A.—who asked to be identified by her middle initial, more to avoid appearing deviant in the eyes of college-admissions officers than in her parents’—has long, layered brown hair, perfectly tweezed eyebrows, and a self-deprecating wit. A senior at one of the city’s most selective high schools, she radiates intelligence and is almost disturbingly driven: Her college applications were complete by mid-July, a cool five months ahead of schedule. Her relationship with pharmaceuticals is paradoxical, if not uncommon: On the one hand, they epitomize rebellious sophistication; on the other, an absolute necessity. She has her own prescription for Xanax for acute anxiety, though it’s too weak (.25 milligrams) and sparse (only seven pills per pharmacy visit) for recreational purposes, and she used to borrow her mother’s to quell her self-diagnosed anxiety attacks. She also takes 100 milligrams of Zoloft every day—before that it was Lexapro, but that made her faint at school—which she went on after years of therapy and depression that spiraled into a dark, impenetrable haze after breaking up with the boy she lost her virginity to. She was cutting herself and lost twenty pounds when she stopped eating. Going on antidepressants had actually been her idea—she’d seen how Wellbutrin helped her mother—and she credits Zoloft with bringing her back to her “normal self.”
And yet she also relies on such substances to escape that normal self. “Okay, so after we snorted the Xanax, we went to eat some pizza,” she told me over lunch at Cosí, describing the rest of the night. “It makes you hallucinate a little, which is cool. Anyway, we stumbled back to my house, where I passed out on my friend’s lap, only to wake up and hear ‘The coke dealer’s here!’ because apparently I’d called a coke dealer before I passed out. I got up and went to the coke dealer across the street—they meet you in a car; it’s really sketchy, but it’s fun, too.” The remainder of the evening is a blur: some lines of coke, a jaunt to a comedy club she saw listed in Time Out, laughter, some more coke, more laughter, then to a friend’s parent-free apartment on the Upper West Side. “Over there I traded some coke and some Xanax for some weed—yeah, high-class, I know. We got back to my house by one and had the coke jitters, so we snorted a milligram each of Xanax and passed out. You know, it’s good for anxiety, but it really works to counteract cocaine.”
And what about the effects of all these uppers battling downers in a brain stem she admits is fragile, one already altered by antidepressants—does she ever worry about that?
“Sometimes I do, but most times I just don’t care. I think it’s just natural to want to escape real life. I know a lot of my friends are doing this stuff and they’re fine.”
As for all the talk about antidepressants and suicide: “I don’t pay attention to reports like that,” she said. “Sometimes my friends are like, ‘Hey, you’re going to kill yourself!’ But it’s like with eggs—they’ve told us a thousand times that eggs are bad for you, then they’re good for you, one part of the egg is good, one part is bad. It’s just stupid—like saying Marilyn Manson made you kill yourself. Gimme a break.”
The New York City teenager may be a notoriously advanced and savvy species of adolescent, but it wasn’t that long ago that even 17-year-old private-school kids didn’t know what Xanax was. And to those who did, it wasn’t exactly something to brag about. As prescription drugs became a sort of cultural currency among adults (Tough meeting tomorrow? Pop an Ambien! First date? Try a Paxil!), they still carried a stigma for teenagers. Being prescribed a regimen of pills to treat something deemed a psychological disorder—from severe depression to mild anxiety to a difficulty paying attention in precalculus—was perceived as embarrassing, something best kept secret. Braces and persistent acne and tyrannical hormones were overwhelming enough without also being known as the Dude on Ritalin or the Crazy Prozac Fiend.
Drug companies, though, have plenty of incentives to market their drugs to kids. Adolescents represent a relatively untapped (but rapidly growing) market for drugmakers, something any successful business looks to exploit. And they’re generally encouraged to do so by the government. A federal law passed in 1997 allows a drug company to keep its patent an extra six months by performing clinical trials on children, which translates into enormous profits. Zoloft, for instance, grossed about $3.1 billon in sales last year, so that additional time is hugely lucrative.
Meanwhile, the shame associated with psychotropic meds continues to dissipate as doctors write more prescriptions and the diagnosed “disorders” become less severe-sounding. First there was depression, then social-anxiety disorder; now we have general-anxiety disorder, which Xanax’s Website defines as having “vague feelings that something bad is going to happen,” an apt description of what it’s like to be an adolescent. Zoloft’s Website describes social-anxiety disorder as often starting in the “mid-teen” years, and yet the drug’s television ad campaign, with its cartoon powder puffs, looks like a Sesame Street outtake. And while Pfizer denies targeting kids, teenagers themselves aren’t so sure. “That’s so geared toward children,” Timothy told me. “It’s like, ‘You’re not happy anymore? Here, take some pills and you’ll be appreciating butterflies left and right!’ ”
“What’s really changed is that now they market medical conditions,” says Marcia Angell, a member of Harvard Medical School’s Department of Social Medicine and author of The Truth About the Drug Companies, the just-published indictment of big pharmaceutical firms. “It’s simple—there will always be more healthy people than sick people, so they need to make more people think they’re sick. Teens are naturally going through an intense period of ups and downs. The marketing makes them think the downs are unacceptable, that they’re a disorder.”
What such marketing cannot take into account is that kids are cynical, reluctant to take the word of adults at face value. When this attitude mixes with prescription drugs, it turns into a desire to reinvent their intended uses in a manner that’s not necessarily ill-intentioned. Because the taboo truth is that illicit use can be legitimately helpful, which makes the dangers that much easier to overlook.