A version of this piece was published in Transition, a Canadian magazine on mental health.
In 1980, the year I was born, the board of directors of the American Psychiatric Association voted to allow pharmaceutical companies to offer paid symposiums at its annual conference. Thirty years later I was sitting on coarse beige upholstery in a doctor’s surgery in Glasgow. “Are you sure the results are normal?”
He sighed and repeated that my blood, hormones, iron level and thyroid were all fine.
Disappointment lodged in my oesophagus. Please tell me something’s wrong: hypothyroidism, Vitamin D, anaemia, hormone imbalance, anything.
I had moved to the rain-wracked west coast of Scotland to do a Master’s degree in writing but, after a few weeks, I could barely read. Obsessive thoughts snarled and snapped: you’re stupid, you’re hopeless, you’re a failure. Glasses leapt from my hands at my part-time waitress job. Burns crept up my arms as my reflexes slowed. My boss reprimanded me for being “snappish”. I craved sugar, wolfing my flatmate’s ice cream and cereal then slinking out the next morning to replace them. I slept 12, 15 hours a day, exhausted by the weight of my body.
One more test. The doctor gave me a single sheet of paper. I tend to score well on tests; this was no exception. The Beck Depression Inventory1 is a common screening for depression, intended to “identify [its] presence and severity”2. He skimmed my responses about sadness, guilt, irritability, hopelessness, sleep disturbances, and suicidal thoughts.
“I’ll write you a prescription.”
“Is there someone I can talk to?”
Referral in hand, I walked to another basement office.
That doctor cut me off after ten seconds: “Do you want a prescription?”
He huffed audibly. “If you want to talk to someone go to the counselling service. All the other American students are on meds.”
***
In Anatomy of an Epidemic award-winning journalist Robert Whitaker describes how the “notion that [pharmaceutical] ‘magic bullets’… would bring miracle cures”3 became psychiatric dogma — despite the fact no one fully understands the organic processes of mental illness. Do psychotropic “bullets” hit their target? If so, what happens? No responsible physician would prescribe thyroid and hormone treatment without a lab test. But nobody checked my serotonin or dopamine levels. My doctor had never seen me before. He knew nothing of my family, temperament, or situation, but on the basis of 21 questions offered a drug that would dramatically, maybe irreversibly, alter my brain chemistry.
The most common antidepressants are selective serotonin reuptake inhibitors (SSRI)4 like Prozac. As it happens, I spent several years toying with a fast-acting antidepressant. Methylenedioxymethamphetamine, like SSRIs, boosts serotonin levels in the brain. It obliterates unhappiness in a rush of euphoria, confidence, clarity and empathy. Everything is better: music, lights, colour, conversation, friendship, sex, and cigarettes.
Until the comedown.
“Suicide Tuesday” was a semi-serious joke among club kids. We compared notes on nightmares, hallucinations, and memory loss. We counted the days till jaws stopped aching and appetites returned.
Prozac is legal but brain chemistry is no respecter of legislation. Trials on SSRIs show that “rats fed high doses… ended up with neurons that were swollen and twisted like corkscrews”5. The human evidence is compelling: the Food and Drug Administration received 39,000 complaints about Prozac in the nine years following its approval, including reports of suicidal and homicidal outbursts, “psychotic depression, mania, abnormal thinking, hallucinations, hostility, confusion, amnesia, convulsions, tremors and sexual dysfunction.”6
***
Instead of antidepressants I took the second doctor’s advice and went to the student counselling service. Every Friday afternoon between three and four (after dark, for most of those moths) I went to a basement room where a white-faced, gold-rimmed Seth Thomas clock sat in a disused fireplace. A tiny glass pitcher and two small glasses stood on the hearth beside a box of Tork tissues. I had fold them in half to blow my nose.
“I’m scared.”
“Of what?”
“I feel like I’ve lost control.” I threw another fistful of sodden tissues in the bin. “You know the Rolling Stones’ ‘Paint It Black’? It feels like that.”
Words that come to mind now are no less true for being clichéd. Nouns: storm, cloud, void, chasm, maelstrom, black hole. Verbs: choke, crush, frighten, smother, horrify. Adjectives: miserable, catatonic, helpless, damaged, trapped, angry, sad, frustrated, lost.
***
In 1988 the United States Food and Drug Association green-lighted Prozac and America’s National Institutes of Mental Health set up the Depression Awareness Recognition and Treatment (DART) program. Its mission was to promote “greater acceptance of depression as a disorder” and, perhaps not incidentally, spread the word that “antidepressants produced recovery rates of ‘70% to 80% in comparison with 20% to 40% for placebo.”7 Eli Lilly, which held the patent on Prozac, helped pay for eight million DART brochures that highlighted the merits of serotonin-boosting pharmaceuticals.
***
If you’re trying to dodge the magic bullet you need other weapons. I’ve been running since age 13, hooked on the peace and clarity that follows the effort. In Glasgow I got up at 5:30AM, pulled on ski socks, leggings, sweatshirt, jacket, hat, gloves and battered Sauconys then ran for an hour. I swapped my restaurant job for a coffee shop and found comfort in the routine of making espresso, toasting sandwiches, and gossiping with the regulars. At home I baked caraway rye bread, bagels, and lemon cookies to combat the chill seeping through the single-glazed windows. I bought kilos of oranges and taught myself to make marmalade; experimented with vegan mac-and-cheese and coconut milk smoothies. On black afternoons I tiptoed up the ice-slick hill to the gym and did squats, bench presses and seated rows. I used holiday photos for bookmarks and saved quotes on index cards: “A book must be the axe for the frozen sea inside you,” wrote Kafka.
***
“In a [1998] World Health Organization study of the merits of screening for depression,” writes Whitaker: “Those diagnosed and treated with psychiatric medications fared worse – in terms of their depressive symptoms and their general health – over a one-year period than those who weren’t exposed to the drugs.”
***
One year is 365 days of wondering why am I still breathing? It’s a long time to resist the temptation to drag the tip of a knife down your arm just to see how it feels. I scurried and feinted but depression was a patient cat to my mouse. There were still tears in writing workshops, still mornings huddled beneath the espresso machine gnawing my fingers, still cake binges followed by penitent cups of vegetable broth.
Depression is a black-hearted octopus tenderly, insistently probing for weakness. Resistance is the only secret to survival; fight the beast with every cheap, inadequate weapon at your disposal. Work and running were my best allies. I got better at snatching pleasure and being selfish about delight. When insomnia chipped at my fragile defences, I went to the doctor for sleeping pills. At the end of the year I left Glasgow, bruised but stronger. A magic bullet might have been swift relief. But the grit, patience, and humility I learned on my way are side-effects worth having.
- 1 http://www.musc.edu/dfm/RCMAR/Beck.html, 2 Ibid
- 3 Whitaker, Robert. Anatomy of An Epidemic. Crown. 2010.
- 4 NHS Choices: Antidepressants http://www.nhs.uk/conditions/Antidepressant-drugs/Pages/Introduction.aspx
- 5 Whitaker, Robert. Anatomy of an Epidemic (Crown, 2010), 6 Ibid.
- 7 Whitaker, Robert. Anatomy of an Epidemic.
Cila Warncke Writer 