Coming of Age on Zoloft (27 page)

—Grace, age thirty-four

I do feel like life has gotten easier to manage, but I relate to the sense that while time and experience dial them back, old issues never truly disappear. And sometimes—in February, or after a breakup, or during a period of stomach-knotting stress at work—I ask myself whether another way might be better. I consider the possibility that I’m pushing myself to prove a point, or wonder whether I’ve been living inside a low-grade depression for ages without even recognizing it. Once or twice, I’ve even been back to look at the DSM-IV criteria for depression. Each time, I’ve realized I’m nowhere close.

MOST OF THE
people I talked to who used antidepressants are glad they did. “Lexapro was my stepping-stone,” said Shannon. “It was the thing that kept me alive, that made me realize I’m capable of being a human being.” Isabel said that “at the time, when I first went on medication in high school, I didn’t know what to do. I didn’t have any resources in myself to help myself feel better. Medication was like a raft.” Plenty said they’d be willing to go back on antidepressants if they felt they needed to. Some specifically defended others’ choices to use them. “Even though I’m not on them, I’m [down on] anyone who accuses anyone on meds of being weak, or whatever,” said Alexa, “because to me, that is just not understanding.” Maybe surprisingly, most acknowledged that life without antidepressants is a little bit harder than life with them. But they find that they are able to bear the difference, and they often said that they gain a sense of meaning from their choice that makes the extra difficulty seem worthwhile.

Christine, thirty-six, who had stopped taking antidepressants six months earlier on the advice of her psychiatrist in Denmark, said that she valued the emotionality she has when she is not on medication. “He said, ‘There’s nothing wrong with you clinically, and I think we should just stop.’ ”

So I stopped, and he was pretty right. Of course I can feel that the world has kind of stepped one step closer to me, where I start crying a little more often now—but it’s nice, because my sensitivity has come back, and so far, it’s been okay.

—Christine, age thirty-six

Alexa said that while living without medication was tougher in some ways, she liked the feeling of being able to accommodate her natural tendencies, instead of trying to change them. When she stopped using antidepressants, she said, “I totally felt these problems come back, these problems that had not even developed in my teenage years. I’m definitely an anxious person. And when I came off, I was like this person who’s always a little bit too up or a little bit too down, not proportionate to reality.”

And I haven’t come to peace with that in the sense that I like it all the time, but there are ways to manage it besides being on drugs for me. And I guess I try to see the upside of it. Like, being a little up is kind of fun, because I become more creative, I have energy to make things. And then being a little down kind of sucks, but I feel like I’m the kind of person who’s always on the go, and when I get down I try to think of it as like, My body needs to rest, or like, I need to take it easy; I’m going to have a day where I read in bed.

—Alexa, age twenty-three

David, thirty-one, quit under duress; he tried for years to make medication work, but all of the many medications he used eventually caused him to become manic or created other side effects that made it impossible to for him continue. He told me that, on balance, he’s sorry that medication hasn’t worked for him. But he also takes pride in the way he has learned to manage without. When we talked, he had been off of everything for over a year. “And I’m doing okay,” he said. In an e-mail, he elaborated:

I’m not the whirlwind of productive energy I wish I was, but I do okay at my job, I have a fairly busy social life, I carry through moderately ambitious projects outside of work, I’m moving forward in my career. And I’ve come to accept that the person I wish I was is not someone I can be, at least not for longer than a couple days, a week at most. But for me, it has always been borrowing against something, in terms of both emotions and energy level. So let it level out: I’m always going to be introverted, and slightly nervous, and self-critical, and slightly scattered, and easily distracted. But I can almost like that, or at least appreciate it as a viable alternative to the people I have been in the past.

—David, age thirty-one

This type of thinking won’t make sense to everyone. Isabel told me that her mother, like most of her other family members, has been on antidepressants for years. “My mother and I are very close,” said Isabel. “And she couldn’t understand why I would ever want to stop taking medication. Her philosophy about every-thing is, ‘Why be in pain? Why not just play it safe? The thing makes you feel better, so why not just do what makes you feel better?’ And medication has been such a blessing for her life, that she can’t understand why people wouldn’t want to take it. So, for a long time—and only recently did she stop doing this—when I was upset, she would be like, ‘Well, maybe you should just try to go back on the drugs for a while.’ ”

Other people who are drawn to the idea of quitting will discover that it isn’t practical for them. While I think that self-care and lifestyle changes can make a big difference, I know they’re not a panacea. As a personal reminder, I sometimes think back to a moment that occurred near the end of my time in California. I was at the Berkeley YMCA, trying to “manage” my need for medication with exercise, in the last week or two before I packed it in and called the psychiatrist. A few weeks later, when I was feeling better, I tried to wring a little humor out of the memory by saying to myself,
Okay, when you’re doing exercise to try to feel better, and you’re actually crying
while
you’re doing the exercise
(crunches for me, if I remember),
maybe that’s a signal that it’s time to bring out the big guns
. I have a friend who had a therapist who once told her that depression is when you feel like it’s almost impossibly effortful to get through the things you need to do. By the same token, keeping yourself in an acceptable frame of mind shouldn’t feel like an exhausting, full-time job, let alone one you’re slowly failing at.

Maybe this starts to get us back to a sense of why quitting medication has been and still is a delicate topic. The issue can confront us with an unfairness: it’s something that is possible for some people but not possible, and certainly not advisable, for all. It’s delicate because it is tempting to read one person’s choice to forego medication as an editorial comment on the validity of the decisions of others. It is also touchy because it confronts us with the vision of people making themselves suffer to secure an outcome that they want—the possibility that the choice to quit will be guided more by a stigma against medication than a clear-eyed assessment of what is right in a given situation. Finally, it’s delicate because it requires making judgment calls about what is and isn’t normal to feel, calls that may be easy at the far ends of the spectrum but, toward the middle, are difficult enough to make for oneself and very uncomfortable to try to apply to other people. No wonder the question of stopping has been one that we’ve often preferred not to talk about. But we need to find a way to, and we may find that the subject becomes less forbidding the more we try.

