Editor’s Note: Some names have been changed to protect the privacy of individuals mentioned in the article.
Maria is sitting on her bed, telling me about her medication. She is lying on her side with her head propped onto her right arm and her hand immersed in her long black hair. She has a freshly poured bowl of Fruit Loops in front of her. She apologizes in advance for eating while she talks, but she doesn’t want the cereal to get soggy. She isn’t wearing pants, just underwear, and I can see her hipbone jutting out. When she was at rehab for two weeks over the summer, staff members had to follow her into the bathroom to ensure she wasn’t bulimic.
“This is my natural body weight,” she says.
I believe her, but when I wrap my arms around her I worry she might break.
Maria’s room is a Candyland of designer clothes and scattered furniture. Two months into the school year, she is still in the move-in process, and shelves, dressers and boxes all line the floor of her bedroom helter-skelter. On a newly-built shelf adjacent to Maria’s bed rests a two-foot-tall bong.
Next to this, Maria manages her own private pharmacy. Bottles of Klonopin, Seroquel, Lomictal and Vyvanse lie in a row. The Seroquel is new. She opens the lid and turns the bottle upside down, letting the pink, shockingly tiny pills fall into the cap.
“It’s smaller than my birth control,” she notes.
Maria is not the only American with a hefty collection of medications. Roughly 7 in 10 Americans are taking a prescription drug. A sizable portion of these drugs treats mental illness, the two most prevalent of which are depression and anxiety.
Anxiety is the most common mental illness in the United States, affecting 40 million Americans, or 18 percent of the population. Depression is a close second — 19 million Americans have depression in a given year, and the lifetime risk of becoming depressed is 17 percent, according to the Anxiety Disorders Association of America.
Where there is illness in America, there is medication. Data shows 1 in 10 Americans take an antidepressant, a drug used to treat both depression and anxiety. For women, this number is closer to 1 in 4.
Maria is playing with a twiddler — a worm-like green necklace she bought at a drugstore. She has trichotillomania, meaning she obsessively pulls out her hair. Her bald part-line is twice the thickness it should be, because that’s where she prefers to uproot the black strands of keratin from their homes. She does this because she suffers from severe anxiety.
“I try and wear a hat all the time, but I also try and have something in my hands.”
As we talk, Maria repeatedly forgets about the twiddler and absentmindedly sticks her fingers into her hair. Whenever she does this, I silently hand her the twiddler.
Maria had good reason to see a psychiatrist. She has been arrested twice — both times for assaulting a cop. Both while blackout.
Her second arrest is what got her sent to rehab for drug and alcohol abuse. Since then, Maria has been diagnosed with Bipolar II Disorder. This is much less scary than it sounds, as Maria makes sure to inform me.
“I’ve never had a state of mania like a real bipolar person would,” she says. “Other than when I’m blackout drunk. That’s mania.”
Given her past, Maria’s diagnosis seems neither surprising nor inaccurate. Still, the pill bottles on her shelves draw my curiosity. The Klonopin treats her anxiety. The Lomictal and Seroquel act as mood stabilizers. The Vyvanse helps her focus.
She refers to herself and her psychiatrist in the collective when she discusses why she takes all of these pills. In particular, the Lomictal no longer seems necessary now that she has been prescribed Seroquel.
“We don’t know what would happen if I got off it,” she says. “It’s not doing anything bad.”
Over the last decade, it has become more and more common for college-aged women to be on the types of medication that Maria takes. The chance of a major depressive episode in 18 to 29-year-olds is three times higher than in individuals 60 years or older, according to the Diagnostic and Statistical Manual of Mental Disorders.
Most of these episodes occur in females. A quarter of American women take a drug for a mental health disorder, compared to 15 percent of men. The ratio of women to men on anti-anxiety meds is 2 to 1.
For many of my female friends, it began with anxiety. They went to a psychiatrist because they were too anxious to function normally, and were ultimately prescribed either an antidepressant or an anti-anxiety medication. From there, most were eventually labeled with a term like bipolar or clinically depressed.
