The science writer and blogger David Dobbs, whom I know slightly from back when he blogged at ScienceBlogs and I edited there—and whose great Atlantic magazine piece reframing childhood depression was an inspiration and a fascination to me a few years back—has posted an interview with me about SSRIs, talk therapy, identity, youth, and mood at his Wired Science blog, Neuron Culture.

I’m reading from Coming of Age on Zoloft, doing a brief Q&A, and signing books at one of my favorite bookstores, BookCourt in Brooklyn Heights.

The reading is at 7 p.m. on Monday, June 18. It’s free and open to all.

This is the first public event for COAOZ, and I expect a festive mood—including the possibility of some group self-medication with food and drink at a local establishment afterward. Come on out if you’re in the area!

BookCourt is located at 163 Court Street, Brooklyn, a couple blocks below Atlantic Avenue. Get the event details on Facebook.

(Image: Drawn and Quarterly)

The more things change, the more they stay the same, I find: the ads still pathologize women, and they still invite us to interpret everyday life stress as a sign of mental illness.

(Image: Advertisement for Serax, JAMA 200:8 (1967), p. 206-7)

Here’s the full text of the review of Zoloft by Lisa Shea, from page 172.

“Intiuitive and investigative, personal and historical, narrative-rich and fact-packed, Katherine Sharpe’s memoir, Coming of Age on Zoloft (HarperPerennial), examines how a generation of Americans—she included—has been treated for the age-old malady of depression in an era of biomedical predominance that defines the syndrome first and foremost as a chemical imbalance.

Sharpe was prescribed Zoloft, one of the SSRI class of antidepressants, as a college freshman following a panic attack; her diagnosis came after a 20-minute conversation with a campus mental-health counselor. Looking back, she reveals that her father had been on medication for depression since Sharpe, who was born in 1979, was a preteen, pointing to a possible genetic predisposition. During the summer before college, she writes, nostalgia for high school gave way to anxiety and fear—feelings that, combined with being dumped by her boyfriend, ‘created a space that seemed to attract all kinds of negativity into itself.’

Part of what makes this book riveting is the way Sharpe sets her own story within the larger context of cultural, social, and psychiatric changes that moved depression (along with other mental illnesses) into the medical spotlight. She traces the origins of the SSRIs from obscure Swiss lab trials to their rise as Big Pharma’s darlings in the early 1990s, much as tranquilizers had reigned in previous decades.

Underscoring all of Sharpe’s impressive research, trenchant interviews, and intrepid delving into her subject is a single anecdote that gives the book its raison d’etre Seated on a porch during her sophomore year with a group of young women who were housemates, Sharpe confided that she was taking Zoloft. The six other women all said they were on or had taken an antidepressant. None of them was yet 21 years old.”

The Chronicle of Higher Education is a great publication that I’ve dipped into at times over the years, and I couldn’t be happier that they’re running an excerpt from Zoloft.

My article, “Prozac Campus: The Next Generation,” which is largely condensed from the second-to-last chapter of the book, is up at the Chronicle Review, with lively commenting so far. Check it out…

(Image: Christophe Vorlet for The Chronicle Review)

My friend, former classmate, and Goodreads community member to the stars, Jessica Stults, just posted a long and generous review of Zoloft on the site. It generated a nice discussion thread, and when I stumbled across the whole thing today, I jumped in and added a big ol’ comment of my own. I’m going to post it here, because I think it’s a reasonably concise statement of what I’m on about in the book, and in my thoughts about this issue of youth and meds in general.

Jessica, thanks for the beautiful and attentive review.

