O
ne afternoon late in the summer of 1998, I found myself sitting on the long front porch of a weathered student house in Portland, Oregon. I was nineteen years old and had just returned to town to start my second year of college. The porch I was sitting on belonged to the house that would be home that year to my good friend Kate. I had spent the day helping her move in, relaying loads of clothing, books, and LPs from her car, across the yard, up a staircase scuffed by decades of similar use, and into her new room. At 5:00
P.M.
, exhausted, we flopped onto the row of mismatched seating that looked out over the cracked, gray street.

Moving off campus was a sophomore rite of passage at our school, and I considered Kate’s snagging a room in this particular house to be a promising social development. Her new housemates included some of the students on campus I’d looked up to most the year before—smart, fashionable, confident women who seemed as advanced and distant to me then as I remembered high school seniors seeming when I was in eighth grade. As they filtered in and slowly took their own seats around us, I stretched in my thrift-store lounger and smiled. Simply sharing their porch with them felt glamorous, like a good omen for the year to come.

Late-afternoon sun gilded the floorboards, as our conversation meandered through the familiar topics of professors, classes, boys, and books. Kate headed inside to organize her room, and Lauren mixed a pitcher of Amaretto sours for those who were left. And then the thing happened that has fixed this afternoon in my mind for more than a decade. Casually, and in the abstract, someone mentioned antidepressants.

The comment sent a ripple through me. I had been taking an antidepressant since the year before, when a series of anxiety attacks had led me to the student health center, where I’d quickly been diagnosed as depressed and given a prescription for Zoloft. Medication seemed to have helped; the billowing dread that had come upon me during my freshman fall had dissipated, and I’d finished out the year with good grades, friends, a boyfriend, new interests. Still, I felt uneasy about my chemically assisted recovery. There was something creepy about taking a mind-altering drug each day, and thinking of myself as a person with a mental disorder was dispiriting in its own right. Aside from a few close friends, I hadn’t told anybody I took them; I figured other people would find the fact as off-putting as I did myself.

I still don’t know what it was that made me open my mouth that day. Maybe I was lulled by the sunshine, the strange drink, or the urge, in such exalted company, to say something that would call attention to myself.

“I take those,” I blurted and instantly looked down at my hands, wondering whether I’d just effected my own social excommunication. When I managed to raise my eyes again, though, I saw that heads up and down the row were nodding slowly.

“I do too,” said Helen.

“They put me on Prozac last year,” Lauren added. And on we went. There were seven girls on that porch. Every single one of us, it turned out, was or had been on antidepressants.

In the moments afterward, we looked out toward the street, where a patch of weeds cast a long shadow across the pavement. “This is really weird,” somebody said, and the rest of us mumbled assent.

AS I COLLECTED
myself in the silence, I felt two things at the same time. The first was a wave of relief so large and pure it almost knocked me over. All year, taking medication had made me feel uneasy. The pills imparted strength and calm, but they also raised tough questions—
Am I crazy? Will I need these forever? Am I really myself when I take them?—
that I could neither answer to my satisfaction nor successfully push from my mind. Learning that I wasn’t alone in using medication soothed the sense of alienation that had been the pills’ most notable side effect. If people as poised and admirable as Kate’s housemates could also take antidepressants, maybe there was still hope for me.

But if learning that I had so much company on the antidepressant bandwagon was comforting in one way, it was disorienting in another. I had been taught to think of antidepressants as a treatment for depression, which I understood as a real illness, something rare and serious. The fact that all seven of us could be taking medication strained the limits of my sense of probability. Were we all, in some meaningful way, mentally ill? Or were antidepressants being given out not for true depression but precisely for the ordinary angst that I’d been told was so different from it? If we all had this experience in common, why had we not found out about it until now? I felt a little dizzy, and newly suspicious. What exactly was
happening
here?

Before that moment, taking antidepressants had felt like the most intimate and personal thing in the world to me. It was still personal, of course, but I began to see then that it was also more than that. Medication was individual, but also social; it was part of our stories, but equally part of the story of a time and place. In a way that I didn’t yet fully understand, our lives had intersected with something larger than themselves.

