Prozac Nation Depression Quotes

That's the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it's impossible to ever see the end.

I don't want any more of this try, try again stuff. I just want out. I’ve had it. I am so tired. I am twenty and I am already exhausted.

If you are chronically down, it is a lifelong fight to keep from sinking

Some friends don't understand this. They don't understand how desperate I am to have someone say, I love you and I support you just the way you are because you're wonderful just the way you are. They don't understand that I can't remember anyone ever saying that to me. I am so demanding and difficult for my friends because I want to crumble and fall apart before them so that they will love me even though I am no fun, lying in bed, crying all the time, not moving. Depression is all about If you loved me you would.

I was so scared to give up depression, fearing that somehow the worst part of me was actually all of me.

Mental illness is so much more complicated than any pill that any mortal could invent

Insanity is knowing that what you're doing is completely idiotic, but still, somehow, you just can't stop it.

I'm the girl who is lost in space, the girl who is disappearing always, forever fading away and receding farther and farther into the background. Just like the Cheshire cat, someday I will suddenly leave, but the artificial warmth of my smile, that phony, clownish curve, the kind you see on miserably sad people and villains in Disney movies, will remain behind as an ironic remnant. I am the girl you see in the photograph from some party someplace or some picnic in the park, the one who is in fact soon to be gone. When you look at the picture again, I want to assure you, I will no longer be there. I will be erased from history, like a traitor in the Soviet Union. Because with every day that goes by, I feel myself becoming more and more invisible...

At heart, I have always been a coper, I've mostly been able to walk around with my wounds safely hidden, and I've always stored up my deep depressive episodes for the weeks off when there was time to have an abbreviated version of a complete breakdown. But in the end, I'd be able to get up and on with it, could always do what little must be done to scratch by.

In the meantime, I could withdraw to my room, could hide and sleep as if I were dead

I start to think there really is no cure for depression, that happiness is an ongoing battle, and I wonder if it isn't one I'll have to fight for as long as I live. I wonder if it's worth it.

Depression is about as close as you get to somewhere between dead and alive, and it's the worst.

Sometimes, I get so consumed by depression that it is hard to believe that the whole world doesn't stop and suffer with me.

Sometimes it feels like we're all living in a Prozac nation. The United States of Depression.

Everything's plastic, we're all going to die sooner or later, so what does it matter.

In my case, I was not frightened in the least bit at the thought that I might live because I was certain, quite certain, that I was already dead.

It's nonverbal: I need love. I need the thing that happens when your brain shuts off and your heart turns on. And I know it's around me somewhere, but I just can't feel it.

It is so hard to learn to put sadness in perspective so hard to understand that it is a feeling that comes in degrees, it can be a candle burning gently and harmlessly in your home, or it can be a full-fledged forest fire that destroy almost everything and is controlled by almost nothing. It can also be so much in-between

In a strange way, I had fallen in love with my depression. Dr. Sterling was right about that. I loved it because I thought it was all I had. I thought depression was the part of my character that made me worthwhile. I thought so little of myself, felt that I had such scant offerings to give to the world, that the one thing that justified my existence at all was my agony.

Woke up this morning afraid I was gonna live.

I start to get the feeling that something is really wrong.

Hemingway has his classic moment in "The Sun Also Rises" when someone asks Mike Campbell how he went bankrupt. All he can say is, "Gradually, then suddenly." That's how depression hits. You wake up one morning, afraid that you're gonna live.

One of the terrible fallacies of contemporary psychotherapy is that if people would just say how they felt, a lot of problems could be solved.

In a typical mental health catch-22, the alienating nature of depression tends to keep its sufferers from finding their way to the very support groups that might help them.

Madness is too glamorous a term to convey what happens to most people who are losing their minds. That word is too exciting, too literary, too interesting in its connotations, to convey the boredom, the slowness, the dreariness, the dampness of depression…depression is pure dullness, tedium straight up. Depression is, especially these days, an overused term to be sure, but never one associated with anything wild, anything about dancing all night with a lampshade on your head and then going home and killing yourself…The word madness allows its users to celebrate the pain of its sufferers, to forget that underneath all the acting-out and quests for fabulousness and fine poetry, there is a person in huge amounts of dull, ugly agony...Remember that when you’re at the point at which you’re doing something as desperate and violent as sticking your head in an oven, it is only because the life that preceded this act felt even worse. Think about living in depression from moment to moment, and know it is not worth any of the great art that comes as its by-product.

I have studiously tried to avoid ever using the word 'madness' to describe my condition. Now and again, the word slips out, but I hate it. 'Madness' is too glamorous a term to convey what happens to most people who are losing their minds. That word is too exciting, too literary, too interesting in its connotations, to convey the boredom, the slowness, the dreariness, the dampness of depression.

And I know, knew for sure, with an absolute certainty, that this is rock bottom, this what the worst possible thing feels like. It is not some grand, wretched emotional breakdown. It is, in fact, so very mundane:…Rock Bottom is an inability to cope with the commonplace that is so extreme it makes even the grandest and loveliest things unbearable…Rock bottom is feeling that the only thing that matters in all of life is the one bad moment…Rock bottom is everything out of focus. It’s a failure of vision, a failure to see the world how it is, to see the good in what it is, and only to wonder why the hell things look the way they do and not—and not some other way.