Also, I think you totally hit the nail on the head with your comment just above. One of the biggest differences between older people and younger people taking antidepressants is precisely this issue of choice, and also of authority and perspective, as you mention. Older people know what normal feels like for them personally, and a lot of times for them to decide to take a medication because they’re feeling less ‘up’ than they want to—-well, not only does it feel like an empowered decision because they’re making it themselves, but also they’re able to keep it in perspective because they are grown up. I bet Meaghan’s brother, for example, didn’t change his whole perspective on who he is when he started taking meds. He just wanted to stop feeling so bad, and presumably medication helped. And though many people, like Meaghan, don’t like the idea of taking a pill when we are “merely upset,” I personally don’t have any kind of moral problem with it. Antidepressants are just a technology, and I’m all for people using them to feel better, any way they like.

Where it gets a lot more murky and troubling, I think, is when we’re talking about young people who may not be making their own choice about taking medication, and are less able, because they’re young, to keep it in perspective. When older people give younger people medication, they’re not just giving them something to change the way they feel. They’re giving them, like it or not, an identity that is going to resonate strongly. Adolescence is all about asking who you are, and incorporating whatever input is handy into the answer. So when young people who may be “merely” sad are given antidepressants or other medications, even with the best of intentions, what they can come away from it with is the message that ‘there’s something really wrong with me, I must be really sick.’ When, as you say, it’s likely that whatever they’re suffering from is somewhere on the spectrum of normal. And I’ve seen it happen that the identity of mental illness can really mess with people, even when the medications themselves “help.”

This may be changing some as medication becomes even more prevalent and kids’ attitudes about grow ever more blase. Except maybe it’s not–maybe, as your story about your client and my conversations with a handful of present day college students and mental health providers indicate, it’s swinging the other way: the more we talk about out problems as mental disorders, the more any kind of bad feeling starts to seem like a ‘mental problem,’ and the less we all get to experience the comfort of sharing those feelings and affirming them as normal, the comfort of knowing “well, this thing I’m feeling does really fucking suck, but at least I know that other people feel the same way.”

To bring it back to the college mental health center. I always say it’s not necessarily that I’m sorry I was given antidepressants, but that it’s the messages that went along with them (OMG you’re really sick! You’re feeling something you shouldn’t be!) that messed me up, and it’s the fear inside those messages that probably kept me using medication for years longer than I really needed to.

What I really wish is that that woman in the health center could have said ‘You know, you are going through a really tough time right now, and you *are* upset, and if you want, you can take these pills for a while that make you feel better.’ Instead it was all this ‘you have a disease!’ stuff that was and is supposed to make people feel better but really didn’t do so for me, and in my experience, doesn’t for a lot of people. As it was, it took me seven or eight years to figure out that I wasn’t crazy and never had been. And precisely as you say in your review, that’s the biggest piece of why I wanted to write this book: to let people know that they’re not alone, that things get better for people who take antidepressants and for people who don’t, and that whether you choose to use medicine or not, you don’t have to buy into psychiatry and big pharma’s whole disease model, which has about fifty times as much to do with selling drugs as it does with science. If I can save a few people that particular trip, it will all have been very, very worthwhile.

If you belong to Goodreads, get over there and add your two cents. Also friend Jessica, because she’s brilliant. If you don’t, join! It’s a great site, a standout, social media fatigue be damned and everything.

(image source)

I have a post up at Psychology Today, examining a new blood test that claims to be able to diagnose major depression with about 80 percent specificity and 90 percent sensitivity, per its press release. My diagnosis: not so fast.

Like human fingernails, poultry feathers reliably collect traces of everything an animal’s been getting into. The scientists behind the studies were curious about what they might learn about the presence of antibiotics in chicken feed. A researcher who coauthored both the studies said he was “floored” by the broader findings.

What are caffeine, Tylenol, and antidepressants doing in chicken feed in the first place? The answer is a window on factory farming: chickens are sometimes given coffee pulp “to keep them awake so they can spend more time eating.” Benadryl and, presumably, Prozac (which was found in samples of feather meal from China), are given to calm the nerves of birds jangled not just by coffee but by the stresses of living cheek by jowl in an environment resembling something from the mind of a Spanish Inquisitor. The poultry is dosed “apparently because stressed chickens have tougher meat and grow more slowly.” Arsenic is known to make meat more attractively pink.

