What A Decade On SSRIs Forced Me To Confront
Like a lot of young women, I've been on and off of antidepressants for my entire adult life. I started taking them at 18 because I was having an extremely phobic OCD episode; a response to my parents getting divorced, the prospect of going off to college, and getting head lice, all in the same year. I suffered from a constant, plaguing paranoia that I still had bugs in my hair. I developed countless compulsions to keep myself safe from infecting others and even from reinfecting myself. The only time I wasn't thinking about bugs was when I was having particularly exciting sex with my summer fling, the only person I allowed my hair to touch.
After I had a severe panic attack in a thrift store and ended up curled up in the trunk of my mom's car, I admitted that I couldn't take it anymore. My therapist recommended a small dose of Lexapro, a serotonin reuptake inhibitor (SSRI) known for treating anxiety. That was back in 2006. By 2008, SSRIs were already one of the the most popular medications in America, with 11 percent of the adult population taking one. I was relieved to become one of them. On SSRIs, my compulsive thoughts and behaviors subsided enough that I was able to go off to college, continue therapy to address my OCD and anxiety, and even fall in love again. And again. And again.
I thrived on the medication, and could sleep soundly for the first time in my life. In fact, I was pleasantly sort-of-tired all the time. The sedating effect of the SSRI, combined with the freedom of being away from home, was a type of calm I'd never experienced. With continued therapy, my compulsions and anxiety began to lose much of their power. I often slept for 12 hours, and felt that I could just keep dreaming. I didn't mind. I was making up for a lifetime of insomnia.
I didn't have a plan for how long I would stay on antidepressants, and as the years went on, I began to wonder if it would be easier if I stayed on them forever, though something about the idea made me uncomfortable. Was I more authentically "myself" off the drugs or on them? How did I know who the "real me" was? And what did that even mean? I'd started taking antidepressants weeks before I went off to college; it was hard to say what changes in my personality were the result of SSRIs, of living in New York City, or simply of growing up.
Once my phobia had mostly subsided, I began to feel guilty about muting my "natural" self. The difference on or off of antidepressants (which I would test often, by going cold turkey every few months) was relatively subtle but significant — like seeing the glass of life as either half-empty or half full. SSRIs seemed to make me into the more manageable version of myself: the Rachel who could deal with the stresses of New York City, who didn't get so easily agitated, who could sleep, who could stop worrying about the direction her life was going in and just enjoy it. I liked that Rachel. She was sane, and she felt good. But there was also something she was missing.
How could the fact that SSRIs numbed my pussy mean that they weren't also numbing my "true" self?
On SSRIs, a beautiful scene in a movie couldn't bring tears, even when I felt my heart swell. Sometimes, I felt so calm as to feel spacey and complacent, like an observer of my own life. Most of all, the medication made it much, much harder for me to get wet or to orgasm. At least 70 percent of people report sexual side effects on SSRIs, and even though I'd only recently started having sex, I knew I was one of them. How could the fact that SSRIs numbed my pussy mean that they weren't also numbing my "true" self?
I was far from alone with these worries. As author Katherine Sharpe writes in her excellent book on this very topic, Coming of Age on Zoloft ,
Worries about how antidepressants might affect the self are greatly magnified for people who begin using them in adolescence, before they’ve developed a stable, adult sense of self. Lacking a reliable conception of what it is to feel “like themselves,” young people have no way to gauge the effects of the drugs on their developing personalities ... And for some young adults, the idea of taking a medication that could frustrate that search can become a discouraging, painful preoccupation.
I coped with my uneasiness with antidepressants by establishing a cycle of serial monogamy. When I was high on the dopamine rush of falling in love, I would stop taking my medication and experience heightened arousal and excitement, distracted from any anxiety. As lust faded, my anxiety and irritability would return, and I'd go back to taking an SSRI. That would help me deal with whichever guy I was with that year for a little longer, until I could plan my exit, which I always did. Wash, rinse, repeat. I fell in love and had a different relationship nearly every year, from age 18 to 27.
Dr. Julie Holland, psychiatrist and author of Moody Bitches , says that my pattern is not at all uncommon. "It's not unusual for a patient of mine to fall in love, and just sort of disappear. They go off their meds, they're feeling fine," she tells me. "When you really fall in love, there's a lot of dopamine and euphoria — but when you start falling out of the infatuation phase and start getting more stable, if you have a long history of being depressed or anxious, you're going to go back to that sort of baseline state where you feel lousy, like you need meds."
I enjoyed taking three-to-six month breaks from SSRIs each time. I preferred the "natural" drug of falling in love. I've always wanted to feel as intensely as possible — but only insofar as it felt good. Once the high faded, I would feel guilty for wanting to go back on SSRIs, for being so afraid of my anxiety when I knew it could no longer cripple me in the same way it had at 18. So I compromised by spending part of my year in love and happily agitated, part of my year subdued and plotting a breakup.
