Sean

Up until this June, I’d been taking an antidepressant called Zoloft for about 8 years and 10 months of the preceding 9 years. The fact that I’m no longer taking Zoloft is an accident of history: I had a lot of trouble obtaining Clozaril, a medication I was instructed to take with Zoloft. When it became impossible for me to obtain Clozaril, I stopped taking Zoloft, not merely out of frustration (though I admit that played a part), but because I believed that, if my doctor had wanted me to take Zoloft without Clozaril, she would have prescribed it that way.

The first 3 weeks without Zoloft were difficult. I experienced severe withdrawal symptoms (especially within the first 5 days). After a month went by, something interesting happened: the compulsive shopper in me which for almost a decade had fed my addiction for pro-audio equipment and computer accessories just up and died! I can’t think of any better way to explain it. It was like, despite the fact that I was more broke than I’d ever been, for the first time in as long as I could remember, financial security was on the horizon.

You may be wondering “how could a drug prescribed to alleviate depression have any impact on your spending habits?” This is a good question for someone who (like myself) has been on both sides of Zoloft treatment. Based on my experience, while Zoloft can keep you from getting majorly depressed, it also has the unfortunate tendency of preventing you from feeling genuine happiness or joy. Even if you have sufficient insight into this reality to report it while you’re still on Zoloft, communicating this experience to your doctor will inevitably lead him to prescribe even more Zoloft, a decision which may not exacerbate the problem, but certainly won’t make it any better.

So here you are, still not happy, taking 150 milligrams per day of Zoloft, a medication that’s clearly advertised as an “antidepressant”—literally, “that which fights depression”—and your choices are to console yourself by purchasing an Xbox 360 and a flatscreen TV or allow yourself to be convinced by your doctors that your unhappiness is a symptom of even bigger problems with names like “bipolar mania” or “schizoaffective disorder.”

You may be wondering how you could sit across from your doctor and uncritically accept as diagnoses such obvious euphemisms for “crazy.” Well, consider this: what if each and every time you reduced or discontinued a medication you were taking in conjunction with Zoloft, you went insane?

Around the time of my revelation that Zoloft can detract substantially from your happiness potential, I stumbled across an article online entitled “Antidepressant-Associated Mania and Psychosis Resulting in Psychiatric Admissions” which documented this very phenomenon; three M.D.’s and a Ph.D published the research in a 2001 issue of “The Journal of Clinical Psychiatry.” The article explains that more than 1 in every 13 people undergoing combination drug therapy for mental illness (by using “mood stabilizers” in conjunction with antidepressants, for example) will experience a break from reality upon reduction or discontinuation of the “other” drug (e.g., Depakote, Abilify, Haldol, Geodon, Clozaril, etc.). In theory, this response could occur when changing from one mood stabilizer to another, since one of the most frequently implemented methods of switching psychotropic medications (i.e., “cross-titration”) entails gradual discontinuation of the drug being replaced. Finally, according to the article, the mere process of beginning pharmacological therapy for depression (with a drug like Zoloft) can induce psychosis.

Suddenly, the last 9 years of my life began to make sense: my first outpatient psychiatrist diagnosed the “psychotic features” of my depression soon after I started Zoloft (when I insisted that my then-girlfriend had a metallic, foreign object in her body). Psychotic symptoms resurfaced during another treatment experiment with a psychiatrist near my new address where reduction of antipsychotics I’d been taking since the aforementioned delusion was reversed after erratic thoughts adversely affected my behavior at a friend’s engagement party. In 2007, I received treatment from a doctor who, though far and away the most competent and knowledgeable psychiatrist I’d ever worked with, subjected me to grave danger by virtue of her insights into the perils of Zoloft treatment: lowering my Zoloft prescription from 150 to 125 milligrams despite my strong objections and the circumstances aggravating my depression (financial strain) contributed to the state of despair that precipitated my suicide attempt in Fall of 2008. Barely three weeks after my admission to a Manhattan acute mental healthcare facility (following my discharge from the hospital’s affiliated ICU), I received care from a psychiatrist who continued the treatment plan developed and initiated by my recent inpatient psychiatrist: gradual discontinuation of an antipsychotic while still taking Zoloft (after grudgingly returning to that hospital a few weeks later for observation, I was committed by way of a “two physicians certificate”).

Naturally, I was reluctant to defer to the expertise of my inpatient doctor the second time I came under her care (just weeks after she discharged me on a treatment regimen that generated the kind of chemical imbalance that causes people to seek psychiatric help in the first place). What ensued was my first-ever, sustained period of non-compliance with my treatment plan. At various times throughout this confinement, the intensity of my delusions was such that I kissed my sister-in-law on the lips (thinking I was on a “reality show” that wouldn’t release me until I kissed someone), stabbed myself repeatedly in the wrist, and (while in solitary confinement) drank a cup of my own urine (thinking my right to refuse a vasectomy was conditioned on my performance of this disgusting task). These experiences easily comprise one of the most traumatic periods of my life. Even my admission two years later to another facility—-where my doctor’s manipulation of dosages and varieties of antipsychotics and mood stabilizers while on Zoloft induced suicidality and terrifying delusions-—even that wasn’t as bad.

People who know my story sometimes ask “why not sue the doctors or the hospitals that treated you? They’re the ones who failed to recognize Zoloft’s terrible impact on your mental health.” While the culpability of these individuals is hardly debatable, I feel such remarks miss the point.

The point, as I see it, is that if 1 out of every 13 automobiles to roll off an assembly line is destined to spontaneously combust, the vehicle’s engineer should be held as (if not more) accountable as the poor slob who moves them from the showroom.

Thus, given the number of other people who’ve undoubtedly been rendered incapable of working by virtue of their antidepressant-induced “thought disorders,” corporations that research, manufacture, and distribute antidepressants should be required to pay damages to Medicaid and Social Security, the institutions healthcare executives have the nerve to complain are disproportionately subsidized through their tax dollars. It might not bring us any closer to a consensus regarding which symptoms constitute “schizoaffective disorder”–but it will be an important step towards eradicating the perverse incentives afflicting our mental health system.

-Sean Talisman
seantalisman@gmail.com