The Washington PostDemocracy Dies in Darkness

The hard truths your psychiatrist may not be telling you about antidepressants

Amy Ellis Nutt covers neuroscience and mental health for The Washington Post. She won the Pulitzer Prize in feature writing in 2011 and is the author, most recently, of “Becoming Nicole: The Transformation of an American Family.”

In the mid-1980s, Eli Lilly was looking for a blockbuster new drug. Might ILY110141 be it? The drug seemed to have a lot of potential applications — as a treatment for blood pressure, obesity, even schizophrenia. The company had another thought: Maybe ILY110141 could be used to treat people who were mildly depressed.


ILY110141 hit the U.S. market in January 1988 under the name Prozac. Eli Lilly, sensing a windfall, went all out with promotions. The company mailed out millions of brochures and made 200,000 posters. Prozac appeared on the covers of Time magazine and Newsweek, and in its first year raked in $350 million. Pharmaceutically — and financially — a star was born.

There was only one problem. As Prozac sales took off, so did the number of depressed people. The deeply troubling question was: Why was a “miracle” drug to treat depression associated with a rise in depression — or at least in its diagnosis?

In her informative and detailed new book, “Blue Dreams,” Lauren Slater traces the meandering, mercurial history of psychiatric drug discovery, from Thorazine to deep brain stimulation, with a couple of forays into psychedelics. But she is at her most prescient when discussing Prozac, from its initial promise to its saturation of American culture.

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“It was as though everyone with any kind of depressive streak came forward with palm held out,” she writes. “Eventually the concept of depression ballooned to embrace the irritable . . . the workaholics, the pessimists, the panicky, and the malcontents.”

Slater also helps to further debunk the “chemical imbalance” myth of mental illness, citing “the paucity of evidence” supporting the role of neurotransmitters in depression. First and foremost is the fact that no one knows the cause of any mental illness, and as far as neurochemicals are concerned, scientists don’t even know what a balanced chemistry looks like. Slater points out, for example, that there are many people with low serotonin who show no depressive symptoms. Only recently, in fact, have researchers turned to aberrations in brain circuitry, as opposed to unbalanced brain chemicals, as a possible source of mental illness.

The most moving and ultimately most compelling parts of “Blue Dreams” are those where Slater recounts her harrowing history of drug treatment for bipolar illness. Here she illuminates the long-term physical effects of these medications, a subject rarely addressed in the psychiatrist’s office.

Of her dependence on one of the most toxic of these drugs, the second-generation antipsychotic Zyprexa, Slater writes:

By taking it “I was effectively agreeing to deeply damage the body upon which I rely to survive. As the Zyprexa toyed first with my metabolism and then with my body, my weight went up, up, up with the end result that I am now an overweight diabetic.”

Poor blood circulation puts Slater at risk for blindness and even limb amputation. High blood sugar has already taken a toll on her kidneys; elevated blood lipids threaten her with pancreatitis or worse, stroke or heart attack.

“To put it bluntly, I am not aging well,” she writes. “I am unhealthy, and this is largely due to psychiatry’s drugs. And yet, I cannot live without these drugs.”

Slater is certainly not alone in this predicament. About 40 million American adults — 1 in 6 — takes a psychiatric drug, according to IMS Health, which maintains the largest national database of prescription information. More alarming is the increase in psychiatric polypharmacy — taking multiple psych drugs simultaneously — even though very little research has been done on the interactions and side effects of taking more than one such drug at a time. Slater wisely points out that anyone who ingests a pill for the treatment of, say, depression or anxiety or psychosis is essentially introducing a foreign substance into the brain.

And yet, she goes on to say, what would you have people with a serious mental illness do? There are surely untold numbers of those who, without the benefit of a drug for their mental illness, would be dead. Slater considers herself one of them.

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In details both lyrical and crushingly painful, Slater describes her lifelong struggle with what Winston Churchill called the “black dog” of depression. There is the nightmarish daydream of a sun that burns day and night, that never sets, leaving her “trapped in a white hysterical light.”

Where the book occasionally stumbles is in Slater’s description — perhaps more like wishful thinking — of advances in the physiological understanding of mental illness. For instance, she mistakenly points out that the dexamethasone suppression test could be the first biomarker of depression. The test, which ties high levels of the stress hormone cortisol to depression, was briefly employed as a diagnostic tool in the 1980s before scientists realized that many different kinds of stress, such as a head injury or chronic fatigue, can produce the same high cortisol. By 1990 it was largely discarded as a diagnostic tool.

At its best, “Blue Dreams” is a raw and honest memoir, and frankly one of the few that shows the truly dark side of medication — even as that medication saves lives.

By Lauren Slater

Little, Brown. 400 pp. $28