“It’s important to not let the labels bother you,” Maria tells me, taking a bite of Fruit Loops. “All it is is a label for your symptoms.”
I ask Maria if she always knew she had a mental illness. The short answer is yes.
“I was really an angry kid, I did not have a great childhood.”
She sticks her fingers in her hair.
“It looked picture-perfect, but a picture-perfect family is usually not a close family.”
In my mind, I contrast my own experience with Maria’s. I grew up in an extraordinarily tight-knit family. My father and mother spoiled me endlessly, and my three best friends — my sisters — were never more than a bedroom away.
Every day of my childhood, my father took my sisters and me on different adventures, like the movie theatre or the arcade or the park. He called these outings “secret missions.”
There was even a secret mission song (which I have now discovered, to my disappointment, is actually the James Bond movie theme). When we got home, my mom would brush our hair and take our coats off for us, then heat something up for dinner (she is an awful cook).
Growing up, I went to the same private school for eight years, but when I walked out of those heavy iron doors for good, I had made few close friends. My sisters and my parents were my best friends.
When I started my freshman year of college, I left my family members behind. My older sister didn’t go away to college. I was the first one, and I had no idea what I was in for. At school, I felt completely alone. My family was only 45 minutes away, but it might as well have been light-years. I had no one close to me, and no idea how to let someone get close to me. I missed my family terribly.
All I could think about was how my life would never be the same again, how it would never be good again.
I stopped eating. I stopped sleeping.
I thought about death and dying constantly, and I cried all the time. This went on for months.
Despite some of my peers’ concerns, I never sought professional help. I was sure if I told a therapist what I was going through, he or she would try and convince me to take medication. The concept of taking a pill to make me happy made me uncomfortable. It reminded me of all the books I’ve read where the main character gets brainwashed, and suddenly she’s lost all her individual thoughts. She becomes the minion of some generic Disney-type villain who has an odd hairstyle and gives long monologues about his evil plans.
I used to tear through these types of books. Experiencing my favorite character lose the ability to think for herself gave me a sick sort of pleasure. It would almost be freeing, I thought, to have someone else controlling you, thinking for you. I didn’t want to be prescribed antidepressants because I wasn’t sure I could resist. I wasn’t sure I could stop myself from taking one of those tiny pink pills that would wipe my sadness blank.
When Marilyn Gilbert returned my phone call, she was elated for the chance to get to know me. She left me a voicemail: “I have seen your photo in your dad’s office, so I have kind of already met you.”
A patient in my dad’s internal medicine practice, Gilbert, who holds a doctorate in psychology, verifies the rumor that doctors need doctors too.
Over the phone, her voice sounds like a character from Sesame Street. It maintains a softness, like she is teaching a child, but it is comforting rather than condescending.
As she talks, she continually uses examples drawn from tennis. I smile, realizing she knows I’ve played the sport my whole life.
Gilbert says she believes antidepressants are overprescribed, particularly to teenagers.
As a psychologist, Gilbert does not have the ability to prescribe the medication herself. What she can do is help to wean her young patients off antidepressants when she finds them unnecessary.
“It becomes a real problem for a lot of the college-age kids that are on them,” she tells me. “They’re embarrassed. They don’t want people to know, and they begin to worry it’s interfering with other functions.”
In place of drugs, Gilbert prefers to trigger our body’s natural medication — endorphins. Endorphins are endogenous opioid neuropeptides. Essentially, they’re our body’s built-in drug pathways meant to induce pleasure and relieve pain.
There are multitudes of healthy ways to trigger a spike in endorphins: eating a good meal, exercising, getting enough sleep. Even seemingly superficial pleasures like eating dark chocolate or getting a massage will increase endorphins. High endorphin levels make people happier, reducing the need for antidepressants.
