King (whose name has been changed for this story) knew she was lucky to have a comfortable house in a nice Massachusetts town. There was no immediate crisis she could point to, nothing that would look to an outsider like anything more than the ordinary strain of raising a toddler and an infant. As a psychotherapist, she knew intimately that all mothers feel overloaded from time to time. But she could not help blaming herself for losing control—and wanted to do better for her family, to become the calm, competent mother she’d imagined she could be. So she decided to start on the antidepressant Wellbutrin. Eighteen years later, she still takes it. Though she didn’t know it then, millions of women her age across the country were making the same decision. King, now 53, belongs to a generation that has made antidepressants silent partners in the project of motherhood. Take a long look at any group of moms and the capable, energetic, usually put-together ranks will be full of those who rely in part on medication to maintain their equilibrium. America’s stereotype of the antidepressant user may be of a distraught young person searching for her place in the world (an image I explored myself in my 2012 memoir, Coming of Age on Zoloft), but in truth, the heaviest users of antidepressants are women between 40 and 59 years old, with one in four taking a prescription at any given time. (The national average for adults is 11%.) Why have women of this age group resorted to antidepressants? I talked with some of them in a bid to understand. This group is younger than my own mother, whose psychotropic drug experience is limited to coffee, wine, or a watery Old Forester before dinner, plus a onetime prescription for Xanax before a particularly harrowing multifamily camping trip in the 1980s (sorry for being such a handful, Mom). And they’re older than I, who used antidepressants as a college student and don’t yet have kids of my own. Their stories were a window into great and hard-won achievements: children raised and launched, jobs held down, relationships maintained and sometimes painfully ended, endurance, and personal growth. They were also, undeniably, postcards from a difficult, sometimes impossible struggle to lead the lives they’d expected to have and to live up to their own standards. Lindsey Jennings, 54, went on the drug because she felt overwhelmed by responsibilities. She stayed on it for a decade. An imperfect solution in the age of “having it all” Most of all, the stories these women told were about finding a solution to a problem. This is what much of the conversation about antidepressants has missed. Two decades ago, in his landmark book, Listening to Prozac, psychiatrist Peter Kramer predicted that people without serious mental illness might soon use the then-new class of antidepressants for “cosmetic psychopharmacology,” chemically tweaking and perfecting their psyches as a plastic surgeon might sculpt a nose. More recently, as the number of Americans on antidepressants has soared from 6% (13 million people) in the mid-90’s to 11% (more than 30 million) by 2010, doctors and pundits have emphasized that the drugs are overprescribed. But the way these pioneering women use medication has little to do with the hunt for self-perfection and focusing on overuse takes attention away from how many of them needed help in order to survive their complicated lives. What drove—and still drives—these women is the sense of care and responsibility they feel for the people around them and their common desire to be more flexible and emotionally available for their children, spouses, and friends, even under pressure. For the women I spoke to, medication wasn’t just about getting the job done but about being the kinds of mothers, partners, and human beings they wanted to be: listening instead of snapping, lighting up for a child or aging parent instead of giving an absentminded scowl. In this age of “having it all,” these women have found in antidepressants a solution that they know is far from perfect—but has gotten them far. Take, for instance, the experience of Kathleen Shaputis. An upbeat 60-year-old who lives in Olympia, WA, and works full-time as the head of customer service for a printing company, Shaputis is a writer, a foster mom to guide-dog puppies, and the caretaker of three teenage grandsons. She’s also, as she likes to put it, the Prozac Princess. Her enmeshment with the little green pills began 20 years ago, during a time when she rearranged the living room of her two-story house in Rancho Cucamonga, CA, to accommodate her mother’s hospital bed. Months later, her teenage daughter moved back home, pregnant with Shaputis’s first grandson. Soon Shaputis found herself responsible for the care of four generations living under one roof. “It was a