Depression is a lot like that: slowly, over the years, the data will accumulate in your heart and mind, a computer program for total negativity will build into your system, making life feel more and more unbearale. But you won't even notice it coming on, thinking that it is somehow normal, something about getter older, about turning eight or about turning twelve or turning fifteeen, and then one day you realize that your entire life is just awful, not worth living, a horror and a black blot on the white terrain of human existence. One morning you wake up afraid you are going to live.

My God, I could raise a family of six children and hold down a full-time job with all the energy I expend on depression!

In those pamphlets that they give at mental health centers where they list the ten or so symptoms that would indicate a clinical depression, 'suicide threats' or even simple 'talk of suicide' is considered cause for concern. I guess the point is that what's just talk one day may become a real activity the next. So perhaps after years of walking around with these germinal feelings, these raw thoughts, these scattered moments of saying I wish I were dead, eventually I too, sooner or later, would succumb to the death urge. In the meantime, I could withdraw to my room, could hide and sleep as if I were dead.

The brief relief of seeing other people when I leave my room turns into a desperate need to be alone, and then being alone turns into a terrible fear that I will have no friends, I will be alone in this world and in my life. I will eventually be so crazy from this black wave, which seems to be taking over my head with increasing frequency, that one day I will just kill myself, not for any great, thoughtful existential reasons, but because I need immediate relief.

Some catastrophic moments invite clarity, explode in split moments: You smash your hand through a windowpane and then there is blood and shattered glass stained with red all over the place; you fall out a window and break some bones and scrape some skin. Stitches and casts and bandages and antiseptic solve and salve the wounds. But depression is not a sudden disaster. It is more like a cancer: At first its tumorous mass is not even noticeable to the careful eye, and then one day -- wham! -- there is a huge, deadly seven-pound lump lodged in your brain or your stomach or your shoulder blade, and this thing that your own body has produced is actually trying to kill you. Depression is a lot like that: Slowly, over the years, the data will accumulate in your heart and mind, a computer program for total negativity will build into your system, making life feel more and more unbearable. But you won't even notice it coming on, thinking that it is somehow normal, something about getting older, about turning eight or turning twelve or turning fifteen, and then one day you realize that your entire life is just awful, not worth living, a horror and a black blot on the white terrain of human existence. One morning you wake up afraid you are going to live. In my case, I was not frightened in the least bit at the thought that I might live because I was certain, quite certain, that I was already dead. The actual dying part, the withering away of my physical body, was a mere formality. My spirit, my emotional being, whatever you want to call all that inner turmoil that has nothing to do with physical existence, were long gone, dead and gone, and only a mass of the most fucking god-awful excruciating pain like a pair of boiling hot tongs clamped tight around my spine and pressing on all my nerves was left in its wake. That's the thing I want to make clear about depression: It's got nothing at all to do with life. In the course of life, there is sadness and pain and sorrow, all of which, in their right time and season, are normal -- unpleasant, but normal. Depression is an altogether different zone because it involves a complete absence: absence of affect, absence of feeling, absence of response, absence of interest. The pain you feel in the course of a major clinical depression is an attempt on nature's part (nature, after all, abhors a vacuum) to fill up the empty space. But for all intents and purposes, the deeply depressed are just the walking, waking dead. And the scariest part is that if you ask anyone in the throes of depression how he got there, to pin down the turning point, he'll never know. There is a classic moment in The Sun Also Rises when someone asks Mike Campbell how he went bankrupt, and all he can say in response is, 'Gradually and then suddenly.' When someone asks how I love my mind, that is all I can say too

That’s the thing I want to make clear about depression: It’s got nothing at all to do with life. In the course of life, there is sadness and pain and sorror, all of which, in their right time and season, are normal—unpleasant, but normal. Depression is an altogether different zone because it involves a complete absence: absence of affect, absence of feeling, absence of response, absence of interest. The pain you feel in the course of a major clinical depression is an attempt on nature’s part (nature, after all, abhors a vacuum) to fill up the empty space. But for all intents and purposes, the deeply depressed are just the walking, waking dead.

And she keeps saying, how can you do this to me? And i want to scream, what do you mean, how can I do this to you? Aren't we confusing our pronouns here? The question, really, is How could I do this to myself?

Depression is all about if you loved me you would. As in, if you loved me you would stop doing your schoolwork, stop going out drinking with your friends on a Saturday night, stop accepting starring roles in theater productions, and stop doing everything besides sitting here by my side and passing me Kleenex and aspirin while I lie and creak and cry and drown myself and you in my misery.

If I were another person, I go on, I wouldn’t want to deal with me, I don’t want to deal with me, It’s so hopeless, I want out of this life. I really do. I keep thinking that if I could just get a grip of myself, I could be all right again. I keep thinking I’m driving myself crazy, but I swear, I swear to God, I have no control. It’s so awful, It’s like some demons have taken over my mind. And nobody believes me, Everybody thinks I could be better if I wanted to. But I can’t be the old Lizzy anymore, I can’t be myself anymore, I mean, actually, I am being myself right now and it’s horrible.

That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and its compounds daily, that it’s impossible to ever see the end. The fog is like a cage without a key.

Getting help for substance abuse can be reduced to the deceptively simple focus of ‘keeping away from the dope.’ But what does getting help with depression mean? Learning to keep away from your own mind?

I know by now, only too well, that you can never get away from yourself because you never go away.

How can you hide from what never goes away?

I start to get the feeling that something is really wrong. Like all the drugs put together – the lithium, the Prozac, the desipramine, and Desyrel that I take to sleep at night – can no longer combat whatever it is that was wrong with me in the first place. I feel like a defective model.

