Coming of Age on Zoloft (9 page)

—Heather, age thirty-nine

Heather told me that her crisis seemed to come out of nowhere. “When I was fifteen, bipolar just kind of hit,” she said. Other people pegged their crises to a triggering event, like a breakup or a major life transition. Shannon, a brassy former fashion model who grew up in Wisconsin with her sister and mom, was an excellent student but hated the high school environment. She dropped out six months early and spent a couple of years moving around the country with her boyfriend, arriving in Massachusetts when she was nineteen. “It was there that the adult part of my life really hit me,” she said. “ ‘I need a job, I have to pay bills,’ that sort of thing. He and I had an apartment together, and I was doing temp jobs.” She continued:

I decided I needed to do something with my life, so I went to a community college. But I had the same issue I had with high school; it was slow, it was tedious. So after one semester, I decided not to continue. And that’s when the depression really started to set in. It began with the reality that I was nothing at that point. I didn’t have a career. I didn’t have much to live for, so to speak. My relationship with my boyfriend was falling apart, and I was nervous because there was this intense pressure, at least in the city where I went to high school—by the time you were twenty-three, you were married, you had kids, you had a car, you had a house, you were successful, all this kind of stuff, so that pressure was somewhat ingrained in my head, and I just kind of lost it.

I fell into a horrible depression. I was so nervous I couldn’t answer the phone. I couldn’t even walk outside to get the mail. I was terrified of anything and everything that was outside of the living space that created the comfort zone. I didn’t know what to do. I was at the end.

—Shannon, age twenty-six

Other times a situation can seem like a crisis precisely
because
there’s no identifiable triggering event, and the seemingly illogical nature of the problem is part of what’s disturbing about it:

When I was fifteen I was really sad and anxious, and I was tearful a lot, I would cry in school and I couldn’t—I would just lie on the floor in my room and I couldn’t get up. I did have this kind of generalized anxiety thing, where I would just look at something and a visual something would snap in my brain that would make me feel horribly anxious. Like, it didn’t matter, like a tomato in a commercial, it didn’t make any sense. And that was horrible, it was like anything could throw me off and it didn’t have any sensible story to it.

—Rachel, age twenty-eight

But without exception, everyone who talked to me about their crisis described a sense of isolation. Heather felt compelled to “withdraw” from her family and even became alienated from a sense of her own feelings, which were replaced by numbness. Shannon became depressed when she was having trouble finding a way to fit into the world as a productive adult, and in an unfortunately typical piece of irony, being depressed made it even more difficult for her to connect with others. Lindsay suffered partly out of a sense that she couldn’t burden anybody else with her suffering. “By the time I was sixteen, I was definitely struggling with some clear depression,” she said.

It’s kind of a tough year, I think, for anyone; you’re a junior in high school, and that’s known to be the really hard one. And then my mother was diagnosed with breast cancer, right before Christmas that year. I was spiraling more and more depressed but just keeping it really to myself. I didn’t feel that, in spite of my very loving and supportive family, that at that particular moment I could share any of my pain or contribute to the burden that anyone was under, because my mom was so sick.

At one point I started to fantasize about suicide. I had to have a plan. I could make it through my day as it was, but what if it got a tiny bit worse? So I would visualize cutting my wrists and then calling a teacher who I confided in a lot who lived close to me. Visualizing the blood coming out of my wrists was like a release and a hit of something; it kind of perked me up and gave me a bit of strength. At first it was occasional but then I remember picturing this every five minutes or so in class. And that was kind of my coping mechanism, but I totally didn’t feel like I could tell anyone that.

—Lindsay, age twenty-six

One way of thinking about what crises do is to say that they move people to strike out against their isolation by seeking help. For people who have already moved away from home, this usually means reaching a personal breaking point. Shannon remembers arriving at a clear sense that her problems had become more than she could handle alone.

Six months later, my boyfriend and I ended up splitting up. But it wasn’t long after that ended that I came to the personal realization, I need help. I can’t do this on my own. Something is wrong with me, and I can’t live the rest of my life this way. At the time, I was only nineteen. And I mean, I can’t live until I’m seventy like this. I’m not going to make it to seventy. This is awful. So I got help. I found a local counselor, and I started going to counseling.

—Shannon, age twenty-six

For people who are still living at home, though, parents usually play a large role in assessing what is wrong and deciding whether to seek help—and what kind it should be.

When I was young, I was pretty anxious, and then I had like your classic sort of being nudged away by the cool girls in my school. I was thirteen. And then I became basically anorexic because I was like, I can’t deal with this. I was in this small environment, and I was totally unhappy. My parents saw me and they were like “Okay, she needs intervention and it needs to be chemical.”

—Alexa, age twenty-three

Some people remember their parents as benevolent helpers. “When they put me on drugs, I think it was a great decision,” said Alexa, “because I really was wasting away, and I went on them and I was a lot better. I gained the weight right back, I made friends, I joined track, and I think I cared a bit more about school.” Lindsay dreaded what would happen after she confided her daydreams about suicide to a high school counselor who was obligated to notify her parents. But she remembers their finding out as a good thing. “My parents were really broken up that I was in that much pain and didn’t come to them,” she said. Having to talk about it was awkward, but fruitful: Lindsay’s parents helped her find a therapist and get on Prozac, and they became more involved in her life in a way that Lindsay welcomed. Jamie, eighteen, and her mother, Patricia, both said that coordinating Jamie’s care the year that Jamie was a junior in high school brought them some much-needed closeness as mother and daughter.

