Timothy Chernyaev wasn’t having an easy time in life. There were issues with close friends, issues at home, issues at school—issues that, frankly, he didn’t feel like deconstructing on a therapist’s oily leather couch. What was the point? To his mind, you could save a lot of money by just talking to a mirror—or, better yet, speaking into a tape recorder, then playing it back while skimming a psychiatry textbook: comparing, contrasting, reaching a diagnosis. And yet he couldn’t shake the idea that what was making his mind and body literally ache might just be . . . depression. So he called a friend who had a prescription for Prozac, and asked if he could “borrow” her pills. This was in April. Middle of his sophomore year at Bronx Science. He was 15 years old.
The decision, in a way, made perfect sense. Though he’d never been prescribed anything by a doctor, pharmaceuticals had become impossible to avoid, an intrinsic part of his life. Timothy had taken Ambien (his grandmother’s prescription), at first simply to unwind, then in larger doses—three pills, five, one time seven—discovering that doing so caused minor hallucinations. He’d sampled Xanax (a friend’s prescription), which he called “tombstones” because the pills resembled two gravestones stuck together. He’d dabbled with Vicodin when his mother got a prescription to treat a pulled muscle, which cracked him up: that a doctor would prescribe a synthetic opiate—wasn’t that sort of like heroin?—for such a routine ailment. And once he’d used Adderall for kicks, something seemingly every other kid he knew had done. Prozac, he understood, was different, an SSRI, which meant it subtly recalibrated your brain’s serotonin levels, and took a few weeks to take effect. Fine. This was a different sort of experiment. He just wanted to feel better.
“And I did—I felt serene almost,” Timothy told me not long ago. “I wasn’t sure if it was the placebo effect, or if it really was working. I just felt kind of numb to everything. You don’t get your lows, but you don’t get your highs either, which can be comforting.”
He’s a tall kid, Russian-born, with striking Slavic features: inquisitive, almond-shaped eyes, wide flat cheeks, full lips. Fiercely articulate, he tends to be seen by adults as too snide and cynical for his age, which he takes as a compliment. Yet as happy as he is explaining why Dostoyevsky trumps Tolstoy, he’s still very much a teenager. Just check him out most Friday nights, hanging with friends in Forest Hills, listening to Modest Mouse, drinking Flaming Doctor Peppers, a cocktail made by lighting a shot of Bacardi 151 on fire, dropping it into a beer, and chugging the whole thing as it foams up like crazy. Like a lot of kids, Timothy keeps an online diary, and after he took the Prozac, its tone became increasingly clinical. Having diagnosed himself, he became his own therapist. Sample entry:
I’m happy. Sheerly happy. Now the decision I have to make is if I’m actually happy or if my mind is stabilized by antidepressants making me happy. Either way, I may need to stop taking them soon. You know, actually deal with my issues as opposed to avoiding them shamefully.
“The other day, my mom decides to try my Adderall and she ﬂips out. She called me literally crying, and insisted I go off it. And I’m like, I’m not going off this during my senior year of high school.”
The Prozac was a secret until one recent afternoon, when he told a close friend about it. They were sitting on the hood of car, smoking menthol Marlboro Lights. She took a drag, looked at him, and said, “Well, I think it’s pathetic, but it’s your call.” That struck a nerve. He stopped taking the drug. Because, when he really thought about it—especially in retrospect—he kept coming back to the notion that he’d done what a lot of doctors in America seemed to be doing these days. Had he unwittingly diagnosed adolescence as a psychological disorder?
Lately, when adolescents and antidepressants come up in conversation, the talk gets stuck on one subject: suicide. A yearlong debate culminated two weeks ago, on September 14, when a Food and Drug Administration panel advised that more stringent “black box” warnings—similar to what you see on the sides of cigarette packs—be placed on guidelines for doctors to highlight possible links to suicide in children and teenagers. A bombshell, as they say, one that had its origins in England, where it was revealed that GlaxoSmithKline may have suppressed data suggesting a link between use of its antidepressant Paxil and suicidal thoughts in children and adolescents. (The investigation is ongoing.) This caught the eye of New York State’s crusading attorney general, Eliot Spitzer, who sued GSK—a case that was settled in August when the company agreed to post all clinical data online and pay New York a conciliatory $2.5 million fine. Meanwhile, Senator Chuck Grassley, an Iowa Republican, launched an investigation into the FDA, claiming that it too had blocked a scientist, Andrew Mosholder, from speaking out about similar findings. There was pressure. Something had to be done. The FDA contracted Columbia University to analyze 25 clinical trials involving 4,000 kids, and a conclusion was reached: Kids on antidepressants are about 1.8 times more likely to have suicidal thoughts and behavior than those not on medication.
So there it was—the mysteries of the teenage mind reduced to a hard number. Fear spread. People panicked. The Times editorialized. A $13 billion industry shuddered. And yet, for all the alarm, the findings are still pretty thin. Suicidal tendencies, of course, are a classic symptom of depression, and there were no actual suicides during any of the clinical studies. (Though one 19-year-old college student with no outward signs of depression killed herself at an Eli Lilly lab during a clinical trial for Cymbalta, the latest antidepressant to hit the market; it’s common that such trials involve healthy patients as well as depressed ones.) But what the debate misses entirely is the role prescription drugs play in the life of a teenager like Timothy Chernyaev—how the off-label prescriptions deemed “relatively promiscuous” by Dr. Michael Fant, an FDA panel member, have slyly bred a new cocktail culture of off-off-label use among kids—part self-diagnosis, part self-destruction.
Especially in New York, a city where, perhaps more than anywhere else in the world, the border between adult and child fluctuates between blurry and nonexistent: Top schools offer cutthroat environments similar to top law firms, and many children are quick to adopt their parents’ tendencies toward hyperactive perfectionism. “It’s very common that it’s the parent who first introduces the child to the drug,” says Tessa Kleeman, the coordinator of the independent school program at the Freedom Institute, a Manhattan outpatient rehab facility where, she says, there’s been an increase in problems related to prescription drugs. “The parents are often in similar environments, often relying on substances to wake up, to get through the day.”
More than 50 kids were interviewed for this article—I spoke to them online, over the phone, and many at length and repeatedly in person. Ambien, Adderall, Prozac, Ritalin, Percocet, Valium, Xanax, Klonopin, Zoloft, Wellbutrin, Vicodin, OxyContin, Concerta, Focalin—these names, and others, punctuate their sentences with the same frequency and familiarity as iPods, cell phones, instant messages, homework. Prescription drugs are sold and traded, sometimes for other prescriptions, for beer, for test answers, for cocaine. On LiveJournal, a popular Website where many teens keep online diaries, you can find Xanax, Prozac, and Ambien listed as interests alongside more prototypical teen fare like miniskirts, Carrie Bradshaw, candles, boys, girls, and Britney Spears.
It’s a tricky issue. Many doctors say that psychotropic drugs are underprescribed to kids—that, nationally, those who could seriously use them outnumber those on them. “But in a place like Manhattan, I’d say there is a bias toward overprescribing medicine to kids,” says Dr. Stanley Turecki, an Upper East Side psychiatrist specializing in adolescents, and author of The Difficult Child, a book about pediatric mental health. Turecki, who describes himself as “conservative” when it comes to writing prescriptions, points out that upper-middle-class parents are especially quick to seek chemical treatment, for themselves and their kids. “The pressure in a certain demographic is extraordinary. You see parents who talk about underperformance as if it’s a disorder, which really goes to the heart of the issue: Are we still treating disorders here? Or are we offering performance enhancement?”