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My Adventures in
Psychopharmacology By
Gogo Lidz (courtesy of New York Magazine and PURE)
Between the ages of 16 and 21, I
was prescribed more than fifteen different stimulants,
antidepressants, antipsychotics, and mood stabilizers. The cure was
worse than the disease.
Fall 2001 Ritalin
I was 16 when I was prescribed my
first mood-altering drug. I'd been a dreamy, drifty child. But when
adolescence closed in, I became tall and clumsy and socially inept.
The flood of hormones seemed to unsettle my mind. I was silly and
giddy one minute, bursting with rage the next; running around
excitedly in the afternoon but impossible to rouse out of bed in the
morning. I lost friends almost as fast as I could make them.
By 16, my concentration had ebbed
so low and my grades had plummeted so deep into the alphabet that my
parents decided to send me to a child psychiatrist. I was concerned,
too, and put up no resistance.
So, six Halloweens ago, my father,
my mother, my kid sister, and I went to the office of an upright
fellow in his late thirties who wore a cardigan sweater and a
narrow, straight-edge bow tie. All of us found the psychiatrist
charming - except my sister, Daisy, who called him Dr. Titrate
because he talked incessantly about "titrating" the drugs he
prescribed.
"What's titrate mean?" I asked
during that first session. "I'll explain the term as simply as
possible," Dr. Titrate said, grabbing a dictionary from the
bookcase. "Titration is the process of determining the concentration
of a dissolved substance in terms of the smallest amount of a
reagent of known concentration required to bring about a given
effect in reaction with a known volume of the test solution." Though
it didn't sound simple, we all nodded our heads in agreement.
I described my symptoms and family
medical history (depressed aunts, a schizophrenic uncle) to Dr.
Titrate, who wagged his head wisely and asked me a few questions to
screen for attention deficit disorder:"Do you have trouble following
through on things?" "Are you often sidetracked?" "Do you make
careless mistakes?"
I answered yes to every one. Then
again, so did my father. And my mother. And my sister. Not only was
I a candidate for ADD, but so was everyone else in my home.
Satisfied that I was suffering from ADD, Dr. Titrate gave me samples
of Ritalin.
Winter 2001 Metadate, Dextrostat,
Dexedrine Spansules, Adderall, Adderall XR, Strattera
Discovering that I had a recognized
syndrome brought my parents tremendous relief. The news was
comforting to me too. All I had to do, I thought, was pop a few
pills and I'd be as focused and success-driven as everyone else in
my school. I'd be normal.
But the Ritalin made me feel
spacey. Classes were easier to sit through, but if a teacher asked
me a question, I'd answer with a disoriented "Whaaat?" When I
explained this to Dr. Titrate at our next session, he turned
pharmacist. Over the next few months, he plied me with a small
galaxy of ADD drugs: Metadate, Dextrostat, Dexedrine Spansules,
Adderall, Adderall XR, and Strattera, alone and in various
combinations. The non-stimulant, Strattera, had no effect on me. The
stimulants turned me into a tweaked-out whiz kid. It was as if I had
been nearsighted and now had X-ray vision.
Adderall XR was my drug of choice.
It turbocharged my brain during the school day, but when I got home,
I crashed hard. Sometimes I'd lie in bed for hours and sob. To
supplement the Adderall XR, Dr. Titrate prescribed the short-term
amphetamine Dextrostat for after-school studying. Taking so many
stimulants made it hard to sleep more than six hours a night. It
also made me rapidly lose weight. At first, I liked this side
effect. But when my classmates started calling me Anna Rexic, the
thrill faded. I always felt queasy, and food tasted like sand.
Hopped up on stimulants, I gained confidence. After Dr. Titrate
wrote to my headmaster that I had ADD and needed more time on tests,
my performance at school improved dramatically. A C student in tenth
grade, I was pulling A's by the eleventh. After Dr. Titrate wrote
the same note to the College Board, I got a near-perfect score on my
SAT. I turned from a basket case into an overachieving young adult.
But I was dimly aware that the ADD medication was also doing
something else, something I didn't like. I felt impatient,
irritable, explosively angry. I'd scream at my father for buying me
the wrong toothpaste. I'd scream at my sister for borrowing my
hairbrush. I'd scream at my car for running out of gas.
