Post-Prozac Nation: Did our Drugs Work?

In 1995, days after having received my first psychiatric drug prescription, I purchased and speed-read Elizabeth Wurtzel’s best-selling memoir, Prozac Nation. Often compared to Sylvia Plath’s The Bell Jar in subject and cultural impact, this book put bio-psychiatry’s chemical imbalance theory of distress on the young person’s literary map. In the final two pages of her memoir, Wurtzel, a young and depressed Harvard University student writes, “One morning I woke up…it was as if the miasma of depression had lifted off of me, in the same way that the fog in San Francisco rises as the day wears on. Was it the Prozac? No Doubt.”

This tagline praise for Prozac made her the pharma-friendly ally to a growing number of young people who were, like I, told their fear, fury or heart’s desire were identifiable disease and expressions of faulty genetics. Thousands of young people in my generation were quietly ushered into the mental health system because we were energetic and disinterested in classroom lessons, or because we tried hard and alone to metabolize difficult life experience. We stumbled upon doctors, pills, psychiatric labels, and this best-selling book in the absence of someone we could talk to. Its plug for Prozac, alongside shaky scientific theory, helped to create our teenaged view that the drugs we had been told we needed were harmless and effective.

Elizabeth Wurtzel was well cast for the role of unofficial Eli Lilly spokesperson. She was young, beautiful and Harvard-educated. And while she accepted her mental health diagnosis and daily dose of medication, Wurtzel lived out a stereotypically counterculture life publicly packed with sex and rock music. With the distribution of this book, Wurtzel, an already established rock music critic, garnered fans of her own. They created fan clubs and joined her on book tour. During one Portland, Oregon stop, a young man offered Wurtzel his SSRI prescription slip, which, she signed in solidarity. Wurtzel’s book and rise to stardom happened to coincide with Lilly’s marketing efforts which sky-rocketed their stock value over 300% from 1994-1996.

Rightfully, this young fan felt a prescription slip would be the archetypal place for her to autograph.

Eighteen years later, her book is still touted as a Prozac success story. In the April 19, 2012 New York Times Magazine article, “Post-Prozac Nation: The Science and History of Treating Depression”, Dr. Siddhartha Mukherjee refers to her experience on Prozac as “transcendental”. He uses her story to question what he sees as America’s careless tendency to throw the proverbial baby out with the bath water as critics, patients and activists call attention to a conspicuous absence of reliable science and improved outcomes with use of these drugs, while exposing their potential dangers. Mukherjee cites Wurtzel’s words that before Prozac she was living in, “a computer program of totally negativity…an absence of affect, absence of feeling, absence of response, absence of interest.” Dr. Mukherjee asserts that, “just a few weeks after starting Prozac, her life was transformed.”

Last spring, I rested in bed under the covers and cradled my laptop computer to read this article. Mired in month four of a painful and still-protracted period of withdrawal from psychiatric drugs, I had called out sick from work, again. I read this article as my body, covered in welts, shook and ached. I slept for hours at a time during the day or else I sat and stared at the wall, nearly catatonic. But that was only the beginning. One month later I experienced episodes of paranoia and hallucinations. I saw cartoon-like rats running around my bedroom floor. Exposed wall pipes in a church basement turned into cameras. At the May 6th event in Philadelphia, “Imagining a Different Future in Mental Health”, I imagined a man in the pew across from me was concealing a gun and planned to kill me. I sat, breathing slowly and deeply to ground myself while following the sound of speaker Robert Whitaker’s voice, amplified by the microphone he gently held to question the ethics of a mental health system that isn’t clear about its own self-deception: “Delusion is just not a good foundation for good medicine”.

In more private moments, I cried. I considered suicide.

But there was also a part of me, deep and unshakable, that knew this mess wasn’t me. These visions and symptoms were my body’s final push to heal itself, to grow new receptors and recalibrate a chemical messaging system that had been perturbed by 17 years of 12 psychiatric drugs, up to five at a time, for supposed clinical depression turned bipolar, neither of which actually existed in the first place. I woke up to the fact that over the years, each time I had tried unsuccessfully to come off of these drugs, I was not experiencing a reemergence of mental illness, as I was told. I was going through psychiatric drug withdrawal and a phase of repair, which I now understood could take months, if not years to get through. This awakening, combined with Dr. Mukherjee’s NYT magazine article prompted me to reread Prozac Nation with a more critical eye. I asked the question: Did her drugs really work?

I was shocked to find what Wurtzel’s story reveals. Dr. Mukherjee and the majority of readers gloss over a critical detail of her experience on Prozac, and an entire second book in which she changes her tune about the drug’s effectiveness. In Prozac Nation, she reflects on the attempt she made to take her own life after taking Prozac, “The suicide attempt startled even me. It seemed to happen so out of context…it should have never have happened within a few days of returning to Cambridge, at a point when, even I had to admit, the fluoxetine (Prozac) was starting to kick in.” But in interest of preserving a particular narrative and, coincidentally, satisfying Eli Lilly’s need to spin a bit of bad press they endured in 1994 with their first product liability case which went to trial (Wesbecker vs. Eli Lilly), Wurtzel explains that swallowing a full bottle of Mellaril, a drug classified as an anti-psychotic, was par for a worthy course of treatment.