In some cases, though, drugs are necessary to treat depression, namely when the depression is defined as “clinical.” But the line between clinical and non-clinical can be fuzzy.
You can’t take a blood sample and tell if someone is depressed or not — you have to have a conversation.
Gilbert draws the clinical depression line based on two factors: intensity and duration.
“How bad is it, and how long have you been struggling with this?” she asks her patients.
Questions of intensity and duration get at the larger question — is your depression so powerful that you can’t function? Inherent in this criterion is the idea that humans are supposed to be sad sometimes. It wouldn’t be natural if we were never anxious, angry, or upset.
“A good case of the blues, and dealing with loss and life changes is part of being alive,” Gilbert says.
If your mental illness is not harming your life in any tangible way, it’s not a mental illness. It’s a feeling.
Some instances of clinical depression stand out to Gilbert. These patients’ stories seem rehearsed, as if Gilbert has recalled them repeatedly.
One story is of a Michigan State University student who took a semester off, in part due to her depression. Every morning, she would run herself a hot bath, and stay in the bathtub for hours. She couldn’t convince herself to get out.
“The longer she stayed in the tub, the harder it was to get out and face the day,” Gilbert says.
The next story is of a man who compared living his life to “walking in glue.”
She pauses and takes a slow breath: “When someone says that to you, you get a pretty good image of how hard it is to get through each day.”
Raina sits across from me in one of the study rooms in my apartment building. She usually texts me every morning, but she didn’t answer my texts for three days leading up to her interview. She’s dressed up to her usual hipster standard — a red-plaid, sleeveless collared shirt buttoned up to her chin, dark-wash blue jeans and black combat boots with silver studs on them. She kicks the boots off and they rest, homeless, under the table.
The room is entirely white. White walls, white table, white chairs — the blank, empty kind of white that is almost reflective in its uniformity. It’s the color of the Elmer’s glue kids use for their preschool art projects. The door of the small, square room is closed, and it’s so quiet that I can hear Raina’s slow breaths echo off of the erased walls.
Raina is on Zoloft, an SSRI or Selective Serotonin Reuptake Inhibitor. SSRI’s are by far the most common type of antidepressant. They work by increasing your brain’s levels of Serotonin, a mood-elevating neurotransmitter.
At the beginning of her sophomore year, Raina decided she wanted medication for her anxiety. She had tried regular talk therapy, and she says it didn’t work for her. From a psychologist’s point of view, Raina was a textbook candidate for medication: her anxiety was interfering with her everyday life.
“It was happening all the time,” she tells me. “I would feel awkward participating in class…Random stuff like that.”
Raina’s dark brown hair is pulled back, a typical style for her, and she plays with her ponytail as she talks. I watch her cleave the hair that is trapped in her hair tie into two strands with her fingers, then pull in opposite directions, tightening the ponytail.
“I was unhappy for no reason.”
I watch her loosen her ponytail and bring her hair over one shoulder.
“There would be fun things going on and I would still be overly emotional about everything and overreact to things.”
When Raina first began to feel anxious, she turned to the University’s resources for students with mental health concerns. She went to Counseling and Psychological Services, which provides University students free mental health care, for individual therapy sessions to psychiatry appointments.
Outside of the door of its third floor Michigan Union office, there is a wooden board with block letters that say “Stop Student Suicide.” There are about 20 hooks nailed into the board with handwritten notes hanging from them. I don’t stop to read the notes as I walk in.
There is a rumor at the University that, if your roommate commits suicide, you get straight As for the semester. The rumor has such dark implications that I can’t fathom how it continues to seep through college freshmen like water spreading on a dry paper towel. Maybe it’s because everyone imagines it’s just a rumor — that no one’s roommate will ever actually commit suicide.
But they do, I think to myself as I stare at those words.
Stop Student Suicide.
