didn’t have any immediate plans to get back on them. Five years later, I still don’t. Not taking medication has become routine, a habit that feels as ingrained as taking it used to be. That’s not to say that I don’t sometimes think about going back. I agree somewhat with Grace, who, when I asked her whether life was easier to manage now, said:

Not really, no! [Laughs.] I mean, I think. Not really. It’s still just as hard. I think I’m less dramatic about it, certainly. I allow myself less drama. But when I think back on it, I still have the same problems that I did, the same things still drive me crazy.