This sudden, trance-like drive to suicide Wurtzel describes is strikingly similar to my own experience. Within weeks of taking Prozac, I developed an insatiable appetite. I could not sleep. I began to behave in unusual ways, expressing uncharacteristic levels of anxiety, recklessness and aggression. Several incidents of self-harm landed me in a northern New Jersey psychiatric ward where I was held and told my behavior was an indication of even greater disease. I could be bipolar. Like Wurtzel, hospital doctors gave me two additional pills: one sedative and one mood stabilizer. Eleven years later Eli Lilly is forced by the FDA to include a black-box warning with its product which states that SSRIs can cause an increase in aggression, suicide (which they call suicidal behavior) and suicidal thinking in teenagers and young adults. I was 16 years old. I was not bipolar or anxious. I was having a reaction to Prozac. It would be years of struggle, strange symptoms and research before I’d come to understand the connection.

I also read Wurtzel’s 2002 follow-up book, More, Now and Again: A Memoir of Addiction to find out if what happened to my life over time on these drugs, happened to hers. In this memoir, readers find Wurtzel doubting the value of the drugs she was prescribed. She writes that her old, “reliable antidepressants were not working so well, the whole regimen needed a boost.” Here Wurtzel uses the word ‘regimen’ to describe what had, over time, become a cocktail of drugs. The “boost” she and her psychiatrist summon comes in the form of Ritalin, a stimulant prescribed to treat her curious emergence of extreme fatigue and an inability to concentrate, two common effects of a serotonergic system which has been damaged by the long term use of psychotropic drugs. Though in her case and mine, this was not known or admitted by the prescriber.

I was told the onset of fatigue and memory loss were manifestations of continued depression. Or else I had an entirely separate condition called Chronic Fatigue Syndrome, which itself was unexplainable. My provider encouraged me to stay on prescription medication, offering to up doses or add more pills. Like Wurtzel, I was offered a stimulant to help me stay awake and alert to treat what I would discover were effects of the drugs I was told I needed. However, given my experience with benzodiazepines, another highly addictive class of drugs, I declined.

Ultimately, Wurtzel’s life on psychiatric drugs inspires her to write, “I start to think that this is a cabal of the pharmaceutical industry to make us into addicts.” This book walks readers through the years she spent in drug rehabilitation centers, step-down facilities and therapist’s offices.  Essentially, we see the same thing happen in Wurtzel’s life that happens in so many peoples’ lives, including my own. One diagnosis and one drug in a young person quickly become new symptoms, which become multiple diagnoses, and multiple drugs, which pave a life-path of unwitting addiction, even to those drugs like antidepressants which we’re told are not habit forming.

Dr. Mukherjee left this critical perspective on the devastating, long-term effects of these drugs out of his New York Times Magazine article.

While some people feel helped by psychiatric drugs, so many of us, particularly those who were denied informed consent, who were not offered alternatives, or who were forced to take these drugs, feel violated to discover they were also causing us harm, perturbing multiple chemical messaging systems in our bodies. These drugs created the symptoms doctors could not explain—everything from acne to cognitive dysfunction, amenorrhea to dissociation, and a worsening of the symptoms which the drug was meant to treat.

Four months ago, when I endeavored to reread Prozac Nation, I didn’t have to check it out at the local library. I have held onto it over the last 17 years of my life as a patient in our mental health system. No matter how many times I took off for a new state, coast, crash pad or credential, ditching bell bottoms and other appliances along the way, Wurtzel’s book and my psychiatric drugs stayed with me—as did my distress. Now, in some kind of strange synchronicity, it sits on my bookshelf in the same quiet Cambridge, Massachusetts neighborhood in which Elizabeth Wurtzel lived while writing this book. Though it’s ideology and apparently incomplete picture of her life (and mine) on psychiatric drugs make it difficult to read, I don’t toss it just yet.

Prozac Nation stands as a reminder of the failed promise and language of bio-psychiatry. It also highlights what the first and real problem was for me at age 16. Still underlined are the words that drew me in, made her an ally, and which could have inspired great dialogue had they not been sidelined by psychiatric drugs. She writes, “I feel like a defective model, like I came off the assembly line flat-out fucked and my parents should have taken me back for repairs before the warranty ran out.”

At 16, I stood alone, enflamed with a fear of questioning the politics of family, my own identity and life’s purpose. The elusive feeling of brokenness which Wurtzel describes, a common imprint of traumatic experience, was something I could relate to. No one said, “Let’s imagine you aren’t broken”, or “How did you come to entertain this idea about yourself?” or “Let’s talk about this brokenness…what does it look like?” bio-psychiatry did exactly the opposite. This ghostly fear or cast spell, smoke-screened by weight loss and a withdrawal from all that I loved, was actualized, codified and amplified by our bio-psychiatric model of mental health care. I only started to heal eight months ago when I shed my labels, swore to endure whatever psychiatric drug withdrawal would bring, and swiftly exited the system.