The atypically depressed are more likely to be the walking wounded, people like me who are quite functional, whose lives proceed almost as usual, except that their depressed all the time, almost constantly embroiled in thoughts of suicide even as they go through their paces. Atypical depression is not just a mild malaise...but one that is quite severe and yet still somehow allows an appearance of normalcy because it becomes, over time, a part of life. The trouble is that as the years pass, if untreated, atypical depression gets worse and worse, and its sufferers are likely to commit suicide out of sheer frustration with living a life that is simultaneously productive and clouded by constant despair. It is the cognitive dissonance that is deadly. Because atypical depression doesn’t have a peak- or, more accurately, a nadir, like normal depression, because it follows no logical curve but instead accumulates over time, it an drive its victim to dismal despair so suddenly that one might not have bothered to attend to treatment until the patient has already, and seemingly very abruptly, committed suicide.

Forget about the scant hours in her brief life when Sylvia Plath was able to produce the works in Ariel. Forget about that tiny bit of time and just remember the days that spanned into years when she could not move, couldn’t think straight, could only lie in wait in a hospital bed, hoping for the relief that electroconvulsive therapy would bring. Don’t think of the striking on-screen picture, the mental movie you create of the pretty young woman being wheeled on the gurney to get her shock treatments, and don’t think of the psychedelic, photonegative image of this sane woman at the moment she receives that bolt of electricity. Think, instead, of the girl herself, of the way she must have felt right then, of the way no amount of great poetry and fascination and fame could make the pain she felt at that moment worth suffering. Remember that when you’re at the point at which you’re doing something as desperate and violent as sticking your head in an oven, it is only because the life that preceded this act felt worse. Think about living in depression from moment to moment, and know it is not worth any of the great art that comes a its by-product.

Affection as medicine is highly overrated...a person who is as sick with depression as I most certainly was cannot possibly be rescued through the power of anyone's love.

You don't need an excuse to be depressed.

Depression gave me more then just a brooding introspection. It gave me humor, it gave me a certain what-a-fuck-up-I-am shtick to play with when the worst was over..the side effects, the by products of depression, seems to keep me going. I had developed a persona that could be extremely melodramatic and entertaining. It had, at times, all the selling points of madness, all the aspects of performance art. I was always able to reduce whatever craziness I’d experienced into the perfect antidote, the ideal cocktail party monologue...I thought this ability, to tell away my personal life as if it didn’t belong to me, to be queerly chatty and energetic at moments that most people found inappropriate, was what my friends liked about me.

Depression is a very narcissistic thing, it's a self involvement that is so deep and intense that it means the sufferer cannot get out of her own head long enough to see what real good, what genuine loveliness, there is in the world around her.

In order for therapy to be effective, a patient must be prodded and provoked, forced into confrontations, given sufficient incentive to push herself out of the caged fog of depression.

And I always feel so stupid sitting in therapy talking about my problems because, Jesus Christ, so what? I can't equate the amount of pain and misery and despair I have suffered and endured as a depressive with the events of my life, which just seem so common.

No one who had never been depressed like me could imagine that the pain would get so bad that death became a star to hitch up to, a fantasy of peace someday which seemed better than any life with all this noise in my head.

I hated him for not being depressed. He seemed a fool-- everyone who didn't feel like me was a fool. I alone knew the truth about life, knew that it was all a miserable downward spiral that you could either admit to or ignore, but sooner or later we were all going to die.

Sometimes I wish there were a way to let people know that just because I live in a world without rules, and in a life that is lawless, doesn’t mean that it doesn’t hurt so bad the morning after.

Depression gave me extreme perspicacity; rather than skin, it was as if I had only thin gauze bandages to shield me from everything I saw.

Lying in bed for a few days wouldn't help enact the kind of personality overhaul it would take to pull me away from my well-established pattern of mapping out escape routes, clinging to them like vines, and then watching as these lifeless forces suddenly pushed me away, though I continued to hold on for dear life.

I don't mean to sound like a spoiled brat. I know that into every sunny life a little rain must fall and all that, but in my case, the crisis-level hysteria is an all-too-recurring theme. The voices inside my head, which I used to think were just passing through, seem to have taken up residence And I've been on these goddamn pills for years.

...sometimes they almost made me feel glad that I had a few extra years to play my depression out with therapy and other means, because I think its useful in youth- unless suicide or drug abuse are the alternatives- to have some faith in the mind to cure itself, to not rush to doctors or diagnosis's...I sometimes worry that part of what creates depression in young people is their own, and their parents, and the whole worlds impatience with allowing the phases of life to run their course. We will very likely soon be living in a society that confuses disease with normal life if the panic and rush to judgment and labeling do not slow down a bit. Somewhere between the unbelievable tardiness that the medical profession was guilty of in administering proper treatment to me and the eagerness to with which practitioners prescribe Ritalin for 8 year old boys and Paxil for 14 year old girls, there is a sane course of action.