It is strange, as a young person, to realize that you have lived through something that can be considered a real historical change, but that’s exactly what we had done. When I was a child, in the early 1980s, taking psychiatric medication was decidedly a fringe phenomenon. Prozac came onto the market in 1987, the year I was eight. The first member of a family of drugs called SSRIs (for “selective serotonin reuptake inhibitors”), it quickly became the leading edge of a psychopharmaceutical revolution. Throughout the 1990s and 2000s, Americans grew ever more likely to reach for a pill to address a wide variety of mental and emotional problems. We also became more likely to think of those problems as a kind of disease, manifestations of an innate biochemical imbalance. Depression, social anxiety, obsessive-compulsive disorder, and the like went from being strange clinical terms or scrupulously hidden secrets to constituting acceptable topics of cocktail party conversation—talk that was often followed up by chatter about the new miracle drugs for despair.

Statistics bear out the sense of changing habits. Antidepressants began to climb steadily in popularity after Prozac’s introduction, eventually becoming a truly mass phenomenon. By 2005, SSRIs had surpassed blood pressure medications to become the most-used class of drugs in America,
1
with 10 percent of adults taking them in any given month.
2
By 2008, that figure had bumped up to 11 percent.
3
While they were becoming part of the fabric of American life, psychopharmaceuticals also became, with much greater frequency, a part of American youth: in 2008, 5 percent of adolescents aged twelve to nineteen took an antidepressant.
4
The same year, another 6 percent of twelve-to-nineteen-year-olds used psychostimulant medication for ADHD.
5

Nothing has changed since that moment on the porch, I sometimes think, except that I’m not surprised anymore. Antidepressants are part of the story of my generation, an invisible but very real strand woven through our collective experience. Psychiatric medication saturated the country during our childhood and adolescence, and for many of us, the involvement became personal. In our twenties and thirties now, with birthdays that fall from the mid-1970s to the start of the 1990s, we are members of the first generation to have literally grown up on psychiatric medications in significant numbers.

And sometimes those numbers still overwhelm me. Antidepressant use saturates certain populations more than others, which may help explain why antidepressants have often struck me as being even more ubiquitous among my peers than the above figures suggest. Women take them at higher rates than men, a difference that emerges in early adolescence; a recent survey found that 16 percent of women use antidepressants, compared to 6 percent of men.
6
White adolescents are more than five times as likely to use an antidepressant than black adolescents, and more than twice as likely as Latino adolescents,
7
racial disparities that also hold true for adults.
8
Personally, I can’t remember the last time I shared the topic of this book with a group of more than three twenty- or thirtysomethings without eliciting someone’s own medication story, often from the person I least expected. Not long ago, I was talking to a male friend, age thirty-five, who exclaimed, only half in jest, “I’ve never
known
a girl who wasn’t on antidepressants!” I must have come a long way from Portland, because I knew exactly what he meant.

THIS IS A
book about what it’s like to grow up on antidepressants. It attempts a faithful description of an activity that has become remarkably common—using antidepressants as a teenager or young adult—but still engenders intense, complicated, and often conflicted feelings, both in the young people who do it and the adults who are involved in their care. Advertisements and reductive media stories often portray antidepressant use as simple. Depression is a disease “like diabetes,” the story goes, and the appropriate treatment is equally straightforward: find a doctor, locate a pill, take it, and be well. Further soul-searching about it isn’t just unnecessary, it’s likely to be counterproductive. But the truth is that even when the medications work just as they are supposed to, taking antidepressants is an experience that can feel profound. Rightly or wrongly, antidepressants command powerful emotions; they can lead people to examine their deepest assumptions about themselves and the world.

It is also an experience that can be substantially different for a young person than it is for an adult. Ever since the early 1990s, much of our cultural conversation about antidepressants has revolved around questions of selfhood. Adults who take anti-depressants have been known to worry whether the medication is altering their habits, their proclivities, or their outlook on life—whether it is in some way changing the very people they are inside. Conversely, adults who are happy with their treatment often speak of antidepressants as facilitating a return to authenticity; they say that medication “turned me back into my old self again.” Indeed, the notion that depression distorts the true self and that antidepressants merely restore what was there all along has often been invoked against the fear that by taking anti-depressants, we might somehow be betraying our true natures.

But that belief in particular is one that people who start medication young cannot fall back on. 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. Searching for identity—asking “Who am I?” and combing the inner and outer worlds for an answer that seems to fit—is the main developmental task of the teenage years. And for some young adults, the idea of taking a medication that could frustrate that search can become a discouraging, painful preoccupation.

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