Abba pulses through the nightclub and I dramatically burst into tears due to a recent breakup. I apologise for my outcry to friends over a late-night takeaway. I watch The Worst Person in the World on a Sunday night solo date and weep into my popcorn. I meet my mum for lunch and wail over a jacket potato.
“I’m…” I start. She interjects. “Stop. Saying. Sorry.”
I was born the year Prozac came to market in the UK. In 2004, by the age of 14, I was a Prozac user. It’s strange to think that as a young, confused teen, I had been part of a profound social-historical change. Before the mid-2000s, adolescents taking psychiatric medication experienced a hefty stigma. If, like me, you were born in the 1990s, you’ve lived through a psychopharmacological breakthrough. In 2021, the number of teens taking antidepressants in the UK reached an all-time high. And, according to the Royal Pharmaceutical Society, the number of patients under 17, medicated for anxiety, rose by 26% between 2015 and 2020.
In the wake of the breakup, I decide to make a trip home to my parents, so I can wallow, yes, but also so I can trail through a box of psychiatric medical notes from my adolescence that I find in the loft.
2004: “Your daughter is describing a classical description of florid depersonalisation. This is normally onset by a trauma. The standard treatment is a few weeks on SSRIs. I suggest we start her on Prozac. It’s not yet licensed for her age, but I think it’s our best port of call.”
Depersonalisation is a type of anxiety disorder that can manifest as a feeling of being disconnected or detached from the world. For some people, including my teenage self, it can feel as though the world is like a movie that we are watching rather than being a part of.
When I ask my mum about those difficult years, she tells me she had no idea what was wrong with me. “You were struggling and it had gone on so long. You were desperate. We didn’t really talk about mental health before you came along. Other than Auntie Nancy” – my 101-year old great-aunt, who had shock therapy after witnessing someone get crushed by a train – “but even she kept it all hushed up. Me and Dad, we didn’t really know much about it.”
I try to push her further. The psychiatrist said depersonalisation is often brought on by trauma. I search for environmental triggers.
“It was so physical,” my mother says. “I tried my best to talk things through with you, to calm you. But you were getting worse and it was hard to watch. So I went to the GP and she referred me to a child psychiatrist.”
I still remember how it manifested physically. It began way before the depersonalisation days of my teenage years. I was 10 when I developed an unbending need to “organise the house” before bedtime. I’d spend an hour lining up all the kitchen utensils in a straight line, followed by the ornaments in the living room. The finale took place in my bedroom. I’d spend an infuriating amount of time putting my slippers in the “right” place, making sure my cupboard doors were perfectly shut, lining my curtains up “correctly”. If I didn’t, something horrible would ensue, probably involving freak accidents, cancer and a family member. Or so I convinced myself.
And then when my teenage years hit, the anxiety became more extreme. I first experienced a depersonalisation attack just before my GCSEs in a busy Topshop store and became convinced I was in the midst of a dream so took to shaking a poor, helpless stranger to “wake me up”.
Those waves happened countless times. Eventually, that dreamlike state went from lasting for short periods to becoming chronic. I was so disassociated, so ghost-like, I felt I was experiencing two worlds unfolding at the same time: my external reality and the chaotic internal experience in my head.
No wonder my parents felt desperate.
“I didn’t know what to do,” my mother says. “I remember Dad was watching The Sopranos around the time we took you to the psychiatrist. Remember Tony mentions Prozac? We felt relieved! To hear someone else mention it all. It made us feel less alienated.”
Mum would try to reassure me, saying: “I’m diabetic, I use insulin. You’re anxious, you use Prozac.” That was the tagline for SSRIs (selective serotonin reuptake inhibitors): it prioritised the scientific cause and put the social on the backbench. We know now that the serotonin-imbalance theory (that anxiety and depression were caused by low levels of serotonin) is not the answer. “There is not a single peer-reviewed article that can be accurately cited to directly support claims of serotonin deficiency in any mental disorder, while there are many articles that present counterevidence” (2014, Lacasse and Leo).