The trouble is that when we get around to solutions, it always seems to come down to Prozac. Or Zoloft. Or Paxil. Deep clinical depression is a disease, one that not only can, but probably should, be treated with drugs. But a low-grade terminal anomie, a sense of alienation or disgust and detachment, the collective horror at a world that seems to have gone so very wrong, is not a job for antidepressants. The trouble is, the big-picture problems that have so many people down are more or less insoluble: As long as people can get divorced they will get divorced; America=s shrinking economy is not reversible; there is no cure for AIDS. So it starts to seem fairly reasonable to anesthetize ourselves in the best possible way. I would like so much to say that Prozac is preventing many people who are not clinically depressed from finding real antidotes to what Hillary Clinton refers to as 'a sleeping sickness of the soul,' but what exactly would those solutions be? I mean, universal health care coverage and a national service draft would be nice, but neither one is going to save us from ourselves. Just as our parents quieted us when we were noisy by putting us in front of the television set, maybe we're now learning to quiet our own adult noise with Prozac.

...if you ask anyone in the throes of depression how he got there, to pin down the turning point, he'll never know. There is a classic moment in The Sun Also Rises when someone asks Mike Campbell how he went bankrupt, and all he can say in response is, 'Gradually and then suddenly.' When someone asks how I lost my mind, that is all I can say too." -Elizabeth Wurtzel, Prozac Nation

You know you’ve completely descended into madness when the matter of shampoo has ascended to philosophical heights.

I can’t quite shake this feeling that we live in a world gone wrong, that there are all these feelings you’re not supposed to have because there’s no reason to anymore. But still they’re there, stuck somewhere, a flaw that evolution hasn’t managed to eliminate yet. I want so badly to feel bad about getting pregnant. But I can’t, don’t dare to. Just like I didn’t dare tell Jack that I was falling in love with him, wanting to be a modern woman who’s supposed to be able to handle the casual nature of these kinds of relationships. I’m never supposed to say, to Jack or anyone else, ‘What makes you think I’m so rich that you can steal my heart and it won’t mean a thing?’ Sometimes I think that I was forced to withdraw into depression, because it was the only rightful protest I could throw in the face of a world that said it was all right for people to come and go as they please, that there were simply no real obligations left. Deceit and treachery in both romantic and political relationships is nothing new, but at one time, it was bad, callous, and cold to hurt somebody. Now it’s just the way things go, part of the growth process. Really nothing is surprising. After a while, meaning and implication detach themselves from everything. If one can be a father and assume no obligations, it follows that one can be a boyfriend and do nothing at all. Pretty soon you can add friend, acquaintance, co-worker, and just about anyone else to the long list of people who seem to be part of your life, though there is no code of conduct that they must adhere to. Pretty soon, it seems unreasonable to be bothered or outraged by much of anything because, well, what did you expect?

No man is going to solve my problems, no one can rescue me, because I am too sick.

I know I want out of this mess. I want out. No one will ever love me, I will live and die alone, I will go nowhere fast, I will be nothing at all. Nothing will work out. The promise that on the other side of depression lies a beautiful life, one worth surviving suicide for, will have turned out wrong. It will all be a big dupe.

People talk about the way disembodied spirits roam the world with no place to park themselves, but all I can think is that I am a dispirited body, and I’m sure there are plenty of other human mollusk shells roaming around, waiting for some soul to fill them up.

But what if you are the only resting point you know of? What if you are absolute zero? What if only you can catch yourself?

life was one long distraction from the inevitable.

Just as our parents quieted us when we were noisy by putting us in front of the television set, maybe we’re now learning to quiet our own adult noise with Prozac.

The idea of throwing away my depression, of having to create a whole personality, a whole way of living and being that did not contain misery as its leitmotif, was daunting.

Nothing is real to me unless it's right in front of me.

... but they don't know how enormous my need is. They don't know how much I will demand of them before I even think about getting better.

Nothing that extraordinary, but when you’re four years old, it’s cats and dogs that make life worth living. And I kind of think it’s maybe not so different now.

Yes, there was a certain beautiful honesty to my depressed state—I miss it sometimes now. I miss having so little stake in maintaining the status quo that I could walk out of rooms in tears at times that other people would have deemed inappropriate. I liked that about myself. I liked that disregard for convention.

I am so caught up in the idea that nobody would actually try to save me if I were to slit my wrists or hang myself from one of the rafters in the bunk. I can't believe anyone might care enough to try to keep me alive.

I know how taxing it is to do something even as small and brief as having a meal with a depressive. We are such irritating people, can see the dark side of everything, and our perpetual malcontentedness kind of ruins it for everybody.

I kept imagining the end, the despair I would suffer when it came, and it made any happiness I had in the present seem not merely ephemeral, but doomed. Because the happier I allowed myself to be now, the more miserable I would be later.

I think the closeness that you’re able to experience when you’re with Rafe is something you’ve been deprived of and something you’ve needed for so long that it’s causing you to go to these extremes of emotion every time you feel him slipping away,

I need love. I need the thing that happens when your brain shuts off and your heart turns on.

I believe there is an integrity to my intolerance: Why does the rest of the world put up with the hypocrisy, the need to put a happy face on sorrow, the need to keep on keeping on?

At age twenty-six, I feel like I am finally going through adolescence.

I tell myself I'm not scared, I tell myself I really want to die, and it never occurs to me until the last possible moment that what I really want is to be saved.

I'm effectively taking time off without actually taking time off, which for some reason assuages my conscience and makes me think I'm less sick than I am.

It seems like no amount of reassurance from him can convince me that he's really mine.

I was, after the breakup, what you call a complete wreck. For the first time in my life, my pain had a focus.

Mommy, if you could only know how far gone I am, you would find another choice.

I find myself praying, wishing, hoping that God could just give me whatever it is that makes girls attractive to boys my age.