It wasn't until I met my current partner at 27 that I had grown truly tired of falling in and out of love, in and out of peace with myself. When my anxiety and depression became overwhelming four months into our relationship (and four months off Zoloft), I recognized that my newly-paranoid feelings — about my partner, and the rash decision I had made to move in with him within weeks — were not so much based in any insolvable problems so much as in my difficulty trusting that not all commitments are bad and potentially toxic. I could see my impulse to run away, to sabotage, to plot my exit from the relationship — but for the first time I didn't want to. I also couldn't sleep.
I refilled my prescription for Zoloft. As usual, this muted symptoms of anxiety and insomnia almost immediately, in exchange for my sex drive. Though I'd previously been OK with that tradeoff, it had become unacceptable to me. I went to a new psychiatrist, a middle-aged orthodox Jewish man, who, ironically, I was more open to talking about sex with than any psychiatrist I'd spoken with before. I brought up an article I'd read about Wellbutrin, an atypical antidepressant that is often used to counteract the sexual side effects of SSRIs. He confirmed this, and wrote me a prescription for half of the lowest recommended "effective" dose.
The desire to find my "perfect" drug concoction — or really, my perfect self — was strong. Yes, I felt good now. But what if I could feel even better?
The effect was pronounced. I wanted to have sex again, yet I wasn't crying all the time. I couldn't believe I'd waited this long to try out what turned out to be such a simple solution for me: taking an SSRI in conjunction with Wellbutrin. It worked.
You'd think I would have stopped there. But the desire to find my "perfect" drug concoction — or really, my perfect self — was strong. Yes, I felt good now. But what if I could feel even better?
I started to wonder if Wellbutrin alone might be enough to keep me happy. Though the drug acts like more of an "upper" than SSRIs — it helps with focus and motivation (a problem I don't tend to have), and can worsen irritability and insomnia (hello) — I felt a compulsion to try on yet another version of myself. After all, I was clearly entering a new phase of my life. Maybe, the fantasy went, I'd feel like "myself" on just Wellbutrin — only, you know, happier.
As Sharpe writes of her not entirely dissimilar experience,
When I first began to use Zoloft, my inability to pick apart my “real” thoughts and emotions from those imparted by the drug made me feel bereft. The trouble seemed to have everything to do with being young. I was conscious of needing to figure out my own interests and point myself in a direction in the world, and the fact of being on medication seemed frighteningly to compound the possibilities for error. How could I ever find my way in life if I didn’t even know which feelings were mine? ....
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?” … most of us still want to feel, in some way, like ourselves.
Still in search of the answer to that question, I went off Zoloft altogether, and stayed on my very low dose of Wellbutrin. And that's where I've remained for the last few months. Falling asleep has become difficult again and I'm definitely more anxious, but I'm not spiraling into full blown depression, insomnia, or paranoia, either. My sex drive is as high as it is off antidepressants, and I can cry.
Sometimes my insomnia gets so bad that I'm tempted to go back on SSRIs, as if Zoloft is an ex-boyfriend I just miss cuddling with. The other day, after yet another sleepless night, I even refilled my prescription. I haven't taken it yet — but it makes me feel better to know it's there, to know that another version of myself is always within reach.
I have a feeling that Dr. Holland, were she treating me, might say I'm practicing cosmetic psychopharmacology at this point, a term she uses to describe the way many women like me may be taking an antidepressant because life is simply more manageable and pleasant on it.
"I understand that there are many people who need medication," Dr. Holland tells me. "The thing that I'm worried about is that more and more women are taking antidepressants, they're getting used to them, their friends are on antidepressants. It's creating a new normal where it's abnormal to be emotional at the office, and everyone is so worried about being emotional that they're medicating away their normal human responses to the stressful lives that we're living."
Perhaps if I didn't live in a tiny apartment in New York City, or work on a computer all day in an office, I would feel less of a need to medicate myself. I have a hunch I'd be far less anxious if I had more time to myself to think, to take breaks and exercise throughout the day, away from screens and in the sun instead. But that's not an option for me right now. So I take a pill to deal with my unnatural environment and stressors, and add the idea of "One day weaning myself off of antidepressants altogether" to my list of Future Considerations, along with the items "What my life's purpose is" and "Who I really am."
I'm old enough to realize now that there is no such thing as an Ideal Self, and I am re-learning that humbling fact every day. Sometimes, it's a relief to know it. Other times, it keeps me up at night, and I want to go back to the medication that tells me to just hush.
In the meantime, I compromise. I seem to deeply need the security of knowing that I'm not totally without some form of chemical support. So I take my Wellbutrin groggily, every morning. It makes me feel ready to face the day, like a little espresso shot of dopamine. I keep myself just happy and even enough to maintain my New York lifestyle, just anxious enough to know it's ultimately unsustainable. This, I tell myself, is the best prescription for my longterm happiness and success. We are all dependent on one drug or another, and perhaps the most addictive one is rationalization.
Images: Rachel Krantz