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Monday, Mar 4, 2024

Sarah Says: Who’s Afraid of SSRIs?

I was surprised how easy it was to get a prescription for Prozac. 

My consultation with the doctor, though a sleep-deprived, teary blur, could not have been more than thirty minutes. She told me I would probably have the medicine by the evening; the script was that common. 

That evening, picking up the prescription from the CVS counter, had the ring of an anti-climax. I resisted treating my anxiety with medication for so long, but when the crisis point came, the decision to take Prozac was easy. My anxiety was just another problem in need of solving. 

It won’t surprise anyone to hear that America is embroiled in a mental health crisis. In the years before Covid-19 hit, the rates of Americans reporting depression and anxiety were already on the rise, and with the onset of the pandemic, they skyrocketed. The New Yorker introduced an issue this past summer devoted to therapy by claiming “if our current moment has a defining impulse, it’s the drive to feel good again.” 

Young women have been hit especially hard. The Youth Risk Behavior Survey, published by the Center for Disease Control and Prevention (CDC), found the number of girls experiencing “persistent feelings of sadness and hopelessness” increased from 36% to 57% between 2011 and 2021, with the highest jump occurring during the pandemic. The survey shows that within this same period, the number of girls who have seriously considered suicide increased by 11%. 

As a result, more Americans are on antidepressants known as selective serotonin reuptake inhibitors (SSRIs) than ever before. As of the spring of 2022, just under a quarter of Americans between 18–29 were on medication for mental health. Writing for the New York Times, columnist Maureen Dowd mourned “campuses awash in S.S.R.I.s… young women who seem to have everything, yet they are unable to fully enjoy a stretch of their life that should be sizzling with adventure and promise.” 

Since their debut, SSRIs have been a locus of concern. Many of the peers and adults in my life express their great wariness toward the drugs. They don’t want to use a drug that might make them a “zombie” and alter their brain chemistry. This alleged sanctity of the brain strikes me as slightly misguided. After all, these are the same people who binge drink regularly or incessantly use their phone — both activities that are proven to deteriorate brain activity. Many of my friends on SSRIs, some of the most intelligent women I know, carry a deep shame from the stigma of what they fear is a life-long dependency.

I don’t mean to come across as sanctimonious. I understand their wariness. 

Until about six months ago, I shared it.  

Early in my semester abroad last spring, I was violently mugged. The study abroad program recommended I see a therapist, and though I agreed that made sense, I ducked the calls and emails from my program coordinator until they went away. For the first time in a long time I was not seeing a therapist, and I had the sense that if I talked about what had happened to me then my composure (which alone in a foreign country was as good as a survival instinct) would break. So, I did the unhealthy thing; I repressed my feelings. I went out drinking, went to class, toured foreign countries and got commended for my strength. 

For most of us, repression comes with a built-in expiration date. Eventually what we bury floats back to the surface; it’s basic physics. 

Soon after I returned home to the United States, I began to see danger everywhere. Each bump of turbulence portended a plane crash, I watched my back while I walked and in my bed at home, I lay rigid with the fear that someone might break in. I started to experience panic attacks, but I didn’t realize that until much later — the lightheadedness, the feeling that I was breathing through a straw, was quite unlike what I saw on TV. I was so afraid of the pain in my chest and the tingling in my legs that I saw a doctor, and even though I was almost certain it was anxiety, it took an E.K.G. to relax  (“perfect,” by the way) and it only lasted a moment. 

My body was in crisis, but only when it became clear that there was no other recourse did I begin to seek the proper treatment. I would never be so negligent with any other health issue or any other medication. Why did I fight so hard against helping my mind, which is just another one of my body’s organs? 

I blame the rhetoric of the true self. Much of the opposition to SSRI is grounded in a fear that we are at risk of diluting ourselves on medication. People worry who they will be if they stay on SSRIs forever. Among artists, there is an unfortunate tradition of lionizing mental illness. Taking medication I had done just fine without seemed to be an unnecessary risk to my creativity. 

Even the pro-SSRI rhetoric is grounded in the true self. From the endless scroll of my Instagram feed, Kristen Bell, an ambassador for the mental health platform Hers, asks me with a beautiful smile, “what if [medication] made us feel more like ourselves?”

Though my mugging triggered an escalation of my anxiety, my history with anxiety far predates the crime. Even before I could name it, anxiety has always been with me. 

It can be exhausting to feel so overmastered by my thoughts, to always fear the worst-case scenario. But anxiety has shaped me in other ways, for better and sometimes worse. I’m highly sensitive, a considerate friend, more disciplined than almost anyone I know and the same relentless, analytical thinking patterns that lead me down internal rabbit holes are also what make me an able student. So, what does it mean to treat the enemy that holds you in its grips if the hold is sometimes an embrace? 

I’ve come to think one of our main problems with SSRIs is a collective overestimation of their abilities. This fall, after over three months on SSRIs, I had an anxiety flare-up. At first, I was affronted. Wasn’t I supposed to be finished with anxiety? But, as anyone on a SSRI knows, they are not designed to eliminate anxiety. Nothing can. Prozac is just one piece of a multifaceted treatment plan. 

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Every morning, I take a slim white capsule. My other daily routine is by far more grueling: I’ve committed to meditating at least once a day. I came to meditating not just kicking and screaming, but years late. I can do an untold number of things to procrastinate meditating. Suddenly, deep-cleaning my sink becomes desperately appealing. 

But eventually the time comes to sit alone with my thoughts. One of my favorite meditations is designed specifically for anxiety. I am told, by the pre-recorded voice I have come to know so well, to imagine myself as sitting by a gently flowing stream with leaves floating on the surface. As the thoughts run through my head — good, bad or neutral — I place them on leaves and watch as they float away. 

Slowly, each day, I teach myself to breathe again.

Sarah Miller

Sarah Miller '24 (she/her) is an Editor at Large.   

She previously served as Opinions Editor and Staff Writer. Miller is an English major on the Creative Writing track. She hails from Philadelphia and spent the spring studying English at Trinity College Dublin. She has interned for The New England Review and hosts a WRMC radio show where you can still listen to her many opinions.