I want so badly to have my life circumstances match the oppressiveness I feel internally.

I can't equate the amount of pain and misery and despair I have suffered and endured as a depressive with the events of my life, which just seem so common.

My improved affect did not in any way sway me from the philosophical conviction that life, at its height and at its depth, basically sucks.

Rock bottom is feeling like the only thing that matters in all of life is the one bad moment.

Of course, there are some guys who really will fuck anything. Even me.

I’m a stranger wherever I go because I’m strange to myself. My mind just goes off doing its own thing, never consulting me at all about whether it’s all right to feel this way or that.

I, on the other hand, had taken a small overdose of pills and scarred my legs with razor blades, and still no one seemed to be rescuing me. Because, on paper, there was no actual problem.

I was an astronaut who was going to fly so high, so far beyond the moon, so far beyond the whole wide world. But then I never had to worry about a crash landing because I never even took off.

Homesickness is just a state of mind for me. I’m always missing someone or someplace or something, I’m always trying to get back to some imaginary somewhere. My life has been one long longing.

No matter what Dr. Sterling or any of the other mental health practitioners ever said, I never felt I had a right to be depressed. I always felt like: Really, if I wanted to, I could snap out of this.

At first, the idea was to get me going so I could respond to talk therapy, but now it seems clear that my condition is chronic, that I’m going to be on drugs forever if I just want to be barely functional.

Depression is, especially these days, an overused term to be sure, but never one associated with anything wild, anything about dancing all night with a lampshade on your head and then going home and killing yourself.

I began to cry because I couldn't understand what my mother thought she would accomplish by saying these things to me. I was the one depressed, and somehow she managed to make it sound like I was supposed to feel sorry for her.

I tell each of them whatever it is I think they want to hear because it is the only way to guarantee that either of them will love me. Insofar as a truth existed for me, it changed depending on whether I was with my mom or my dad.

When would I stop wondering what right—what nerve—I had to be depressed? Enough with this going on about all my blessings. I was starting to sound like a character in a TV movie with a title like The Best Little Girl in the World or Most Likely to Succeed.

Sometimes I think that I was forced to withdraw into depression because it was the only rightful protest I could throw in the face of a world that said it was all right for people to come and go as they please, that there were simply no real obligations left.

It is hard for me to remember a life that was so cocksure, so free of self-doubt, so pure in its certainty. How did all that life-force energy turn so completely into a death wish? How quickly it seemed that my well-developed superego managed to dissolve into buckets of free-flowing, messy id.

want out. No one will ever love me, I will live and die alone, I will go nowhere fast, I will be nothing at all. Nothing will work out. The promise that on the other side of depression lies a beautiful life, one worth surviving suicide for, will have turned out wrong. It will all be a big dupe.

Some consider this a paralyzing moral dilemma. I don't. For me, having lived through episodes of major depression, this is a no-brainer. If there is a pill that will make you well, or make it less likely you will get sick, you take it. If Prozac hasn't saved my life, it has profoundly changed it.

Rock bottom is everything out of focus. It’s a failure of vision, a failure to see the world as it is, to see the good in what it is, and only to wonder why the hell things look the way they do and not—and not some other way. As if there were any way that might look right from behind that depressive fog.

I can’t believe anyone might care enough to try to keep me alive. And then I realize that, yes, of course they would, but only because it is the thing to do. It’s not about true caring. It’s about not wanting to live with the guilt, the insult, the ugly knowledge that a suicide took place and you did nothing.

Forget about the scant hours in her brief life when Sylvia Plath was able to produce the works in Ariel. Forget about that tiny bit of time and just remember the days that spanned into years when she could not move, couldn’t think straight, could only lie in wait in a hospital bed, hoping for the relief that electroconvulsive therapy would bring.

It is the cognitive dissonance that is deadly. Because atypical depression doesn’t have a peak—or, more accurately, a nadir—like normal depression, because it follows no logical curve but instead accumulates over time, it can drive its victim to dismal despair so suddenly that one might not have bothered to attend to treatment until the patient has already, and seemingly very abruptly, attempted suicide.

It all seems pointless in light of the fact that we’re all going to die eventually. Why do anything—why wash my hair, why read Moby-Dick, why fall in love, why sit through six hours of Nicholas Nickleby, why care about American intervention in Central America, why spend time trying to get into the right schools, why dance to the music when all of us are just slouching toward the same inevitable conclusion?

And I’m starting to wonder if I might not be one of those people like Anne Sexton or Sylvia Plath who are just better off dead, who may live in that bare, minimal sort of way for a certain number of years, may even marry, have kids, create an artistic legacy of sorts, may even be beautiful and enchanting at moments, as both of them supposedly were. But in the end, none of the good was any match for the aching, enduring, suicidal pain.

Atypical depression is not just a mild malaise—which is known diagnostically as dysthymia—but one that is quite severe and yet still somehow allows an appearance of normalcy because it becomes, over time, a part of life. The trouble is that as the years pass, if untreated, atypical depression gets worse and worse, and its sufferers are likely to commit suicide out of sheer frustration with living a life that is simultaneously productive and clouded by constant despair.

And it came as a relief to know that I truly had no one, nowhere, and nothing, that my belief that this whole life thing was just a big sham had been confirmed completely. I could now safely sink into the surrender of what little was left, I could experience the leisure of borrowed time and the pleasure of free-falling. And once I had decided that I was going to commit an act of self-destruction, if that were necessary, I felt necessary, I felt released from the harshness of the pain.