When I told Dr. Titrate about this,
he nodded empathetically and said, "Remember to take your medicine."
To be honest, I didn't always. My only friend with ADD took Concerta,
a kind of slow-release Ritalin. Occasionally, we'd have "no-medicine
days" when we'd skip our daily doses and giggle and act random. The
problem with skipping the meds was that I'd want to sleep all the
next day.
Spring 2002–Summer 2003 Adderall
XR, Dextrostat, marijuana, Tylenol PM, Effexor, Zyprexa
During my junior year of high
school, I hooked up with a pudgy stoner, a senior. If I took
stimulants and finished all my homework, I'd smoke a joint with him
in the evening. Smoking weed took me out of my usual speedy state.
I'd get blissful and drowsy and amused by gravity, and finally I
could sleep. What perfect titration, I thought.
This system worked very well until
Pudgy Stoner graduated and enrolled at a party school a thousand
miles away. My source of herbal titration was gone, and the pressure
to get into college was on. At first, I called Pudgy every night.
But gradually, he stopped picking up the phone. One morning, before
school, he dumped me over e-mail. I was devastated. After lunch, I
asked to be excused from class and ran to the girls' room, where I
sobbed and slapped my wrists against the tile floors.
The next day, I dropped off my
sister at school and, while searching in vain for a parking space,
decided to end my life. I drove to a pharmacy and bought a box of
Tylenol PM. Then I drove to another parking lot. As Fiona Apple's
"Sullen Girl" played over the car radio, I swallowed twenty pills. I
tore four pages out of my AP European-history notebook and wrote a
dramatic suicide note. Then I waited.
As I settled into a stupor, I
suddenly realized the gravity of what I had done. I grabbed my cell
phone and dialed home. My father picked up. As hysterical as I was,
I still managed to tell him where I was and what I had done. He
found me and drove me to a hospital, where I was given a charcoal
lavage and admitted overnight to the psych ward.
When I was released from the
hospital 24 hours later, my parents took me to see Dr. Titrate. I
told him I hadn't really wanted to commit suicide; I just wanted to
get back at my ex-boyfriend. My mother asked Dr. Titrate if he
thought I might be suffering from depression. "Well, that may be a
tiny component of her condition," Dr. Titrate said. When my father
asked about manic depression, he said, "That's another tiny
component. She's also got a little cyclothymia and phase-of-life
issues. She's a unique case. I hope some day to write about her in a
medical journal." Dr. Titrate kept me on the stimulants Adderall XR
and Dextrostat and added the antidepressant Effexor to my drug
regimen. But Effexor seemed to have no effect on me, and so the day
before I left for college in upstate New York, my father and I met
with Dr. Titrate again. He put me on a heavy-duty antipsychotic
called Zyprexa. Dr. Titrate warned me of side effects. "Watch out
for tardive dyskinesia, acute dystonia, and neuroleptic malignant
syndrome," he said. I nodded dumbly. "Of course," he added, "the
possibility is remote."
Fall 2003 Adderall XR,
Dextrostat, Zyprexa, alcohol, marijuana, mushrooms, hash, cocaine
With my parents eleven toll booths
away, and my mind on Adderall and Dextrostat, I allowed my wildest
impulses to take over during my first semester at Bard. I drank,
drugged, and got the world's most ridiculous tattoo (oh my!)
inscribed on the small of my back. My substances of choice were
mellow drugs: pot, hash, mushrooms. I snorted cocaine once, but it
had little effect on me - I already had quite a tolerance for
stimulants.
Stoked by Dr. Titrate's little
helpers, I hosted my own college radio show and called it "The ADD
Hour." Naturally, "The ADD Hour" lasted just nine minutes, and I
played only the first eighteen seconds of every song. I couldn't
keep still in class or the library or even my dorm room. I put off
starting assignments until the last possible moment. My classmates
pulled all-nighters; I pulled all-several-nighters. To finish an
art-history paper, I once stayed up 72 hours. Which wasn't that
difficult - the stimulants made sleep nearly impossible.
Bard had a don't-ask-don't-tell
attitude toward drugs, and a thriving black market for stimulants.
