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.
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.”
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.
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.
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.
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.”
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?”
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.