Then there’s Prozac. It is so new at this point that Dr. Sterling still refers to it as fluoxetine. Prozac, like Zoloft, Paxil, and other drugs of its type which were not yet available as I lay in Stillman in 1988, acts only on serotonin. It is very pure in its chemical objectives. Its drug family will come to be known as selective serotonin reuptake inhibitors (SSRIs), and it can act very powerfully and directly within its narrow domain. Since fluoxetine’s aims are less scattershot than those of its predecessors, it tends to have fewer side effects.

Here was a woman who should have had a house in the suburbs, a job she liked, involving either art or architecture, and a husband who cared for her, someone who owned a shmata company on Seventh Avenue or worked as a stockbroker or a middle manager at some large corporation like Procter & Gamble. That was all she wanted, nothing fancy, nothing like the kinds of stargazing dreams that I and everyone I know set their sights on. Instead, all she got was a daughter who is such a mental wreck that she is actually scared to answer the phone, never knowing what’s going to happen next.

It’s not just depression—it’s atypical depression. Who would have thought they have a name to describe what is happening to me, and one that pinpoints my symptoms so precisely? In the book Understanding Depression, Donald F. Klein, M.D., and Paul H. Wender, M.D., characterize atypical depressives as people who “respond positively to good things that happen to them, are able to enjoy simple pleasures like food and sex, and tend to oversleep and overeat. Their depression, which is chronic rather than periodic and which usually dates from adolescence, largely shows itself in lack of energy and interest, lack of initiative, and a great sensitivity to periodic—particularly romantic—rejection.

sometimes i wish i could walk around with a HANDLE WITH CARE sign stuck to my forehead. sometimes i wish there were a way to let people know that just because i live in a world without rules, and in a life that is lawless, doesn’t mean that it won’t hurt so bad the morning after. sometimes i think that i was forced to withdraw into depression because it was the only rightful protest i could throw in the face of a world that said it was all right for people to come and go as they please, that there were simply no real obligations left. certainly deceit and treachery in both romantic and political relationships is nothing new, but at one time, it was bad, callous, and cold to hurt somebody. now it’s just the way things go, part of the growth process.

The McLean people recommend fluoxetine because they have diagnosed me with atypical depression. This diagnosis was not easy for them, or for Dr. Sterling, to come by, as the occasional appearance of manic-like episodes (for instance, during my energetic first month in Dallas) might indicate that I suffer from either manic-depressive illness or cyclothymia, a milder type of mood-swing disease. But in the end, the diagnosticians conclude that I’ve been too persistently down and not florid enough in my manic periods to be bipolar. Atypical depression is long-term and chronic, but the sufferer’s mood can occasionally be elevated in response to outside stimuli. This diagnosis seems a better way to explain the periodic occasions when I seemed happy or productive, but would always return to my normally depressed state in perfect boomerang fashion.

if there is no proof that a depressed person has a chemical imbalance, and you choose nevertheless to put that person on a medication that will alter neurotransmitter levels in his or her brain, then in effect you are causing a chemical imbalance rather than curing one. According to Steven Hyman, a neuroscientist and former director of the National Institute of Mental Health, all psychotropic drugs cause “perturbations in neurotransmitter functions.” And this is Whitaker’s main point. We are subjecting millions of brains to drugs that change natural neurotransmission, sometimes radically, disturbing and upsetting the complex interplay inside our heads, clogging neural pathways with excess chemicals, and sometimes causing the entire brain, which is intricately interlinked, to malfunction in ways we do not yet understand. An unmedicated depressed patient does not have a known chemical imbalance in his brain, but once he ingests Prozac, he will. The drug crosses the blood-brain barrier and gets to work, jamming serotonin into the synaptic cleft. Whitaker explains the result this way: “Several weeks later the serotonergic pathway is operating in a decidedly abnormal manner.

Some catastrophic moments invite clarity, explode in split moments: You smash your hand through a windowpane and then there is blood and shattered glass stained with red all over the place; you fall out a window and break some bones and scrape some skin. Stitches and casts and bandages and antiseptic solve and salve the wounds. But depression is not a sudden disaster. It is more like a cancer: At first its tumorous mass is not even noticeable to the careful eye, and then one day -- wham! -- there is a huge, deadly seven-pound lump lodged in your brain or your stomach or your shoulder blade, and this thing that your own body has produced is actually trying to kill you. Depression is a lot like that: Slowly, over the years, the data will accumulate in your heart and mind, a computer program for total negativity will build into your system, making life feel more and more unbearable. But you won't even notice it coming on, thinking that it is somehow normal, something about getting older, about turning eight or turning twelve or turning fifteen, and then one day you realize that your entire life is just awful, not worth living, a horror and a black blot on the white terrain of human existence. One morning you wake up afraid you are going to live.

It’s nonverbal: I need love. I need the thing that happens when your brain shuts off and your heart turns on.