The going rate for Adderall was $5 a pill. After less than a month
at school, I got reprimanded by the dean for giving a fellow
freshman a couple of my Adderall XRs. "I've got a paper due," he had
told me, before selling them to a narc for $10 apiece and ratting me
out to save his skin.
As the semester wore on, I became
increasingly erratic. I skipped classes and disappeared from campus
for days at a time. My friends still talk of the day they lost me in
a Wal-Mart: After paging me for twenty minutes, they found me with
no money and a brand-new .22 hunting rifle. (It hadn't occurred to
me where I would store the gun or shoot it or what I would shoot
at.) Another day, my parents and Daisy drove up to Bard to meet me
for lunch, but I was 100 miles away at a friend's apartment in
Brooklyn, hungover from a night of hard drinking.
Daisy, then a high-school
sophomore, was crushed that I had blown off the visit. She didn't
blame me as much as Dr. Titrate, whom she called my "enabler." When
her concentration began to wane in school, she, too, had seen him.
She, too, had been diagnosed with ADD and prescribed Adderall. But
she stopped taking it after a few months. "It changes my
personality," she said. "It makes me mean." I stayed on Adderall,
but I stopped taking recreational drugs: Downers only brought me
down.
Spring 2004 Adderall XR,
Dextrostat, muscle relaxants, Ambien, Abilify
Four weeks into my second semester,
my parents received a late-night phone call from my roommate. I had
OD'd again. I vaguely recall staggering around campus in a speedy,
woozy haze. I later learned a classmate had found me unconscious and
called for an ambulance. An EKG revealed I had come close to cardiac
arrest.
The next morning, my father signed
me out of the hospital and we met with the college dean. Still in a
haze, I rabbited on about all the hard drugs I had taken. My father
was horrified. So was the dean, who kicked me out of school. By
afternoon, my head had cleared and I realized I had been
regurgitating what I had read in Naked Lunch. "I didn't know what I
was saying," I told my father. He believed me. We met again with the
dean, who didn't.
When I got home, I saw Dr. Titrate
in an emergency session. He kept me on Adderall XR and Dextrostat
and added Abilify to stabilize my mood. Two days later, the
toxicology report came back from the lab - on the night of my
overdose, nothing had been in my system except my prescribed
stimulants, an Ambien, and muscle relaxants. Now I remembered: I had
self-medicated for menstrual cramps. The combination of drugs must
have caused the overdose. After Dr. Titrate called the dean to plead
my case, I was allowed to return to school. Conditionally.
I submitted to random urine
screenings, and passed every one. I got a new boyfriend, a
straight-arrow lit major. Soon after that, Dr. Titrate took me off
Abilify, but not Adderall XR. The following year, health regulators
in Canada would suspend Adderall XR following the deaths of twenty
people, including fourteen children, who had taken it between 1999
and 2003.
Fall 2004 Adderall XR,
Dextrostat, Lexapro, Advil
Feeling anxious at the start of my
sophomore year, I phoned Dr. Titrate from college to ask if he knew
of a potent antidepressant called Lexapro. My new boyfriend was on
the drug for depression. Dr. Titrate said he recommended Lexapro for
anxiety, and had a prescription faxed to my off-campus pharmacy. His
only warning: "Let me know if it starts making you feel manic. " I
was unsure what Dr. Titrate meant, but I swallowed my daily Lexapro
with my daily Adderall XR and my daily Dextrostat.
Over the course of my sophomore
year, I did not get any less anxious. I spent day after gloomy day
in bed, feeling dizzy and nauseous and paranoid, getting
stomachaches, driving my friends crazy, and wanting to kill myself.
I became more and more unstable: sometimes moored to my bed,
sometimes restlessly ricocheting around campus. I had a couple of
scary panic attacks - each followed by sudden eerie moments of
composure and lucidity. I became terrified of being alone. One
night, after my boyfriend told me he needed more "alone time," I
went back to my room and screamed and cried and beat my walls for
three hours. I phoned Dr. Titrate, who suggested I "dial down" my
Adderall use and increase my dosage of Lexapro.
That summer, on an art-class trip
to Italy, I imploded. Convinced that my classmates hated me, I tried
to slice my wrists with broken glass. When that proved inefficient,
I swallowed a handful of Advil with a glass of wine. After a night
in the Venice psych ward, I was put on a plane back to the States.