Suddenly, I am 16 years old again. It’s morning, and my parents are talking in hushed whispers outside my bedroom. Anna, my older sister, is 18. She drives me to school and seems unashamed of the white hospital bracelet that clings to one of her sticky, taped up wrists. No one will tell me what is going on but I find out anyway because the blood is all over the place. She cut too hard this time.
When I approach the woman working at the CAPS front desk and tell her I am there to interview Dr. Lindsey Mortenson, she tells me to have a seat. I imagine she is about to schedule me an appointment with a therapist.
You’re here as a reporter, I keep repeating to myself, but I’m not convincing anybody.
Heat begins to seep through my skin and crawl into my soul like a worm eats its way through an apple. It’s so hot that I worry my sweat will flood the room, lifting all the chairs off the rug and making them float down the hallway like ghosts. The room is completely windowless, and every surface is covered with its own sickening shade of purple. The walls are lilac, the seats magenta, and the carpet violet. None of the other students seem to mind, though. Everyone is well dressed and complacent. We could be waiting to board a cruise.
Just as I am beginning to get seasick sitting in purgatory, Dr. Mortenson comes to my rescue.
Dr. Mortenson is a psychiatrist, meaning she is licensed to prescribe medication. Four floors up from the Union basement’s Subway restaurant, her office perpetually smells like $5 Foot Longs.
Like the rest of CAPS, Mortenson’s small workplace lacks a window. She gestures to a mirror on the back wall.
“That’s my window,” she jokes, sadly.
Impressive degrees line the walls, including a medical degree from Columbia University.
We make small talk for a second, and then she asks me to have a seat in one of two squishy gray chairs, positioned across from one another. Sitting, I can’t shake the feeling that I am a patient and Mortenson is about to prescribe me medication. We speak in soft, intimate voices, and my questions sound almost like guilty confessions.
When I ask, “What are the criteria you use to prescribe medication?” I could be admitting, “I’m having trouble sleeping.”
Usually, patients come to Mortenson because they’re already considering the option of medication. By the time a patients are sitting across from Mortenson in one of those comfy gray chairs, many have already tried other approaches, like going to talk therapy, eating better and working out more.
“Usually by the time I see them those changes have not been working and they are pretty symptomatic,” Mortenson says.
Mortenson’s job is to diagnose the patient with a disorder and then decide what medication would be most appropriate for that particular patient.
I ask her whether this process is difficult.
“Not really,” she says, shaking her short blonde hair from side to side.
The DSM-V — Diagnostic and Statistical Manual for Mental Disorders — lists specific criteria for every type of mental illness. Mortenson makes her diagnosis based on a checklist.
When I ask Mortenson if she ever tries to talk her clients out of taking medication, she says no. The way she sees it, that is not her job. Her job is to help people.
“If you have a medicine or procedure to help somebody, you do it.” she says, her blue eyes shining like morphine stars. “What would that mean to withhold treatment that we know works for a lot of people?”
I try to see Mortenson as a villain for prescribing drugs so freely, but I can’t. I think about my father. When I call him with an ear infection or a headache or a sore throat, he brings me medicine. He never tells me that drugs are not the answer or that I should try other methods first. He just treats the illness.
In the 2013-2014 academic year, CAPS had 20,000 mental health care appointments. It’s no coincidence that University therapy centers like CAPS see so much action. College is a huge stress inducer.
“It’s a tough time in life,” Marilyn Gilbert, the psychologist, had told me. “There’s a lot of pressure to succeed and be academically present and to get a job and see what your life situation is.”
For the most part, students beginning college are also away from their normal social support system — friends, families, doctors — for the first time. This loss is extremely challenging for many students and can act as a trigger, especially for those who have already been struggling with their own mental health.
Additionally, there is much, much higher substance use during college years compared to other periods of life. Binge use of alcohol, weed and other drugs is standard practice on college campuses. It is easy for a student to turn to substances when they are feeling down. And it’s also extremely dangerous.
“Alcohol is a depressant,” Gilbert said. “It’s tempting because it takes away the bad feelings, but it really adds to the depression.”