lot,” says Shaputis, who was working full-time as a computer tech for the city of Chino. “I came up with tricks for getting through, like throwing laundry in the washer in the morning before work and then in the dryer after coming home. You multitask to the ultimate degree.” Shaputis has natural high energy and a penchant for finding humor in the absurd. But acting as her family’s linchpin for 18 months while her mother lay dying took her to her mental and physical edge. “You feel helpless when you’re in that with a parent,” she says. “You feel drained, tired, and stressed.” When her doctor suggested Prozac at a checkup, she accepted gratefully. All overwhelmed people need a hand sometimes, and most have an idea of what would help, whether it’s quitting work, moving to the country, taking up yoga, or connecting more deeply with spirituality. But it’s one of the ironies of having too much to do that such effortful solutions often feel impossible to pull off. And sometimes they seem beside the point. To Shaputis, medication was more appealing than the alternatives. She didn’t feel a need to deeply analyze her problems or escape from them—she simply wanted a higher gear to power through. Once, when I was in my mid-20s and venting to my mom about how ragged I felt because of all the obligations converging on me—burdens my boyfriend couldn’t seem to relate to—she made a comment that has stayed with me: “I don’t think men understand stress.” At the time, I found the remark bizarre but resonant. Years later, it’s unnerving to find that experts agree. “Women entering midlife are subject to more stress than anyone else,” says David Almeida, a professor of human development at Pennsylvania State University. First, they are raising families and often working and dealing with aging parents at the same time. Second, they are encumbered by the very relationships they build so assiduously, a phenomenon called network stress. “Women are more likely to take on the troubles of other people,” Almeida says. And stress wreaks havoc on our ability to respond to life with anything that resembles joy. Brigid Schulte, a Washington Post reporter and mother of two who lives in Alexandria, VA, became interested in this idea when she was assigned to a committee at work to look into why more women weren’t reading the newspaper. To her and the other women in the group, the answer was so obvious, it didn’t warrant investigation: Duh! Everyone knows women are occupied by so much that takes priority over being informed. When Brigid Schulte, 51, realized that most women in her generation were feeling the same sense of inundation she was, she wrote a book about it called Overwhelmed. Certainly that was the experience of Schulte, who used the antidepressant Lexapro for a year to deal with stress-induced depression. “I felt like my hair was on fire all the time,” she says, remembering her days of balancing a career and two kids of single-digit age. “I felt overloaded and like a failure in every sphere of my life.” After realizing how many people felt the same way, she started doing research for a book, and in March published Overwhelmed, which looks at Americans’ issues with time use, especially those of working women with kids. She found an indicator that may explain more than a few cases of heads aflame: The average mother performs 21 hours of paid work a week—up, not surprisingly, from 8 hours a week in 1965. What is surprising is that mothers today also spend even more time on child care than moms in 1965 did—another 3-plus hours a week. But it isn’t just how much time women spend on obligations, says Schulte. It’s the imperative to switch back and forth between primary duties at work and at home (where women tend to feel in charge, even when others help out). “You’ve got this incredible strain of trying to live two lives at once,” she says. “Men don’t have that.” Double duty can lead to guilt and frustration about underperforming in both roles. “I’m one of those women who felt aligned with the feminist ‘We can do everything’ theory until I had my first child,” says Lindsey Jennings, 54, a resident of Richmond, CA, who was on Prozac for 10 years following the birth of her second child. “I wish someone had said, ‘Be prepared; you’re going to be 70% at work and 70% as a parent. You can’t do both.’” Busy women who use anti-depressants often describe the drugs as more like a steroid than a cosmetic, as Kramer saw them. King found in antidepressants a source of energy to do all the things it seemed other mothers pulled off so effortlessly. “I could be social, functional, pleasant, and patient with my kids,” she remembers. “I could go work out and look good, and then have a full-time job. It’s ridiculous! I don’t think I could have done it without that.” Shaputis calls Prozac wonderful, saying