As Meghan discovered, sometimes it is possible to change the story that you are telling about yourself. But at other times, just wanting to tell a different story about oneself does not make it feasible, or even a good idea. Quitting becomes problematic when your desire to fit your life into a certain narrative starts to cloud your ability to see things as they are. The few times during these interviews when I became uncomfortable were the times when I began to get the feeling that someone was trying too hard—that their quitting seemed to have more to do with a wish to bring their life in line with an identity that they wanted to take on than it did with attention to how things were actually going for them.

Conversely, the quitting stories I felt best about were the ones in which someone described a choice that felt, in the truest sense, free—as if it were made in the absence of a need to secure one outcome or the other. I felt comfortable when I was talking to people who seemed able to balance their gladness about not being on medication anymore with a sense that this gladness wasn’t essential to them—it was something extra and nice, but not central to their ability to value themselves as a person. It is a delicate balance to achieve, one I thought that Dana put very well. When I asked her in a follow-up e-mail how she thought that growing up on antidepressants had affected her, and whether she would make the same treatment choices over again, she replied:

It’s quite possible that without medication, I would have been too depressed and anxious and unsure of myself to go to college 2,500 miles from home or spend a semester in Australia or have love affairs with cool and strange men or move to New York after graduation or make it through the first two years of graduate school. I might have used more drugs and alcohol instead of less. I might have become more socially withdrawn. I might have thought even more about killing myself. I can’t know, but it feels very possible.

So, no, I wouldn’t change a thing. The choice was mine from the start. I exercised my independence (perhaps unwisely) over and over again by going on and off the meds as I saw fit. The past three years have demonstrated to me that I can live life and weather enormous stress without the medication—I emerged neither physically nor psychologically dependent. In my estimation, the medication served me well and did me no harm. And I’m happy where I am.

—Dana, age thirty-one

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A
s I moved into the second half of my twenties, taking a considered break from antidepressants seemed like a reasonable thing to try; when it turned out to be supportable, I decided it was something that I wanted to continue. In the last chapter, I described a handful of people who performed a similar maneuver. As they left college days and quarter-life crises behind them, they felt pulled to experiment with leaving medication behind too, and the move often felt valuable and right to them. But as I continued with my interviews, I also noticed a countervailing pattern. Some people, even those who felt diffident about antidepressants when they were younger, find that they become more committed to using medication as time goes on. People who stick with antidepressants or return to them a little later in life often find new ways to think and talk about medication that allow them to feel a greater sense of control than they did at first. They replace the worries that many younger people have, about how antidepressants might alienate them from their real selves, with a sense that antidepressants are a tool they can use deliberately to achieve a way of life that is right for them.

At first, James seemed an unlikely candidate for a champion of antidepressants. His stories about medication had much more to do with the things that medications hadn’t done for him than the things they had. The failure wasn’t for lack of effort. “I’m what’s considered ‘treatment-resistant,’ ” he said. “Very, very, very treatment-resistant.” Early in our interview, James explained to me patiently that he’d been on medication for most of the last half of his thirty-two years. All in all, he had tried forty-seven different drugs, singly and in a mind-boggling array of combinations. “With that amount of effort,” he said with a small sigh, “most people would have found something that worked.”

James was tall and broad-shouldered, with a neatly trimmed brown beard and the precise amount of extra poundage that, on a man, invites teddy bear comparisons. He was a web developer by trade, and put his words together with a degree of precision that gave his speech a slightly formal air. James said he had been aware of depression as a force in his life for almost as long as he could remember. School officials first commented on his “issues of sadness and anger” when he was six. At fifteen, he carried out what he described as a “major suicide attempt,” swallowing a massive overdose of his family members’ prescription drugs. He was found unconscious and rushed to the hospital where, he noted matter-of-factly, “I actually literally did die for four minutes.” Afterward, James spent several months in the hospital—in the waning days of the 1980s, long hospital stays underwritten by insurance were still common.

Though he’d been depressed for a long time, the hospital stay was James’s first entrance into the mental health care system. James’s attending physician in the hospial put him on Prozac, then still a new and exciting drug. As James recalled, Prozac made him anxious at first, but over a few weeks its effects faded away to nothing. But he vividly remembered feeling hostile toward the idea of taking Prozac. “I was afraid of the stigma, and what it said about me. Even though I’d been hospitalized for so long, the idea of taking meds seemed to solidify the idea that I was crazy,” he said. “What’s going on in my head isn’t visible, but me taking a pill is much more tangible to the world.” When he was transferred upon his release to a new psychiatrist who took him off of Prozac, he felt immensely relieved.

James didn’t try medication again until he was nineteen, when a second suicide attempt forced him to withdraw from college. “It was nowhere near as bad [as the first one],” he said. “Technically it was a very good-looking cry for help.” Still, it was alarming to James, and to his parents too. James moved home, got a job, and began working intensively with a psychiatrist to find a medication or a combination of medications that would help. For six years, he tried one drug after another, with a lack of success that reached almost epic proportions. James had side effects major, minor, and nearly unheard of. On the mood stabilizer Depakote, he said, he packed on extra weight that he hasn’t been able to shed since. “Either I had a side effect from a drug, or it didn’t work, that was the pattern,” said James. “It was a merry-go-round of absolutely nothing.”