The Feel-Good-Enough Drugs

I’ve been taking antidepressants since 1994. That may seem like a long time, but since I expect to pop these pills every morning until I die, I’ve stopped keeping count. You could say I’m reconciled to the fact that I was born with bad brain chemistry and need a little extra push to reach that state familiar to everyone but the chronically depressed as well-being. I like it there and have no intention of leaving.

I remember vividly the moment when Prozac first kicked in, like switching from black-and-white to color. I was talking on the phone to a friend who was telling me about her problems, which included taking care of a husband who was dying of AIDS. I heard in the familiar tone of her sad voice how hopeless she felt, but for the first time it failed to find an echo inside me. I proceeded to deliver my first-ever pep talk to her, with all the annoying sincerity of a fresh convert to hope.

The novelty wore off soon enough.

The Prozac took longer to poop out, but after a few years it did—one of several drawbacks of the drugs, though not nearly as common as the notorious sexual side effects. Lucky for me, there have always been other antidepressants to make me feel better until each no longer does. Zoloft, Effexor, Serzone, Wellbutrin, Cymbalta—such uplift in their names! But despite their differences, when they work, they all restore you to the same sense of well-being that is as unique as your shadow.

Which is to say, not unique at all. Everyone seems to experience that state of emotional homeostasis in more or less the same way. It may be the highs and lows and other extremes that make you feel “special,” and one of the haunting questions being on antidepressants can make you ask is, Have I lost something valuable, some “me-ness,” by gaining well-being? Yeah, sure—you lost your drinking habit, your obsessive thinking, your negativity, etc.

There’s lots of skepticism and misinformation about the value of these drugs. In a way, they’re a victim of their own success—and the success of Big Pharma marketing. Antidepressants are now the most prescribed drug in the nation, exceeding even high blood pressure pills. One-quarter of all doctor visits made by a woman results in her walking out with an antidepressant prescription. Most estimates put rates of depression among women at between 10 and 25 percent, so there’s clearly some careless diagnosing and treating taking place. A backlash was inevitable.

Mental-health medicines have always had a suspect aspect, much like psychotherapy. Many people still view them as either ineffective (“It’s all in your head”) or dangerous (“They’ll turn you into a zombie”). It’s true that not a lot is known about their mechanism of action. They were designed to raise and regulate levels of two brain chemicals that are believed to control mood, which they do just fine. But scientists can’t say exactly how they do it—and they’ve only begun to study the drugs’ effects on so-called neural gene expression, where the real action is.

But for a depressed person’s purposes, it doesn’t much matter if it’s molecules or magic at work. Drugs are funny that way. Sometimes I get greedy for more and better and persuade my doctor to prescribe a stimulant, say, like trendy Provigil, the “wakefulness agent.” These experiments never succeed, as if there’s a limit to the human tolerance for feeling good.

These drugs don’t really make you feel good. They just make you feel good enough. The rest is up to you.

Next: When the meds stop working…