Zoloft, Revisited
This one is personal...
This is a narrative of the night after my first dose of my first psychiatric medication. It was Zoloft. I was a teenager. It did not go well.
Welcome to the Frontier Psychiatrists newsletter. There is now a whole book of these. Inessential Pharmacology. (Amazon link)
September 29th, 1995.
I woke up at about 3 AM. Maybe it was four. I had a clock next to my bed. It was triangular when you looked at it, end-on. It was about 8 inches long.
It had a cassette player built-in. It had a radio built-in. It had a deafening alarm. It had bright red digital numbering. The time was somewhere between 3:00 and 4:00. AM. I was 16 years old. I was very, very awake.
I had taken my first dose of Zoloft the night prior. I was depressed—or at least the night before, I was very depressed. Now, I had energy. I was awake. I didn't know what to do with it. I looked up. My eyes followed the canted ceiling of the third-floor room, with the high, peaked ceiling, till the dim red light from my alarm clock bounced in just the right way to allow my eyes to come to rest. They stopped, for a moment, on the wood of the bed frame. My bed had four tall posts. They were painted a dark green. They were made of pine. They were about 7 1/2 feet tall. I was not 7 1/2 feet tall. It was as if the princess bed concept had been co-opted by something male, teenage, and desperate.
In my room, a ceiling like a cathedral rose to a point in the dim red light of the alarm clock’s LED. It was an implausible ceiling. I pretty regularly had trouble sleeping. This was different. I wasn't tired. I was awake. I got out of my bed. In my youth, I was very thin.
I weighed 119 pounds. I was 5'8" tall. I was wearing pajama bottoms, and I had taken off my shirt. I have these old, ratty square floor pillows. Feeling restless, I got out of my bed and lay on them. I was squirming and moving back and forth. This restlessness was novel. In fairness, it was novel then. At the age of 44, I've been restless many times since. If I had known that restlessness would continue, I might not have been so casual about the experience of restlessness at the time. It is awful.
I was very awake. I should've been asleep. This medicine was doing something. I didn't know what, but it was something.
Two weeks earlier, I finally told my mom I wanted to die. I had wanted to die for a long time. She got me an appointment with a psychiatrist. I don't remember this person's name. She had curly gray hair. She was in her late 60s. As I remember it, she didn't ask good questions, but I don't recall a word.
I remember she prescribed sertraline— Zoloft—and I dutifully took 25 mg. My mom and I picked up the prescription about two weeks later, and now I was awake. One dose in. At 3:45, now. Torture danced in my mind as my legs moved back and forth. And…back.
I was in love. That's what I told myself. I was in love. And she didn't love me back. And that was torture. That was a story I could believe. Catherine was my age. We both attended the same high school. She was a boarding student. I was a day student. She played piano beautifully. It's more beautiful than I could stand. She didn't know what I thought. At that age, you don't tell anyone what you think. Because you're too worried about what they're going to think. I recall, vaguely, spending a lot of time worrying about what Catherine would think.
She had been through a lot. It's one of the reasons she spent so much time practicing the piano. It was a place for her to think. It was a place for her to be. It was a place where she could talk to me. It was a place for me to fall in love.
I had fallen in love before. Melisande was, in all fairness, the second. Marissa was the first. I couldn't get enough of girls who could get enough of me. The secret to falling in love, it turns out, is to understand that It can happen more than once, twice, or thrice. You don't run out of love. You don't run out of the ability to feel that feeling for somebody. It's an endlessly renewable resource.
I didn't know that then. I didn't realize that it was now 4:15 a.m. And I was still energized. I'd still not fallen asleep. I still haven't told Catherine what I thought. I was still in love with her.
There should be an introductory class, which, of course, makes it useless. Nobody pays attention to style. Nobody pays attention to the introductory anything. We're all busy worrying about what other people think. When it turns out the actual answer is that they are worrying about what we're thinking. It's a lot of worrying. Worrying is common. I had a lot of energy. And I was worrying. I wasn’t a worrier. This was, even to me, odd. It was now 4:30 AM. I just had more energy. My legs moved. Back, fourth. Back and forth. Toes, wiggle, more. More. Move. 445. 446. 447.
I keep moving. I had so much energy.
