Zoloft Put the Pleasure in My Sobriety
"Better living through chemistry" isn't just a slogan: I've been on antidepressants for 20 years, and can still remember exactly when the first one started to work—allowing my recovery to begin for real.
Drug addicts and alcoholics are surprisingly conservative when it comes to psychiatric medications. We’re willing to try virtually anything to get high—but when it comes to taking drugs to get better, we tend to get all “Just say no.” For me, this tendency led to years of suffering before I finally had no choice other than to try antidepressants.
Part of the problem can be attributed to widespread skepticism about these medications, which is prevalent in some 12-step programs. This fear has two facets: the first, a justified anxiety based on historical claims about certain medications not being addictive, which later proved false; the second, a more problematic moralizing that use of medication to “fix” an emotional or mental problem is somehow “cheating.”
The issue of AA members telling people to stop taking—or advising them never to try—psych meds became so acute by the early ’80s that a 1984 conference-approved document, “The AA Member and Other Medications,” explicitly warns against “playing doctor” and states starkly:
AA members and many of their physicians have described situations in which depressed patients have been told by AAs to throw away the pills, only to have depression return, with all its difficulties, sometimes resulting in suicide.
Although I attended 12-step groups daily for the first five years of my recovery from cocaine and heroin addiction, I never thought that I bought into the extreme anti-drug line. Indeed, I handed out that pamphlet to many people who had been reprimanded for sharing, or felt otherwise beleaguered, about taking medication—and yet I resisted it for myself.
And so I continued going to meetings and trying to get on with my life, even as I wrestled with feelings of self-hatred and anchorless fear. I’d spend hours on the phone, analyzing tiny incidents of social rejection, thereby ruining the friendships I actually had but felt I didn’t. I tried talk therapy, but several years of ruminating about my childhood didn’t change much.
Throughout this time, my mid-20s, my career was taking off and I’d managed to sell my first book. At the lowest points of my life, work was the one area of life where I’d always felt good about myself. But when the publisher killed the book, I found myself paralyzed by apprehension.
I thought the problem might be the structurelessness of my freelance life, so I got a job. When even working on an AIDS documentary—something that normally would have energized me—didn’t change the state of deadness and dread, I knew I had to try something else, especially when I found myself unable to stop crying at the office.
The next day, I managed to get myself to a psychiatrist, who rapidly prescribed Zoloft. It turned out to be lucky that I took the oblong blue pill for the first time on a weekend. Several hours later, I experienced an oddly familiar sensation.
It was a feeling in the pit of my stomach that things were about to get weird—the vaguely nauseous lurch I’d often experienced after taking acid, right before the drug kicked in. Soon, as with LSD although less intensely, I was seeing multidimensional red and green geometric shapes if I looked at anything bright for too long.
Concerned, I called my psychiatrist, and she said it would pass and that I should take my next dose on time, but halve it. And indeed, the hallucinations soon diminished to the point where I felt normal enough to go back to work on Monday. Ironically, I missed my colorful visions: although the hallucinations hadn’t lifted my depression, they had at least distracted me from it.
I had never before been consciously aware of the minute bursts of pleasure until they’d leached away—and now suddenly returned.
For about 10 days after first taking Zoloft not much changed. I didn’t relapse; I went to meetings. I did the bare minimum necessary to get through the day. This was not helped by the fact that after my office-crying incident, one of my bosses responded cruelly. I tried to explain what was wrong with me, saying I was seeking help. She barked, “Don’t bring it to the office.”
Then one morning, something changed. I noticed it when I was writing an op-ed and found myself pleased by a line that I had written. It was no great ecstasy, but it was striking all the same. I actually felt…good. That’s when it hit me: This drug is working and I am going to get better.
What I hadn’t realized until that moment was that pleasure had disappeared from my life. I knew something was wrong, of course, but I had never before been consciously aware of the minute bursts of joy that I had typically gotten from my work and my interactions with people until this pleasure had leached away—and now suddenly returned.
That moment and those that followed helped me recognize a fundamental truth about my addiction: It had largely been driven by an inability to take pleasure in emotional support. The reason I seemed insatiably needy was that I didn’t see or feel the love around me. I always needed more support because I couldn’t truly take in what I had.
Twelve-step programs had taught me that my perceptions of social rejection might be misguided and that when I walked into a room and thought everyone wanted me to leave, that was my interpretation, not necessarily what the data suggested. But they couldn’t teach me to experience emotional connection that I wasn’t physically—chemically—capable of feeling. When even work no longer provided satisfaction—when whatever brain chemicals that had allowed that last pleasure broke—everything had collapsed. And by boosting dopamine, serotonin or some type of nerve growth factor—as current theories of antidepressant action suggest—the Zoloft solved the problem.
One study of the effects of these antidepressants shows that almost immediately after you first take them, you start to perceive emotional expressions in faces more accurately—and the better you get at recognizing happy faces, the greater the improvement in your symptoms. It may be that the time it takes for the drugs to kick in is the time it takes you to really take in these smiles and warmth that you have missed. It may also be that when you can feel pleasure again, you are better able to see it in other people.
Regardless, this experience taught me that simply changing your thinking often cannot solve serious problems; a change in brain chemistry is needed. And that’s not an ignoble shortcut. We cheer new medications that make recovery from cancer or heart disease possible, why should someone already cursed with depression or addiction have to do more and more “hard work” to overcome it if an easier, softer way does work? While opposition to medication has certainly mellowed in the 12-step world—to the point where Hazelden itself now offers maintenance medication for opioid addiction, when once it wouldn’t even permit Prozac—there is still lingering discomfort, if not stigma.
I’ve taken antidepressants for around 20 years. The drugs have dramatically improved my relationships, ending the days when I needed so much reassurance that no one could stand it. Now I get to support other people. By turning down the volume on negative emotions, they have also allowed me to be sad when it is appropriate—not when I watch AT&T commercials. Incidentally, the fact that the drugs have worked for me in this way also shows that I am not simply having a placebo effect: In their ability to lower emotional over-responsiveness, studies have shown that serotonin antidepressants like Prozac and Zoloft have dramatically better effects than placebo.
While they don’t work for everyone, the widespread notion that these antidepressants have no pharmacological effects—or only negative ones ("they "turn you into a zombie," etc.)—has been debunked by more than two decades of research. For many people, including a surprising number of 12-step members, these drugs improve or regulate mood to a very significant degree—and that can be exactly what a person needs to do the work of recovery. But because these medications alter brain chemistry, they can also have undesirable side effects. These can be truly terrible: The wrong drug for the wrong person can absolutely be worse than doing nothing.
For me, however, the only thing I regret about taking medications for depression is not having done so sooner—in fact, I wonder if I might have skipped addiction entirely had these drugs been available during my teens. Of course, your mileage may vary, but I encourage everyone who is struggling in recovery to consider the possibility that drugs can help as well as harm. And whatever you do, make sure it truly works for you. Don’t settle for any treatment—whether medication, talk or support group—that doesn’t allow for the full return of joy.
Maia Szalavitz is a columnist at The Fix. She is also a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006).
Ms. Szalavitz has no financial or nonfinancial interests, and no affiliations with the pharmaceutical companies that produce Zoloft or any other industry firms or groups, to disclose.