When I finally got home, I threw a
huge tantrum - body thrashing, head whipping from side to side. My
mom grabbed my shoulders and hugged me, but I struggled against it.
"Why are you doing this to me?" I shrieked.
Daisy begged my parents to fire Dr.
Titrate. "He can't read people," she said. "He doesn't listen." But
my parents still trusted him, or at least wanted to trust him. And
so they took me to yet another emergency session.
Dr. Titrate said he doubted I had
"suicidal ideations" and recommended that I be sent to a
substance-abuse-treatment facility. He told my parents, "You can, of
course, seek a second opinion." But there didn't seem to be time for
that. Dr. Titrate spoke with great urgency: He wanted me in the
facility within 48 hours. I crumpled in hysterics on his office
floor.
June 2005 Lexapro, lots of
Lexapro
Dr. Titrate recommended a
consultant, and the consultant recommended a treatment program in
Utah. It cost $450 a day and was not covered by my parents'
insurance. The next morning, I was shipped off to a remote campsite
in the High Uinta Mountains. This wilderness program was designed
specifically for drug addicts and alcoholics. Dr. Titrate had
assured my parents that although I wasn't technically an addict, the
treatment would be beneficial.
But the field therapist - a
recovering alcoholic in battle fatigues - and her staff of
instructors didn't seem to be in on the secret. They treated me like
the worst kind of addict: one who was in denial. "Acknowledge your
addiction, or you're not getting out of here," one of the
instructors told me.
My attitude baffled the
instructors, and I was routinely disciplined with silence and the
withholding of hot food. When informed of my resistance, Dr. Titrate
upped my daily intake of Lexapro again, to three times the normal
dose.
I should note that I was over 18
and technically could have left the program at any time. But leaving
was not really an option. Dr. Titrate had given my parents strict
instructions: If I phoned and said I planned to come home, they were
to say I wasn't welcome. I would be stranded with no money in the
mountains of Utah.
I had little to no contact with the
outside world during this time. My mother and father had weekly
hour-long phone conversations with the field therapist, who, in
turn, had weekly hour-long phone conversations with Dr. Titrate. My
parents could send e-mails to the center, but anything deemed "nontherapeutic"
was withheld from me.
The letter that did get through was
one they were required to write: an "impact letter" that I was to
read aloud in group therapy. My parents later told me that it was
the hardest thing they ever wrote. They debated. They agonized. They
revised the text endlessly. They wrote that they were desperate that
I be accountable for my life, that they had sent me to the treatment
center because they had no idea how to help and this seemed the best
option. They wrote, "Instead of taking responsibility for your life,
you are foisting that responsibility on others. But the price is
terrible. From middle school on, we have seen you struggle to forge
friendships. But this is not the way to make lasting relationships.
In fact, it's just the opposite. We are terrified." I was terrified,
too, but I didn't know how to stop. My mental state still swung
violently between extremes.
As the Utah program came to an end,
Dr. Titrate's consultant arranged to have me sent to a 90-day
"aftercare" program in Southern California. This program, too, was
designed for recovering addicts and alcoholics. To get in, I was
required to "admit" my addiction in a phone call to the center's
director. After a tearful hour of trying to be honest, I lied and
said, "Okay, I'm an addict."
When I was released a week later,
the Utah field therapist said, "I don't think we can do much else
for you, but at least you've admitted your problem."
August 2005 Lexapro, Lamictal,
Provigil, Wellbutrin, Cymbalta, more Lamictal
In California, I had a brief
honeymoon. Now, in addition to a large dose of Lexapro, Dr. Titrate
prescribed the mood stabilizer Lamictal and, for focus, Provigil, a
non-stimulant used to keep narcoleptics awake. I went to twelve-step
meetings, body-image meetings, risk-assessment, and love-addiction
meetings. I did t'ai chi, I meditated, and I wrote daily "letters to
God."
But the honeymoon didn't last. The
Provigil made me faint and frenetic. I got dizzy and had frequent
stomachaches. I experienced sudden, overpowering moments of terror.
Whenever I refused to get out of bed all day (often) or refused to
attend group meetings (even more often), I was grounded, which just
gave me an excuse to retreat even further into myself.