And yet I, and millions of other teenagers, swallowed the narrative that we were chemically unwell and muted the social context surrounding it. I was hugely fortunate that I didn’t experience an intense traumatic event. But, there were some pretty evident triggers leading to my highly anxious state. I spent two years, as a young kid, out of school filming a television soap surrounded by adults and adult issues (drugs, sex and secrets). Weekends were spent with my tight-knit family at my aunt’s house. She was paralysed from her neck down due to MS. Each Sunday we witnessed her body decline and her struggle increase while having to keep up a stifling veneer of loud positivity. I couldn’t handle the emotional silence.
Alongside all of that, transitioning to being a teenager is a universally terrifying experience. For my age group, it was the era when the internet unleashed its dirty claws and our carefully constructed world became an intense flood of terrorist attacks, celebrity breakdowns and misogynistic porn that I couldn’t get my eyes away from. And although I was one of the lucky ones to receive Cognitive Behavioural Therapy, my sessions focused more on “coping” than “feeling”. So, I clung tightly on to the more palatable belief that I was “ill” and with medication I’d be “well”.
2005: “She’s been complaining of a number of symptoms. It seems she is highly anxious. Previously she had depersonalisation. I recommend we put her on Escitalopram.”
I ask Mum if they were nervous about me taking Prozac. “It wasn’t something we wanted to do. It felt like there was no choice. It was urgent and we were out of our depth.”
And it worked. Before, I couldn’t get through a night without waking in the early hours fuelled with adrenaline, with my legs cycling in the air – in the midst of a panic attack. I couldn’t get through a day without ringing my mum, filled with terror, from the school toilets. I felt like I had very little control over my thoughts and experiences. Soon, though, with the help of my nightly pill, the voice in my head, my distorted reality and general existentialism dissolved and finally I was able to focus on things other than my own draining existence. The SSRIs potentially saved my life, but they also changed my life. While my peers were experiencing the dark depths of emotion, I had learned to distrust myself.
To Kill a Mockingbird was one of the GCSE texts at the time. My love for it was shaded by a selfish preoccupation. Atticus tells Scout: “Before I can live with other folks I’ve got to live with myself. The one thing that doesn’t abide by majority rule is a person’s conscience.” I remember reading the line aloud in class and spiralling. “How can I live with myself if I don’t know who I am without these drugs pumping around my brain and body?” I’d been on the medicine for at least a year and the question made me bereft. When our culture tells us that our teenage years are the most critical and formative stages for our search for selfhood, how are the psychologically medicated meant to take part in this rite of passage? And I can only imagine how this must feel even more pressing for teenagers now growing up in an era that worships ‘self love’ and pays homage (and money) to nurture the ‘authentic self’.
These were the years of impending firsts that would shape my future. I’d yet to have my first kiss let alone my first sexual experience, my first friend breakup, my first grief; I didn’t know my social niche, my political leanings, the music I liked, the type of relationships I wanted to build. I didn’t know myself. And the films I was watching and the books I was reading were telling me that during these core years, I would work out my identity. Problem was, I was pilled up. The idea of introspection filled me with horror; it was the very act that earned me the “mental health patient” status in the first place. Rather than allowing space and time to listen to my emotions and responses, I disregarded them as meaningless chemical mutations.
2008: “I think it would help if we increased her citalopram. The panic isn’t subsiding, so I think this will do us good.”
And so I cracked on, while other teens were rebelling or arguing with their parents or having their hearts broken, and committing to the rollercoaster highs and lows of puberty, I wasn’t really. I got good grades, I kissed boys, I pursued my dream of acting, I swallowed my pills and I got on with it.
Adolescent psychiatrist Professor Peter Hill, who headed Child and Adolescent Psychiatry at St George’s, University of London and later worked as a consultant psychiatrist at Great Ormond Street Hospital for Children, explains: “We have to be careful about the chosen dosage of SSRIs and medication that we administer to young people. It needs to be part of the discussion when deciding on a treatment plan… Young men and women can experience loss of libido and this is particularly important to consider during the ages where many experience a sexual awakening. Problem is, GPs are time-poor and resource-poor, which leaves them with little else to do than prescribe.”