Consider, for example, the landmark 2004 study that followed several hundred patients treated with one of three popular antidepressants: Zoloft, Paxil, or Prozac. Among those who took the drugs as prescribed, only 23% were depression-free after six months of treatment. (As you might expect, patients who failed to take their meds did even worse.) And all three medications yielded roughly the same dismal results. A fluke result, perhaps? It’s actually pretty typical. The recovery rate with antidepressants in similar studies usually falls somewhere between 20% and 35%. Clinical researchers at forty-one treatment sites across the country have just completed the largest real-world study of antidepressants ever conducted, and the results fit the same overall pattern. This multimillion dollar project, sponsored by the National Institutes of Mental Health, followed about three thousand depressed patients who initially took the drug citalopram (marketed under the trade name Celexa) for about twelve weeks. By the end of that short-term treatment period, only 28% of study patients had fully recovered. The study’s 28% response rate might even be an overestimate of the medication’s true effectiveness, because patients received higher drug doses and had more frequent doctor’s visits than people do in everyday clinical practice. (In real life, insurance companies sharply restrict the frequency of “med check” follow-up appointments). Remarkably, the study’s authors—a veritable All-Star team of clinical researchers—noted that the observed 28% recovery rate was about what they had expected to see based on comparable studies. That’s right: They weren’t surprised to find that the majority of study patients failed to recover on an antidepressant. In the study’s published write-up, the researchers also raised a provocative question: What percentage of their patients might have recovered if they had received a sugar pill—a placebo—instead of the medication? Could it possibly have been as high as 28%?

In real life, every day you might come to some new conclusion about yourself and about the reasoning behind your behavior, and you can tell yourself that this knowledge will make all the difference. But in all likelihood, you’re going to keep on doing the same old things. You’ll still be the same person. You’ll still cling to your destructive, debilitating habits because your emotional tie to them is so strong—so much stronger than any dime-store insight you might come up with—that the stupid things you do are really the only things you’ve got that keep you centered and connected.

Any time I am bothered about anything, whether it’s a line that’s too long at the bank or a man who doesn’t return my love, I have to remind myself that these emotional experiences (petty annoyance in the former instance, heartbreak in the latter) are reasonable and discrete unto themselves. They don’t have to precipitate a depressive episode. It takes me a long time to realize that when I get upset about something it doesn’t mean that the tears will never stop. It is so hard to learn to put sadness in perspective, so hard to understand that it is a feeling that comes in degrees, it can be a candle burning gently and harmlessly in your home, or it can be a full-fledged forest fire that destroys almost everything and is controlled by almost nothing. It can also be so much in between.

Boys are one interest of mine that never really goes away, though to little avail. None of the guys I go to school with notice me. I’m not even on their lists of alternatives after all the girls with names like Jennifer and Alison and Nicole don’t work out. It’s not that I’m unattractive—I think that maybe I’m even pretty, but my look appeals to an entirely different demographic group. I have cultivated a certain shaggy paleness, I have that boozy and bruise-eyed Chrissie Hynde look, so I end up attracting older guys who are used to women who aren’t bright and cheery.

Of all the odd demands that modern life makes on humanity, the most difficult may be not only its insistence that we comfortably spend our adult lives going from one situation of serial monogamy to another, but its expectation that we get along, maintain friendships, share parental duties, and in cases even attend the second and third weddings of our exes. It asks that we pretend that heartbreak is a minor inconvenience that can be overcome with just the right amount of psycholanguage, with just a few repetitions of the mantra for the sake of the children.

There was no way the head counselor or anyone else would ever understand that I didn't like being this way. How jealous I was of all the other girls who were boy crazy and loud and fun. How much I wanted to flip my hair and flirt and be rowdy but somehow just couldn't -didn't dare- even try anymore.

I mean, I was kind of weird as thirteen-year-olds go, but it's not like I needed to be relocated to another planet in order to fit in. Or maybe I did. I was starting to feel that way.

I will eventually be so crazy from this black wave, which seems to be taking over my head with increasing frequency, that one day I will just kill myself, not for any great, thoughtful existential reasons, but because I need immediate relief, I need this horrible big muddy to go away right now.

I had a moment of what I can only call clearheadedness. The suffocating anxiety was gone, momentarily, and I felt a deep relief, a sense of sudden calm after eons of warfare inside my head. I had gotten so used to the noise that the quiet was unfamiliar. It was as if the evil beast that had been holding my head under water, trying to drown me, had suddenly let go.

Finally, in 2008, Irving Kirsch, a psychologist at the University of Hull in the United Kingdom, found that in the trials of Prozac, Effexor, Serzone, and Paxil, symptoms in the medicated patients dropped 9.6 points on the Hamilton Rating Scale of Depression, versus 7.8 points for the placebo group. This was a difference of only 1.8 points, and the National Institute for Clinical Excellence in Britain had previously determined that a three-point drug-placebo difference was needed on the Hamilton scale to demonstrate a “clinically significant benefit.” It was only in a small subgroup of patients—those most severely depressed—that the drugs had been shown to be of real use. “Given these data, there seems little evidence to support the prescription of antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed to provide benefit,” Kirsch and his collaborators concluded.

That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end. The fog is like a cage without a key.

I felt the tears welling up as I started to talk about everything I did to be with Rafe and the way he made no effort to be with me, taking it for granted that I would arrive, gift-wrapped, with a big bow tied around my neck, each and every weekend like I was put on earth just to love and serve him. I knew I had created this situation, but I still hated him for letting me be this way. Hated him for not doing more. Hated him for never coming to see me in Cambridge, for always begging off because he had a play to attend or a paper to write. Hated him because he made me drop everything without even asking me to.

I think I can handle you pretty well. I’m completely sturdy. I’m just worried about you. I’m worried that you can’t handle yourself. I love you, Elizabeth, I really do. I love you even when you get like this. But it just scares me. It scares me for your sake. Whatever negative effect you’re having on the people who love you, I’m sure it’s not half as bad, I’m sure it’s not a small percentage as bad, as what you’re doing to yourself. You’re going to drive yourself crazy.