But a number of people experienced their parents’ involvement with more ambivalence. Particularly when it’s not the child’s idea, the matter of seeking and sticking with treatment can become a point of conflict between parents and offspring, part of the larger power struggle of adolescence. Rachel remembers resenting antidepressants because she felt as if they were being imposed on her:

My mom decided to take me to be seen. The psychiatrist diagnosed me with obsessive-compulsive disorder and some kind of depression and some kind of anxiety disorder. She gave me some medicine, Paxil, Zoloft, Remeron, one at a time. I was resistant at first to taking medicine.

Do you remember why you were resistant?

Because it felt like my mom’s idea, and I wanted not to be controlled by her.

—Rachel, age twenty-eight

Sometimes parents and children disagree not just about the nature of the problem or the best kind of help to get, but even about whether there is a problem at all. Aaron, who is twenty-two, started taking antidepressants when he was twelve. “I’ve been on and off antidepressants for about ten years,” he recounted.

I don’t know basically why I was put on it. I just remember one day I was at the mall, and I ran off to do something and then nobody could find me and they flipped out at me, and I reacted, like I threw a fit, and then when we got home I went up to my room and I just kind of stayed there, and my mom came in maybe fifteen, twenty minutes later after I had calmed down, and she said, “We’re going to send you to someone to talk about this,” and I had no inkling that this was happening. So I started meeting with this guy. I was in seventh grade at the time. And they recommended that I go on Zoloft.

—Aaron, age twenty-two

Jessica had a similar story. “I started taking antidepressants in fifth grade,” she said.

And it really wasn’t me that noticed the problem. I think it was my mom, in conjunction with our family doctor. And I think that my mom was concerned because I just wasn’t happy. I was way more unhappy than your average unhappy kid should be, I guess. And I mean, nothing traumatic or horribly terrible had happened to me, so she was kind of wondering what else it could be.

—Jessica, age twenty-four

Unlike the people I described at the beginning of this chapter, Aaron and Jessica started taking antidepressants without passing through a crisis stage, at least not one that they were aware of. Their experiences point to one of the main things that makes using antidepressants as a child or a teenager different from using them as an older person, and that is how much weight the opinions of adults carry. At the most basic level, parents are responsible for their children’s welfare and are able to tell children what to do. Beyond that, parents’ interpretations of what is happening can make an enormous impression on children, who are likely to believe what they’re told. Aaron remembers his parents saying to him, “We’ve noticed you’re very sad, you’re very moody all the time,” and he instinctively agreed: “I was like ‘Oh, yeah, I am.’ ” And Jessica recalls that

my mother said “I feel like, and the doctor feels like you’d benefit from doing this [taking medication],” and I was like “All right, whatever, you’re my mom and my doctor.” It was just kind of a no-brainer for me.

—Jessica, age twenty-four

Jessica has doubts about her diagnosis in hindsight. “Looking back on it, I think there may have been other solutions,” she said. “I remember feeling very lonely, and I think that was part of it. It may not have been depression as serious as my mom made it out to be. It seems like she might have—not really exaggerated, but my mom has this way of kind of getting her way from the doctor. [If] she feels that I might benefit from a medication, she’ll kind of ask him, pointing at this particular idea. She benefits from it; she’s actually still on Wellbutrin.” Aaron said that while he occasionally second-guesses his parents’ choice to put him on medication, “I trust that they probably made the decision they thought was best at the time. I’m glad I was on it, even if I still have that difficult relationship of not knowing whether I want to be on it at any given point.”

Friction between parents and children about help-seeking can go both ways, though. I still vividly remember the day I told my friend Joshua that I was going to be working on a book about young people and antidepressants. “I
wish
I’d been put on antidepressants when I was younger,” he said fiercely. “Things could have been really different for me.” In our culture, adolescents are expected to be moody and to start pulling away and hiding more of their inner lives from their parents, a state of affairs that can leave parents in the dark about how their children are feeling. (I’ll also never forget a conversation in which I told my mother that I actually remembered most of high school fondly, as a happy and exciting time.
“What?!”
she almost screamed at me, so surprised was she to hear this. “But you were so . . . horrible!”) It can also leave everyone confused about what feelings are to be considered normal. Sometimes this miscommunication can be perceived in hindsight as tragic. Teresa, a twenty-five-year-old in Iowa, wrote to me about finally receiving effective treatment in her twenties for the depression she’d first started to feel at age seven. She described it as “this horrible malaise that would gradually deepen into sleeping
all the time
(seriously, I would come home, go to bed at 4:00
P.M
., and wake up at 7:00
A.M
. to go back to school. And I’d do this every day).” Teresa always felt that her problems were an illness that needed medical attention. She pushed her parents to get her some help, but with no luck:

My parents didn’t take me to the doctor because (a) they couldn’t afford it, and (b) they assumed it was just teenage angst and anxiety, not something “really wrong.” They’ve since told me that they regret it immensely.

—Teresa, age twenty-five

Because everyone I interviewed for this book took antidepressants, they all at some point received a diagnosis—for depression, an anxiety disorder, obsessive-compulsive disorder, or one of the hundreds of other conditions in the DSM. Getting a “label” is an important step. Not only does it usher one into the world of pill-taking, but almost by definition, it also has a bearing on one’s sense of identity. Nearly everyone I talked to reacted strongly to being diagnosed. But these reactions ran to two polar extremes.

About half of the people I talked to found getting a diagnosis to be an enormous relief. As I discussed in the last chapter, our society over the last thirty years has moved away from seeing many common mental problems as psychological in nature, and toward seeing them as medical—less like facets of personality, and more like diseases that you develop or “catch.” These days, diagnosis confronts people with a biomedical explanation for their suffering. Some people specifically told me they took comfort in the biomedical view that came along with their diagnosis. Thinking of their problems as concrete and physical allowed them to say, at last, “It’s not my fault!” They also mentioned the benefits of feeling like they were part of a group, and of finally having an explanation for a set of feelings that had once seemed frighteningly strange.