At 23, now on a 20mg dose of citalopram, I was in a rehearsal room with a cast of actors taking part in a bizarre acting technique known as “emotional recall”. That meant summoning traumatic moments from our past and reliving them in front of an audience. I watched as 14 young people broke down to the applause of our director. And then it was my turn – I was reliving the death of my aunt. Her decline from MS to ovarian cancer. I built the space, set the scene, and then… Nothing. I felt nothing. Dead. Numb. In that moment it dawned on me, I hadn’t cried for the entire time I had been on medication. That was my trigger. Within a matter of weeks, I sought help to deprescribe myself in a slow weaning-off process.
2013: “We can decrease your citalopram now. If your anxiety increases, come back to me.”
I recall the first time I cried again: I was watching The Curious Incident of The Dog in The Night-Time and a golden retriever puppy pops its head out of a gift box. I was so enthusiastic about the tears pouring out of me they basically stopped immediately. My mum laughs when I tell her. “I was so nervous when you came off about how you would deal with things without medication. I didn’t know if you had the tools to get through.”
I was nervous, too. The process of untangling “normal emotions” and my medical judgment of them has been a long and ongoing task. I’ve found myself clinging on to various other numbing devices to swerve me from looking inwards, but slowly and with some integrative therapeutic help I started to allow myself to “feel” without immediate analysis. I experienced and breathed into my anxious edges.
Professor Hill tells me: “We don’t know the long-term chemical effects of SSRI use when prescriptions are continued for years. If possible, caregivers and medical professionals need to be cautious about treating young patients year in year out.” No randomised clinical trials have yet been conducted to evaluate the efficacy of long-term treatment in primary care. This is an infuriating fact to hold while acknowledging the current state of the mental healthcare system. Young people are at the mercy of their doctors and their caregivers and most are doing the best they can with what they’ve got.
And what they’ve got is pretty dire. The NHS had 4.3m referrals for conditions such as anxiety and depression in 2021, and 25% of them were for children and teenagers. So it’s no surprise that so many GPs are reaching for medication while their patients slowly climb up the waiting list for therapeutic help.
I ask my mum if she’d change anything. “About medication?” I nod. “I don’t think I’d do anything differently. They brought you back to us.” She reflects the question. “Do you wish we handled it differently?”
I think about the day I met the psychiatrist as a 14-year-old scared of the world. I imagine him taking off his glasses and rather than reaching for a prescription for the wonder drug of the decade, he leans forward on his chair and says, “Daniella, I understand.” He says: “Being a teenager is a pretty insane experience.” He acknowledges the reality of it all. “It’s scary to see a family member get sick, it’s scary to realise your parents are flawed, it’s scary to notice the systemic injustice in the world and the overwhelming pressure to work out your view on things.”
He’d offer me some psychotherapy, he’d advise me to visit my aunt alone, and hold her hand, and ask her how she feels about facing her impending mortality. He’d urge me to limit my time in front of screens and to spend more time outside. He’d remind me to eat well and suggest joining a sports team. He’d smile and tell me to fancy whoever I wanted. He’d encourage me to spend time with friends and to not be afraid to tell them how I’m feeling. He’d tell me to write to my MP to prevent our national mental health services from being decimated and reassure me that it’s possible to make change in the world. And after, he’d send me on my way and ask me to come back in a week to decide if I want to start taking Prozac.
My hunch is, this wouldn’t have made a single bit of difference and I’d come back the following week even more bereft and desperate for medication. By the time I found myself in the psychiatrist’s chair in 2004, I felt like I was living in a pretty disgraceful dimension; I was terrified.
I reply to my mum. “No. I needed an intervention. I just wish I hadn’t viewed my experience purely as a biomedical imbalance that needed to be fixed. I wish it had been less binary.”
My mum agrees. “We’ve all changed. We’ve all developed. There’s more emotional space for all of us now.”
My mum and I clear away the papers, come down from the loft and watch Notting Hill on her bed. I laugh wildly and then cry immediately. My mum hands me the tissues and I stop myself apologising for the tears.