Me minus Zoloft equals what?

After seven years on meds, my therapist says I'm stable. Does that mean I'm cured?

Published February 1, 2005 8:00PM (EST)

Dear Cary,

I have been taking Zoloft for about seven years. I started taking it after my short-lived marriage ended, but my depression had roots going back long before that.

I remember being a very sad little kid, and even saying once to my mother when I was very young, "Little kids are supposed to be happy, but I'm not." This was in the 1970s and, at least where I grew up, people had no concept of childhood depression, so I went undiagnosed for years. My family just thought I was the "moody, sensitive one." High school was sheer hell, and in college I finally had a complete meltdown of profound sadness and hopelessness. I never actually attempted suicide, but I thought about it a lot, and I cried almost every day for my entire junior year. I finally started going to therapy on campus, and was put on Prozac. My therapist also taught me about cognitive therapy, a way of thinking and perceiving events in life that was radically different from what I was inclined to do.

Unfortunately, these strides were made near the end of my senior year, so shortly after, school (and therapy and Prozac prescriptions) ended. But I was feeling better, so after just six months on Prozac, I didn't seek out a new therapist to continue my prescription and counseling. Instead, I got married.

I had dated this guy throughout most of college, and I think he thought he was some kind of knight in shining armor who could fix me. This, of course, is a ridiculous notion (that lots of guys seem to have). Besides he couldn't even fix his own problems, so we found out very quickly that we were two young, screwed-up people who should never have gotten married. After less than two years, it ended very, very badly.

Marriage aside, my depression didn't just come out of nowhere. My father is a very messed-up guy, and he takes heavy-duty meds for manic depression. He also was undiagnosed and untreated throughout my childhood, so I can't say if it was his erratic, frightening behavior that caused my depression, or if it was his fucked-up genes passed permanently to me that are responsible. Either way, the Zoloft that I was finally prescribed, along with a more in-depth study of cognitive therapy techniques, finally seems to have made long-term changes in my life.

So here's the part where you come in. I've had several different therapists over the seven years I've been on Zoloft, and the woman I go to now I've only seen three times. At my last visit, I asked her how long people stay on these drugs, and she said that I seem "stable" and that after seven years it might be time to try going off of it if I want to.

I think I do want to, because my insurance sucks and Zoloft is very expensive. But also, when I think back to how I used to feel, it seems like it was another lifetime. My life is so different now -- I know it sounds clichéd, but I feel like a veil was lifted, and now I'm who I really am. Whether it was having some years to heal from my father's poisonous behavior, or the Zoloft, or the absolute genius of cognitive therapy techniques, I feel normal now, like I'm free to actually experience what it's like to feel happy, or even just contented. This is who I really am -- this is the real me when all the muck is scraped away.

But what if this isn't the real me? What if this is just a Zoloft-induced stupor, and I'm actually a very sad person who breaks under pressure? What does that mean for my life? If I do go off Zoloft, it will be done slowly under careful supervision, so there is no danger of a serious relapse, but I'm afraid of what I might discover about myself. Of course, a person can't just stay on antidepressants forever, can they? I have to go off it sometime, I guess, but I'm afraid. I might not be who I think I am, and for all my study of cognitive therapy, I'm at a loss as to how to think about this if I find I can't function normally without Zoloft. Should I even try to?

Girl on Meds

Dear Girl on Meds,

When it comes to going off your meds, I can't advise you either way. I'm simply not equipped -- I don't have any expertise or any firsthand knowledge of your situation.

But we can still have a decent conversation. As a writer, I'm very interested in how we use language to construct reality and to imagine the future, and how our use of language affects the way we feel and how we act. As you may have learned in your study of cognitive therapy, it's surprising how powerfully words affect how we feel. So when you say, "What if this isn't the real me?" I must say: I feel confused! The question follows the grammatical rules of an intelligible sentence, but its subject and object are both elusive.

As far as "the real me" goes, I believe that each of us has unique attributes, and that each of us has something you might call a soul or a core self. But things seem to go a whole lot better when I keep in mind that my "self" includes many roles, and that, taken as a whole, a person might best be described not as a single self but as an unfolding phenomenon.

One of the most shocking but ultimately liberating moments in my short course of cognitive therapy was when the therapist told me, "You are not your writing." I protested that yes, indeed, I was!

"No, you're not," he said.

Yes, I am!" I said.

We went back and forth like that for a while. He eventually wore me down. I understood intellectually that I was not my writing. I was a person and my writing was words. But still, I felt like I was my writing. I was a writer. That's what I did. What I did was who I was. My writing and I were the same. I was my writing.

He was able to demonstrate to me -- or to cajole me into demonstrating to myself, actually -- that I was also a husband, a friend, a worker, a son, a brother, a person in recovery, a poet, a musician, a dancer, etc. (The dancer part is a stretch; I think he threw it in for humor.)

So that's my take on finding "the real you." I wouldn't worry too much about any such category. It's at once too limiting and too vague. Now, as regards your depression, the only way I can talk about it is by talking about alcoholism as an analogy. Like your depression, my alcoholism is something I've got and I have to do things about it or it takes over. Like your depression, my alcoholism was for many years a defining difficulty in my life. Now it is something I live with by following a regimen. If I deviate from the regimen, I have a good idea what will happen. So I don't deviate from it.

Fortunately, not drinking doesn't cost much. We're both on medicinal regimens in a way, except my regimen requires that I not take certain expensive medicines, and yours requires that you do take it. The thing I don't understand, though, is why, aside from the expense, if you're happy on the meds, you are thinking about going off them. You say, "I have to go off it sometime, I guess."

Is it necessary for you to go off it sometime? Why? Is it toxic over a long period of time? Is it just the expense? What benefit is there in going off the drug? Is there a possibility that you will feel not only OK but actually better off the drug? How much of your interest stems from an unexpressed wish to be finally, once and for all, completely cured?

While, again, I can't advise pro or con, here is a quote from that made sense to me: "The most important thing to remember is this -- your symptoms have gone away BECAUSE THE MEDS ARE WORKING! It's not necessarily because you've been cured."

Let's turn to a question I feel better equipped to answer: If you went off the meds and it turned out that you couldn't live happily without them, what would that mean? What kind of person might you be? It might mean that you're a person who, after a long course of antidepressants, made the decision in concert with your therapist to gradually reduce the dosage in order to find out if it was possible to live happily without the drugs. And what if the truth turned out to be that you cannot live happily without the drugs? It might mean you're a person who had the courage to find out the truth about your condition, and now has found out the truth and is trying to live with it. Would that be so terrible?

Here's how I suggest you think about it: On Zoloft or off Zoloft, you are still the real you. The real you has depression. The real you takes meds for it. The real you sometimes thinks about not taking drugs for it. The real you wishes you could be happy without meds. Maybe you'll find out if that's possible. But if you do stop the drugs and become less happy as a result, you won't be less real. You'll just be less happy.

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