It was about 2 am when the Seroquel wore off. I knew because I could laugh again.
I had been on the drug for five days. The first night, I slept for 13 hours. Luckily, I worked at a Houston alt-weekly newspaper, the kind with investigative journalism in the front and sex ads in the back and where everyone set their own hours and usually moseyed in at noon.
I called my psychiatrist and said, "I can't sleep this long every day."
"That will stop," she said. "Just give your body time to adjust."
That weekend, I made no plans. The sleeping spells slipped from 12 to 10 to nine hours. Every waking moment, I felt nothing. I ate microwave dinners and watched whatever was on TV, including 30 minutes of a Spanish-language church service, with neither like or dislike. It felt like I was an empty toothpaste tube from which all emotion and preference had been squeezed.
This was not the first bad reaction I had to a psychiatric medication. Prozac made me unable to focus. Zoloft killed my sex drive. In college, I took clonazepam and Cymbalta in the morning and then laid down for an hour of nausea and drowsiness. Medication has fucked me over since the first one I tried: My first day on Paxil, I lumbered into the high school nurse's office and slept off what felt like a hangover. These are all common side effects of the drugs in uncommon intensity.
Selective serotonin reuptake inhibitors, antidepressants invented and widely prescribed during the Prozac boom, bind to the receptor sites in the brain, assisting its uptake of the body's feel-good chemicals. (Though used more often for schizophrenia, Seroquel works much this way, too.) But they can cross over to other receptor sites in the brain, imposing on balances that regulate everything from sleep to focus to vision to appetite to sexual function. By 2004, the unintended effects of antidepressants—as severe as suicidal thoughts—became sufficiently documented that the Food and Drug Administration put "black box" warning labels on them. In one study—admittedly, one from the '90s—somewhere between one-third and a half of people prescribed the drugs quit in six months and adverse effects are a major factor.
For me, benzodiazepines, with their quick and simple sedating power, are okay. With anything that goes deeper into the mind, I at best feel sick. At worst, I feel mentally hijacked, bereft of the internal controls I used to monitor and manage my mood.
I knew I couldn't work as a journalist on Seroquel—with no ability to decide between strong and weak language or between important or trivial facts. On Sunday night, I skipped the med and stayed up, feeling my emotions return to me in the form of small hopes for the next day: for a short commute and a manageable email inbox. I sat on the couch and watched a "Family Guy" DVD. Then I laughed.
The reason I tried Seroquel, after years of bad reactions to psychotropic drugs, is that my psychiatrist kept insisting. I sought professional help because I was having trouble adjusting to the new job and city. I was new and lonely and I woke up at 4, anxious that my last conversation with my boss about making my copy "snappier" was a prelude to a firing.
Her website said she did "talk therapy," though that's not usually something psychiatrists do.
"People ask if I do talk or medication and I say 'all of the above,'" she said, pleasantly, at our first meeting. She was a middle-aged woman in an office with cream-colored walls and a framed poster of Van Gogh's Starry Night.
She kept bringing up medication. I said I'd tried them all and mostly felt sick. She mentioned Seroquel. I said I'd pass. She said, "This would go better if we explored all our options."
So I gave in, and that's how it usually goes when I interact with psych professionals. To seek mental health care in America is to have drugs foisted on you like you're backstage at Coachella. Anyone in the business of dealing with anxiety and depression insists I try meds again. Really insists. Reciting the ever-growing list of drugs I have tried and describing my living-in-a-house-with-mold-like reaction only inspires them to come up with some obscure drug I haven't tried, like an old-timey antidepressant or a med to use off-label. I think going through medications is their way of troubleshooting. And I usually let each prescribe me one, as a bargaining chip, to show I am "exploring all our options."
I've seen a lot of talk therapists, and they are not an exit off the highway to pharmaceutical insistence. Most I have seen suggest I see a psychiatrist for meds within a few appointments, if I am not already.
Because of this I've developed a sort of dysfunctional relationship with psych professionals. A bad mood is not enough to make me seek help, but I go back if something interferes with daily life: panic attacks, a livelihood-threatening difficulty focusing, or paralyzing pessimism about the future. I hope they can help me without meds. They must have some effective drug-free method, right? Therapist or psychiatrist, they push the pills. I let them have one go and spend a week with a near allergic reaction. I quit. We're at a standstill. They want to try another. I slink back through the revolving door out of treatment.
There are some people who are more susceptible to side effects, says Peter Kramer, a physician and author of Ordinarily Well: The Case for Antidepressants. "They just have a biology that doesn't mesh well with it," he says. This could be one explanation for problems like mine: If your body breaks down medicine into the bloodstream more slowly, you might be more apt to experience side effects, whereas a faster process might mean one needs a higher dosage to be effective.
I also called John Greden, founder and executive director of the Depression Center at the University of Michigan Health System, to ask if psychiatrists underplay the side effects of medications. He says they don't. "Psychiatrists are used to adverse effects," he said. "They hear about them quite often." However, the doctor's solution is usually to switch to another medication or add one, he adds.
He said one of his major beefs with his own profession is that doctors treating depression rely on medications first, rarely considering the uniqueness of the case. "There are different kinds of depression," says Greden. A soldier with PTSD has entirely different root issues than a suburban teenager who suddenly has no appetite and suicidal thoughts, but they get the same bottle of Zoloft.
"Pharma sold the misleading ideas that all depressions are equal," says Allen Frances, chairperson of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine. Frances, who laid out his case in his book Saving Normal, adds to the list of misconceptions "that all [depressions] are caused by a chemical imbalance, that depression is easy to diagnose and is underdiagnosed, and that the treatment requires a pill. In fact, only severe depressions require meds and most people taking antidepressants don't need them."
A 2008 meta-analysis of data found that most antidepressants did not outperform a placebo. The only class of patients who consistently and definitively benefited from the meds—as opposed to the psychological benefit of thinking they were getting help—were the severely depressed.
In my conversation with Kramer, however, he told me the study was flawed. First, it relied on a small sample size. A more recent, larger study also found no difference in inherent—as opposed to imagined—efficacy, up and down the line in terms of the severity of depression.
Still, I sometimes think the problem is that I don't need meds. I have my issues, but I am never Brian Wilson-in-the-1970s depressed. Maybe there is no chemical imbalance in my brain. It's just a stressful world, man, with more of us socially detached and less financially secure than ever. Throw in my particular batch of issues—teen years full of bullying, a dad who drank, a mom who's sick with multiple sclerosis, a profession that's collapsing—and maybe I should feel sad and anxious. A pill won't change any of those fundamental facts. It will only fire away at a target that doesn't exist.
Still, I give every new psychiatrist their try. I reentered the psychiatric bargaining game a few months ago because I began to experience insomnia-inducing nighttime anxiety. I got an appointment with a young 30-something psychiatrist who wore jeans and Chuck Taylors to the office. I was hoping to get a bennie and get out.
"I'd like to try something that will get more to the root of the problem," she said.
I gave her the long list of medications I already tried. Our options had narrowed to two obscure '50s-era antidepressants and Buspirone, an anxiolytic antianxiety med. I chose Buspirone, because it wasn't an antidepressant and maybe wouldn't have the same gut-punching effects.
By day one, Buspirone was increasing my anxiety—a documented side effect. I felt an ever-present tenseness. On day three, I had frightening heart palpations during sex. On day five, I told a rambling story at an open mic. Usually, I can deliver at least competently at a story slam, but my mouth grew drier and my head dizzier until I got played offstage. I didn't do a day six.