I did befriend a girl my age, a
recovering heroin addict who had been in similar programs half her
life. Go through the motions, she told me, and no one will pay
attention. Instead of letters to God, I jotted down Ludacris lyrics
and dated them. She was right: Nobody noticed the difference.
I suffered panic attacks with
greater and greater frequency. One attack was so frightening that I
finally demanded to see a psychiatrist. He decided to start weaning
me off Lexapro, replace it with the milder antidepressants
Wellbutrin and Cymbalta, and increase my dosage of Lamictal.
Around this time, the Utah program
mailed me a box of computer printouts - the e-mails my parents had
sent that were deemed "nontherapeutic" and withheld. One was an
article about cognitive behavioral therapy - a treatment Dr. Titrate
had always dismissed. After I read it, I set up an appointment.
When I related my personal history
and described my symptoms to the cognitive behavioral therapist, she
said, "You don't sound like an addict. You sound like you're bipolar
II, a form of manic depression."
She asked for the names of the
drugs I was taking. "Provigil, Lexapro …" "Lexapro! Do you have any
idea what effects that drug can have on bipolar people?"
At the end of the session, I called
home and told my parents. My father found a Website that
cross-indexed syndromes with drugs. Patients detail their reactions.
He typed in bipolar and Lexapro. A sampling: "When first started on
10mg, about 2 hours later felt insane amount of energy, was zooming,
felt very speedy. Then shortly after that same day I crashed and
couldn't get out of bed" … "I had euphoria/irritability like never
before" … "Manic and then wanting to kill myself all in 15 minutes
time."
The stimulants turned me into a
tweaked-out whiz kid. They also made me rapidly lose weight, which I
liked until my classmates started calling me Anna Rexic.
He flew to California the next
morning. We met at my halfway house and drove to the behavioral
therapist's office. "Your daughter has been misdiagnosed and mis-prescribed,"
she said. I felt ecstatic and oddly vindicated. She said
antidepressants may be used in adolescent bipolar depression in the
acute phase, but only under cover of a mood stabilizer to calm
potential manic storms. She said Dr. Titrate should have prescribed
Lamictal first, then waited for the mood stabilizer to, well,
stabilize me. Then he could have tacked on an antidepressant, but
not Lexapro, one of the more volatile and potentially mania-inducing
of the lot.
According to this psychiatrist, the
stimulants used to treat my alleged ADD may have intensified my
bipolar disorder. Adderall, she explained, can cause dysphoria, a
symptom of depression defined as a "generalized feeling of
discontent." Dr. Titrate had never warned us that stimulants could
complicate depression or hasten the onset of bipolar disorder in
kids prone to it.
The behaviorist said the addiction
therapy I'd been subjected to was pretty much a wash, and possibly
counterproductive. Five months and $75,000 worth of rehabilitation,
all for nothing. "This is so typical of the so-called treatment
bipolar II patients receive," the therapist said. "The disorder is
usually only diagnosed after everything else is ruled out." When my
father and I got back to the halfway house, he called Dr. Titrate. I
listened in while he recounted the recent turn of events. Dr.
Titrate was mostly silent. At the end of the conversation he said,
"I admit I've made some mistakes. I have a conscience. But, at this
point, what can I do?"
January 2007 Lamictal
I'm back in college now, in my
senior year. Since going off Lexapro, I have been free of manic
feelings and suicidal thoughts. I've got a new therapist, who
specializes in dialectical behavior therapy. She shows me how
certain thinking patterns cause symptoms by projecting a fun-house
picture of what's going on in my life. She locks in on what I need
to change and what I don't, then works for those targeted changes.
The therapy is different from any I've ever had. I feel like I'm
taking a college course on myself.
Prescription drugs are still a
hit-and-miss proposition for me. Last January, a new psychiatrist
prescribed Geodon, a schizophrenia medication used to treat mania
associated with bipolar disorder. In rare cases, it can actually
provoke mania. I was one of those cases. I jittered and shook and
could barely sleep. The only medication I'm on now is Lamictal, the
mood stabilizer.
I haven't heard from Dr. Titrate
since an envelope bearing his name and return address arrived at my
home. Inside was a bill for $250, his consulting charge for my
father's last phone call. My dad and I had a good laugh over that.
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