At around 6:45 AM, I decided it was the day, so I got up. I got dressed. We—by “we,” I mean the students of the Taft School, an elite co-educational boarding school for high schoolers in Watertown, Connecticut—had a dress code. We had to dress in slacks and a collared shirt. We had to be prep school material. At least we didn't have to wear a jacket like those Kent low-lifes. Jackets sucked. Fuck jackets. Slacks were the actual language of the school manual handed to students and their parents to describe the ordained pants.
Catherine adhered to the dress code. Rigorously. Still beautiful. I knew, in my chest, what the outcome would be. I didn't have a lot of experience being a person. I didn't have experience being rejected—avoidance will do that. I didn't know it wouldn't kill me. I was afraid it would.
She did not love me. That was the answer. She cared a lot. She did. I mattered to her. But I didn't do it for her. And I didn't get that that wasn't something that would suddenly be made into a brick wall through my disclosure of my feelings. I didn't realize there was no risk that she would love me.
She would never feel that way. Because I was never her type, and that was a gift for both of us. But I didn't know. At 7:05, I was eating cereal.
My kids eat cereal today—every morning. I get it for them.
I've never had as much energy as I did that morning. I used to drive myself to school. I had a red Chevy Cavalier. It was a terrible car. I can't believe cars were that terrible. It was unreliable. In all fairness, I had driven it off the road in a snowstorm and almost died. So, there was a reason for that particular car to be as unreliable as it was. Because I tried to kill myself, using ice, snow, and reckless use, and maybe that had something to do with the unreliability of the car. This was not an unreliable car morning.
This was driving to school, 30 minutes in 25 minutes.
I was so ready to do something, anything, anything, anything, anything, anything, anything, anything but that.
The advice I gave myself later— about the situation— stop.
JUST STOP.
Honestly, I have been dishonest with myself. I didn't tell him what I should've told myself now. Even when I was offered the opportunity to provide my future self the opportunity to provide my prior self with advice, I hedged my bets.
The Arcade Fire is a band. They've had some difficulties. But they made a video a few years back, inviting you to write a postcard to your younger self in the middle of the music video. They began the experiment by asking you to enter your address. It was a fancy show-off for Google Street View. It asks you to enter the address of your group and sets the video on that street. It's the song “We Used to Wait.” It's animated. It's got a video. And it's got the street, on which is the home in which you grew up.
It has the street on which my dad used to drink in the house's basement. Which wasn't unique; he used to drink in the basement of every house. 101 North Street. Litchfield. Connecticut. The town in which every house was a house in which George Washington was rumored to have slept. We used to wait.
I waited.
The advice it requested was advice for your younger self at the age you were when you lived at the address you entered at the beginning of the interactive HTML5 video experience—the advice I provided to myself?
I provide excellent advice. Any advice I provided to myself at the age I lived at that address was about Catherine.
"Beware things that do not matter."
A week and a half later, I drove my car 75 miles an hour in a thwarted attempt to crash it into oblivion. The police thwarted it in my first—and only— stop for a speeding ticket. The following warning wasn’t provided to young Owen, my physician, or my family at the time.
In my subsequent evaluation with physicians, this would be identified as my first manic episode. This is a known adverse effect of Zoloft in individuals with bipolar disorder as the underlying illness. As it turns out, this was the case with me in 1995.
Zoloft has dosing between 25 and 200mg on the FDA label1
"Beware things that do not matter,” but learn the difference. A decade of suicidal behavior in youth on antidepressants would happen before the risk was understood in October 2004. At this point, the FDA required the above so-called black box warning for antidepressant drugs of any class. That warning became effective in January 2005.
The other articles in this series are as follows: Prozac, Xanax, Klonopin, Lurasidone, Olanzapine, Zulranolone, Benzos, Caffeine, Semeglutide, Lamotrigine, Cocaine, Xylazine, Lithium, dextromethorphan/bupropion and Adderall, etc.
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ZOLOFT is a selective serotonin reuptake inhibitor (SSRI) indicated for the treatment of (1):
Major depressive disorder (MDD)
Obsessive-compulsive disorder (OCD)
Panic disorder (PD)
Post-traumatic stress disorder (PTSD)
Social anxiety disorder (SAD)
Premenstrual dysphoric disorder (PMDD)
I can relate to much of this small chapter of your life. I’ve spent much of my life either avoiding relationships that had potential or falling for girls who did not feel the same for me. Yes the rejection hurts but it does not kill you. I’ve learned that in life timing is everything, like in music. And my timing has just always been off, but I’m still here standing. Anyway, well written and thanks for sharing.