Playing into all of these factors are the raging hormones associated with one’s late teens and early twenties.
“It’s a time when your body is developing, and there are a lot of hormonal issues that come into play,” Gilbert said.
Young women have much higher levels of sex hormones than young men, causing their moods and feelings to be much more affected by hormonal changes. This is partly why a much greater number of young women struggle with mental health disorders than men.
At the University, Maria drinks more alcohol and smokes more weed — the size of the bong in her room attests to this fact — than she did in high school. All of her manic episodes have occurred while she was extremely drunk, and these episodes ultimately led to her diagnosis with bipolar disorder.
In contrast, Raina was affected more by the lack of social ties she experienced when she first came to college. As a freshman, she was going to Michigan State practically every weekend to visit her high school boyfriend. She went to CAPS initially due to loneliness.
“I was having trouble making friends because I was gone all the time,” she told me.
I think of my own sadness at the start of college, how unbearable it was. I can’t blame Raina for wanting medication when the feeling remained strong a year later. For me, the depression had ebbed over time. At least a little bit.
It’s 2 a.m., and I’m lying in bed trying to sleep, but I can’t stop worrying about Maria. When I stopped by her room after tennis practice, she was clearly under the influence. Whether it was from her hefty stash of weed, her meds or something else, I can’t say, but she told me the Klonopin was making her all wobbly (“I just like, wobble. I don’t fall”).
She was going through a hard break-up, which was partially why I visited her.
While we had been talking, she stuck her right arm out toward me with her palm facing up, like a child sticks out her tongue after just finishing a lollipop. Slashed across her wrist like ink were three bright red, lateral slits.
“Mornings are the hardest,” she had told me. “You know when there are things in your past and you’re just like, that was so embarrassing. That sucked. I think of all those things in the morning.”
Her wrist is so thin that it looks like I could snap it in half as easily as I could break apart a Hershey bar. Maria’s black, straight hair begins to curl into thick brown ringlets like my older sister has.
Maria and Anna are both there with me and their faces blur and merge into one. I cry and cry and beg them to stop hurting themselves. I grab their wrists and pull them behind me, running so quickly that their thin bodies become like capes flapping behind me, fully horizontal as I speed them away to anywhere but here.
I am about to save them but they start fading away from me, disappearing into the blackness and I’m trying to open my mouth but the words won’t come out the way I want them to and then they are gone. I wake up with sweat beaded on my forehead and the fan blowing loudly, spitting warm air onto my face like it’s laughing at me.
I put off my interview with Brenna for as long as I could. Hearing all these stories of mental illness was sucking the life out of me, and I was reaching a breaking point. Brenna’s story was particularly terrifying to me.
From what her brother told me, she was force-fed mood-altering medication she didn’t need. I finally strike up the nerve to call her at 8 p.m. on a Thursday evening. She apologizes for being so busy this week, not realizing that I’m the one who hasn’t been putting in an effort to talk to her.
Brenna talks fast, and she never pauses to breathe. It’s as if she has more words to say then her mouth can physically speak in a given instant.
I can picture her tiny 5’2” body bouncing up and down and smiling as she speaks. She is sunshine streaming out of my iPhone.
Like my other friends, Brenna experienced severe anxiety before she sought medication. Hers, however, began in high school rather than college.
“It was right before my junior year of high school,” she says. “I started getting super anxious and I’d never really experienced that before. I would cry every single day because I was panicked about school starting.”
Brenna fits the criteria of a clinical condition — she was having difficulty functioning normally.
“I was feeling very depressed and very anxious and couldn’t manage it,” she says.
Her words are all run-on sentences. As I listen, a Disney movie appears with an animated storybook on the screen, but the pages are turning too fast for me to actually read it. I breathe for her.
Brenna’s regular doctor was against prescribing medication, and wouldn’t give Brenna antidepressants when she asked.
“I feel like if I had been given something real before, things wouldn’t have gotten worse.”