There are a few ways of understanding this news, none of them jolly.

First, there’s an economic story. Factory-farmed chicken is shockingly inexpensive. But, as Kristof points out, the sticker price at the grocery store could be hiding larger costs, costs that will ultimately be paid by all of us, whether we eat chicken or not.

The banned antibiotics found in the birds’ feathers come from a class called fluoroquinolones—Cipro is the most familiar—that are known to contribute to the rise of the antibiotic-resistant bacteria that have become the scourge of hospitals. Factory farming is an economy of scale, made possible in part by the widespread use of antibiotics to tamp down infections that animals raised in less crowded conditions would seldom develop. But what price cheap meat, if the medicines that keep the protein flowing freely are, at the same time, giving rise to the “superbugs” that, Kristof reminds, “kill more Americans annually than AIDS”? 99 cents a pound for man, one gigantic and wickedly expensive headache for mankind.

Or you could see this as an environmental story.

In the book, I briefly mention the problem of ‘emerging pollutants‘—pharmaceuticals ending up in the waterways in concentrations great enough to harm freshwater and marine life. (I cite a 2003 study in which researchers working downstream from a waste-water treatment plant in North Texas found metabolites of Prozac and other antidepressant in every single fish they tested. Similar findings have been reported elsewhere in the U.S. and Europe. And while trout might not suffer from ennui, Prozac affects people and fish the same in at least one respect: it’s a potent libido-killer. Canadian scientists studying fish in the lab discovered that male goldfish exposed to Prozac don’t respond to females’ sexual advances. Pharmaceuticals in the water are known to cause severe reproductive problems for fish and other kinds of aquatic life.)

A lot of the reporting on the pharmaceutical-pollution issue focuses on humans as a vector. Active metabolites from the drugs we take pass through our bodies and into our waste-water. Too minute to be filtered out at the treatment plant, they end up in waterways and, ultimately, in everything that lives there. But the chicken news suggests another vector, compounding what’s already on its way to becoming a vexed environmental problem.

Anything we can do to keep antidepressants and other drugs out of waterways is a good idea. Eliminating non-human use just seems like an obvious, low-hanging-fruit kind of place to start.

It’s a little to early to tell a human-health story from the findings. The researchers didn’t test meat, just feathers, so we don’t know whether the chemicals in question are concentrated enough in the chickens’ flesh to make a difference for the people that eat them—though the coauthor said that the more he studies the industrial meat supply, the more he prioritizes feeding his family organic.

But there is, it seems to me, a story here about the particular kinds of mayhem that can arise in a big system, where a product’s place of final consumption is many steps and many miles removed from its origin.

Raising a chicken on Tylenol, Benadryl, arsenic, and fluoxetine, and then eating it, isn’t the kind of corner many people would cut for themselves. Or for their families, or anyone they had to be accountable to personally. But stretch out the production chain long enough, remove the producer from any possible real interaction with the consumer, and it becomes thinkable.

I thought it was telling that, as Kristof wrote, the findings of these studies will come as news to many poultry farmers themselves, who often use a proprietary food mix designated by the large food companies they contract for. They don’t know what’s in it. That decision’s been made even farther up the line—presumably in a place with very little live poultry.

When farming was a neighborhood affair, the eventual customers would have kept some kind of an eye on the farmer’s methods. Now that it takes place on an industrial scale, removed from our sight and even our imagination, we have no choice but to rely on regulatory bodies to be watchful on our behalf. The fact that banned antibiotics were detected in feather meal—and that the presence of other chemicals blindsided researchers completely—does not inspire confidence in the vigilance or the strength of our regulatory apparatus. Organic is nice, but you shouldn’t have to buy specialty food to avoid being exposed to known poisons and prescription drugs every time you choose to eat meat.

I don’t know what to say about this completely, except that it puts me in the mind of the old saying: “If you want something done right, do it yourself.” Or at least be able to look into the eye of the guy who does.

(Photo/Flickr)