The moment in The Bell Jar when Esther Greenwood realizes after thirty days in the same black turtleneck that she never wants to wash her hair again, that the repeated necessity of the act is too much trouble, that she wants to do it once and be done with it, seems like the book’s true epiphany. You know you’ve completely descended into madness when the matter of shampoo has ascended to philosophical heights. So as far as I’m concerned, the last shower I took is the last shower I will ever take.

And I’m starting to wonder if I might not be one of those people like Anne Sexton or Sylvia Plath who are just better off dead, who may live in that bare, minimal sort of way for a certain number of years, may even marry, have kids, create an artistic legacy of sorts, may even be beautiful and enchanting at moments, as both of them supposedly were. But in the end, none of the good was any match for the aching, enduring, suicidal pain. Perhaps I, too, will die young and sad, a corpse with her head in the oven. Scrunched up and crying here on a Saturday night, I can see no other way.

Depression is a lot like that: Slowly, over the years, the data will accumulate in your heart and mind, a computer program for total negativity will build into your system, making life feel more and more unbearable. But you won’t even notice it coming on, thinking that it is somehow normal, something about getting older, about turning eight or turning twelve or turning fifteen, and then one day you realize that your entire life is just awful, not worth living, a horror and a black blot on the white terrain of human existence. One morning you wake up afraid you are going to live.

The measure of our mindfulness, the touchstone for sanity in this society, is our level of productivity, our attention to responsibility, our ability to plain and simple hold down a job. If you’re still at the point where you’re even just barely going through the motions—showing up at work, paying the bills—you are still okay or okay enough. A desire not to acknowledge depression in ourselves or those close to us—better known these days as denial—is such a strong urge that plenty of people prefer to think that until you are actually flying out of a window, you don’t have a problem.

I mean, if I were a rich kid with stable, self-sufficient parents whom I thought I could trust to attend to themselves and to me, and I were heading for a tailspin, I might feel free to let myself free-fall, knowing that someone else would provide a bottom upon which I might eventually bottom out. But what if you are the only resting point you know of? What if you are absolute zero? What if only you can catch yourself?

In the proper fashion of divorced mothers, during her sane, lucid moments my mother would, of course, pay lip service to the idea that I ought to have a relationship with my father. Everybody needs and deserves a mommy and a daddy. In reality, she didn’t want me to get too close to him. She wanted him around, but only in his rightful, Saturday-afternoon place. And who could blame her? How could my mom tell me, whom she loved more than anyone else in the world, that she wanted me to have a good relationship with my father, whom she hated more than anyone else on earth, and not get found out? Ditto my dad.

My mom wasn’t interested in my miserable writing, and she just couldn’t look at it without feeling awful herself. While she was able to continue competently as a parent on all the usual material fronts—she fed me, she gave me a bed to sleep in, she theoretically sent me to school—she was completely dense about my emotional life. She just didn’t want to know about it, had pretty much decided this was a job for the professionals. On the other hand, my father loved chatting with me about how awful the whole world was because he basically agreed.

He could be good to talk to sometimes, but his actual efforts on my behalf added up to a whole lot of nothing. Every time I realized how little he would actually do for me as a father, how indifferent he was to parenting basics like buying me clothes or getting me to school on time or running me over to dance class, my misery was compounded. I could see that he might have understood me better than my mom did, but he really didn’t love me as devotedly.

And the scariest part is that if you ask anyone in the throes of depression how he got there, to pin down the turning point, he’ll never know. There is a classic moment in The Sun Also Rises when someone asks Mike Campbell how he went bankrupt, and all he can say in response is, “Gradually and then suddenly.” When someone asks how I lost my mind, that is all I can say too.

British psychiatrist Duncan Double is a member of the Critical Psychiatry Network, a group of psychiatrists who have major concerns about current psychiatric practice. In a 2018 article Duncan Double wrote that the first official recognition in the medical literature that SSRI antidepressants can cause discontinuation problems was in a British Medical Journal editorial in 1998, more than ten years after the launch of the first SSRI, Prozac.[62] Double points out that the many members of the general public suspected six years earlier that antidepressants were addictive; ‘The Defeat Depression campaign was a five-year national programme launched in January 1992 by the Royal College of Psychiatrists in association with the Royal College of General Practitioners. A door-to-door survey of public opinion was undertaken to obtain baseline data before the campaign started and most of the people questioned in the sample, that is 78%, thought that antidepressants were addictive. This finding caused some consternation amongst those running the campaign, because, as far as they were concerned, the public was misinformed on this issue’.

Jesus, I wondered, what do you do with pain so bad it has no redeeming value? It cannot be alchemized into art, into words, into something you can chalk up to an interesting experience because the pain itself, its density, is so great that it has woven itself into your system so deeply that there is no way to objectify it or push it outside or find its beauty within. That is the pain I'm feeling now. It's so bad, it's useless. The only lesson I will ever derive from this pain is how bad pain can be.

I am crying about the elusive nature of love, the impossibility of ever having someone so completely that he can fill up the hole, the gaping hole that for me right now is full of depression. I understand why people sometimes want to kill their lovers, eat their lovers, inhale the ashes of their dead lovers. I understand that this is the only way to possess another person with the kind of desperate longing that I have to take Rafe inside of me.

because