it’s helped her “keep sanity in the schedule.” “I always felt like my hair was on fire.” Says the Prozac Princess: “It helps keep sanity.” Despite these plaudits, nearly all concede that the drugs aren’t perfect. Nicole Magnuson, 57, of Berkeley, CA, told me that she relied on Lexapro while living with her adopted daughter, a grade-schooler with severe behavioral issues. The price Magnuson paid was an extension of what made the medicine effective in the first place. “In addition to not getting angry, I just didn’t deeply feel other things,” she says. “I didn’t feel deeply in love or deeply happy; I felt like I was walking around in a bit of a fog.” And many women willingly, if grudgingly, gave up sexual desire in exchange for antidepressant relief. Reduced libido reportedly affects up to 70% of people on the drugs. King, who described sexual side effects as a strain on her marriage, put it this way: “The bedroom’s dead. Everything’s in the living room. Yes, you function as a family unbelievably well—but the intimacy really, really suffers.” One poignant indicator of the tradeoffs is the number of women who told me that they plan to stop taking medication when they can—when kids leave home, parents pass away, and the sense of responsibility for others’ well-being diminishes. Then, they say, they’ll be able to figure out who they are without the drugs—a kind of self-exploration I’d mostly associated with young adults on medication, not adult women. King, whose younger daughter just left for college, tells me she is seizing the opportunity to try life without antidepressants after 18 years: “I don’t want to be old and have regrets that I never knew myself without them.” We take as a given that the pharmacological habits of earlier ages tell us something about those times. It is not controversial to say, for example, that the popularity of “mother’s little helper” drugs like Valium among housewives in the 1960s was a signal, perhaps of the lack of opportunities and outlets for women. Lack of opportunity is less the problem now, thank goodness, but I can’t help but wonder how my friends’ kids and grandchildren will look back on the early 21st century. How was it, they might ask, that there weren’t structures to support women as parents, no society-wide effort to relieve them from their squeeze? One change worth applauding is the normalization of antidepressants, which has made it easier to acknowledge struggle. “In my mother’s generation, nobody got therapy,” says Karen Keith, 53, of Oakland, CA, who has been on citalopram (generic Celexa) for the past 9 years. “You drank and smoked; that was the therapy.” Many others expressed gratitude that the days of fighting despair the Mad Men way (destructively and in secret) are over. “I’ve been completely open with my daughter,” says Jennings. “There’s been no shame in it.” Even so, Jennings says she’d like to see more honesty in the conversation about women’s roles; she will counsel her daughter to think carefully before having children instead of assuming that she’ll be able to do it all. King advises her daughters to move close to home before they start families, so they can enjoy the kind of support that their mother didn’t have. Schulte is grateful for antidepressants, even as she believes that some of the problems we use them for are ultimately tasks for history, not pharmacy, to solve. “Our lives are unsustainably unmanageable,” she says, “and you can’t go to a doctor and say, ‘Gee, I think we should change our tax policy and our workplace policy.’ What has the doctor got? He’s got a pill.” Life After PillsFour women who are making it work post-antdepressants “After I gave them up, I dealt with anxiety by shifting my outlook. When I started setting expectations for myself and my children based on my values and what was important for me, I no longer felt the need to keep up with other people. Everything is easier when you pull back from that.” —Elaine Taylor-Klaus, 49, on antidepressants for less than 5 years “I started to run and take fish oil. I also don’t try to multitask anymore.” —Brigid Schulte, 51, on Lexapro for 1 year “I got to the stage in my life where I found more inner reserves to manage my emotions. I think because I was working closely with a therapist. It’s not that life is any easier—the change is in me.” —Nicole Magnuson, 57, on Celexa, Lexapro, and Zoloft and then Wellbutrin for 7 to 10 years “I haven’t told my husband that I’m going off medication. I wanted to see if he could tell. I’m a little more irritable and obnoxious, but I’m becoming more real, and I’m really proud that I’m about to do that. I really like the person who’s coming out.” —Linda King, 53, on Wellbutrin and then Effexor for 18 years Share your antidepressant stories at facebook.com/preventionmagazine.