Brenna went to therapy for a while, which she said was “very helpful,” then started seeing a psychiatrist, who did prescribe her drugs. He cycled Brenna through a myriad of anti-anxiety meds and mood stabilizers including Klonopin, Lexapro, Saphris, and Lomictal.
“I would go back and forth between having antidepressants and anxiety medication, and then mood stabilizers,” she says.
Brenna’s tone is still smiling as she says all of this, but I can tell it is taking an effort. I keep pushing. Although Brenna wanted to go off of her medication after a couple of months, her doctor was dead against it.
“He just kept freaking out and telling me I needed to take medication,” she says, sounding almost offended.
“He would raise the dose of my medication, even if I was feeling fine.”
As I listen to Brenna’s tone, filled with passion and animation, I think of the way her brother described her in the period she is telling me about. He said she was like a zombie.
Eventually, Brenna quit taking all of her medications, against her doctor’s advice. She cut off all communication with her doctor in order to do this.
“I don’t see him anymore,” she says. “I just stopped talking to him when I stopped taking my medication.”
Brenna has been doing well in the three years since she went off of her meds. She has learned how to manage her anxiety and depression through natural methods like talking to her friends, eating and sleeping well, and exercising.
She says it was important for her to be able to function without taking drugs. When she went off her medication, her friends all told her, “you are back.”
One of the drugs Brenna was prescribed was Klonopin, the benzodiazepine that makes Maria wobbly. Benzos are different than antidepressants in that they are much more mood altering and intense. They give you a high.
The potential side effects associated with benzodiazepines are similar to those of any powerful drug — they include dizziness, memory loss and impaired thinking and judgment.
Benzos are also intensely addictive when used consistently. Depending on your dose, if you take a benzo every day for a couple of months, you are likely to become both physically and emotionally dependent on the drug.
You begin to crave it, to need it.
Brenna told me she was given an unnecessarily high dose of Klonopin.
“It was very easy to become dependent on it,” Brenna says. “When I started taking Klonopin, I would take it two or three times a day.”
As with any drug addiction, withdrawal symptoms will occur if you stop taking the drug.
The short-term withdrawal symptom is increased anxiety. If you stop taking the drug too abruptly, though, you could be victim to seizures or delirium.
Brenna had to wean herself off of Klonopin without the help of her doctor.
Like Brenna, Maria was prescribed Klonopin to treat her anxiety. She was too anxious to sleep at night.
“He gave me Klonopin for my anxiety because I’ve been waking up six times, not being able to go to sleep, not being able to sleep through the night.”
Even with her initial dose of Klonopin, Maria couldn’t fall asleep at night. When she called her psychiatrist about this, he upped her dose over the phone.
Unlike benzodiazepines, studies show antidepressants are not addictive and do not cause withdrawals. They are thought to be relatively safe for long-term use. Raina told me she plans to put these studies to the test. She will stay on Zoloft for the rest of her life if she needs to.
“Maybe I just am depressed and there’s something wrong with my brain chemicals,” she says. “If that’s the way it is and I need to take this medication to exist, then that’s how it is.”
Gilbert told me the research on long-term effects of antidepressants is “a little bit murky.”
A few days after our interview, Maria texted me in a frenzy. She told me she had been sleeping for the last 24 hours. Whenever she woke up, she would take another Klonopin and pass out again. I think of Sleeping Beauty and the magic spindle that put her into an endless sleep. She asks me to come over and talk to her.
I beg Maria to get out of bed, to come see me, but she won’t, and I can’t go to her bedroom. Not today. I want to help her but the floors are all sticky and I can’t seem to lift my feet up. She’s just down the hallway, but when I look toward her room the length seems to triple like in a scene from Alice in Wonderland and I know I’ll never make it. Our demons are chasing us like zombies and I can’t distinguish between who need saving and who doesn’t. I can’t go to Maria’s room today. Maybe I’ll feel differently tomorrow.