In Defense of Happy Pills

Why talk to a shrink if Prozac or Zoloft will do the trick?

Maia Szalavitz from the October 2005 issue

(Page 2 of 5)

Considering these questions has helped clarify my thinking about how to deal with my own psychological problems and how to think about the wide variety of psychoactive substances available in our society. As a journalist who covers neuroscience and who has personally experienced some of the brain's aberrant states, I confront these issues almost every day. My chief conclusion is that while psychotherapy validated by research has its place, there is no convincing reason why it should be considered inherently superior to drugs.

Like Myself Again

I began taking antidepressants seven years after I kicked my heroin and cocaine addictions. Both my self-help groups and my individual therapist had discouraged medication, and I'd followed their advice. Twelve-steppers had warned me that avoiding my pain with drugs--any drugs--would only lead back to compulsive behavior.

But in 1996, when I sunk into a depression so profound that I was unable to feel the tiniest spark of pleasure, I began to question this position. A publisher had rejected the manuscript for my first book after paying me an advance, and I became so depressed that nothing felt right.

Having decided that the unstructured life of a freelancer was bad for my mental health in such circumstances, I got myself a good job, as an associate producer on a Barbara Walters AIDS special. I thought achieving simple goals like getting to the office would make me, at the very least, less anxious, and working to fight AIDS had energized me in the past.

Before the book was killed, even when I'd felt low, I could usually improve my mood by easing up on myself or seeking social support. I could use my cognitive techniques to recognize when I was grandiosely "catastrophizing"--for example, seeing one obstacle as a sign that everything else in my life was going to collapse. But the new job and the cognitive techniques failed me now. Even love from friends and family didn't help. I knew I'd lose all motivation, even to get out of bed, if meaningful work and socializing didn't at least reduce my dread.

Talking to people or thinking differently couldn't restore my ability to feel good. Even the best of news or most tender expressions of affection didn't interrupt for long the dull terror I felt. When I couldn't stop crying at the office, I finally went to a psychiatrist, who prescribed medication.

The first day I took Zoloft, I was reminded of my earliest recreational drug experiences. Before I'd tried hard drugs, I'd taken many psychedelics, and what I felt after popping that first pill was similar to a feeling I well remembered from using LSD: a sense in the pit of my stomach that things were about to get strange. Soon, in fact, I was having mild hallucinations: complicated, brightly colored geometric patterns when I opened or closed my eyes. I called my psychiatrist, who told me to halve the dose but recommended sticking with the drug, saying the images would pass.

Two days later, the psychedelic patterns were indeed gone, but the depression and pleasurelessness were as strong as ever, and I found myself missing the hallucinations. At that point, I understood for the first time part of why I'd continued using cocaine long after it had ceased to be at all enjoyable. The distraction of experiencing something, anything, was better than consistent anhedonia.

Ten days in, I felt the first therapeutic effects. I noticed that I wanted to write and that I felt better after writing. That tiny reward gave me more optimism.

When the medication fully kicked in, I again felt transformed, as I had in that welfare hotel a decade before. Unlike heroin, Zoloft did not make me euphoric, but it provided a similar sense of comfort and safety. I felt like "myself again," as one of Peter Kramer's patients puts it in Listening to Prozac. With antidepressants, I wasn't "better than well"; I was the way I am when I'm OK.

In other words, I stopped fearing encounters with friends and dreading the phone. I took pleasure in simple accomplishments. If something awful happened, I felt appropriately upset; the difference was that now I no longer cried uncontrollably while watching families reconnect in AT&T commercials. I began to discover that I wasn't wildly jealous when my (new) boyfriend spoke to another woman--or at least I now had the self-control not to act on those thoughts. I felt competent and far less needy. The reassurance I'd sought from 12-step meetings and phone calls for support didn't seem necessary any more. I could hate myself less because my selfish needs and intrusive worries were genuinely less pressing.

Paradoxically, what the drug gave me was greater control over my own thoughts and behavior and more self-sufficiency. I could still choose to act impulsively when irritated, but I could more easily choose not to. And unlike heroin, the Zoloft did not cause the craving that had ultimately led to obsessive, life-disrupting addiction.

Which was more "real"--my new equilibrium or my previous imbalance? It didn't matter, I decided, because on medication I was better not only to myself but to others as well. I became less needy, less self-centered, less demanding. I will never be a mellow person, but I was certainly calmer. The only downside was greater impatience with people who refused to get help for depression, who still exhibited the flaws I'd hated in myself.

Suicidal Strategy?