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<H2 class="primary first-page">My Adventures in Psychopharmacology</H2>
<H3 class=deck>Between the ages of 16 and 21, I was prescribed more than fifteen
different stimulants, antidepressants, antipsychotics, and mood stabilizers. The
cure was worse than the disease.</H3>
<UL class=byline>
<LI>By Gogo Lidz</LI></UL>
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<P></P>
<P><B>Fall 2001</B><BR><SPAN class=text4>Ritalin</SPAN></P>
<P></P>
<P><SPAN class=drop>I</SPAN> was 16 when I was prescribed my first mood-altering
drug.</P>
<P></P>
<P>I’d been a dreamy, drifty child. But when adolescence closed in, I became
tall and clumsy and socially inept. The flood of hormones seemed to unsettle my
mind. I was silly and giddy one minute, bursting with rage the next; running
around excitedly in the afternoon but impossible to rouse out of bed in the
morning. I lost friends almost as fast as I could make them.</P>
<P></P>
<P>By 16, my concentration had ebbed so low and my grades had plummeted so deep
into the alphabet that my parents decided to send me to a child psychiatrist. I
was concerned, too, and put up no resistance.</P>
<P></P>
<P>So, six Halloweens ago, my father, my mother, my kid sister, and I went to
the office of an upright fellow in his late thirties who wore a cardigan sweater
and a narrow, straight-edge bow tie. All of us found the psychiatrist
charming—except my sister, Daisy, who called him Dr. Titrate because he talked
incessantly about “titrating” the drugs he prescribed.</P>
<P></P>
<P>“What’s titrate mean?” I asked during that first session.</P>
<P></P>
<P>“I’ll explain the term as simply as possible,” Dr. Titrate said, grabbing a
dictionary from the bookcase. “Titration is the process of determining the
concentration of a dissolved substance in terms of the smallest amount of a
reagent of known concentration required to bring about a given effect in
reaction with a known volume of the test solution.” Though it didn’t sound
simple, we all nodded our heads in agreement.</P>
<P></P>
<P>I described my symptoms and family medical history (depressed aunts, a
schizophrenic uncle) to Dr. Titrate, who wagged his head wisely and asked me a
few questions to screen for attention deficit disorder:</P>
<P></P>
<P>“Do you have trouble following through on things?”</P>
<P></P>
<P>“Are you often sidetracked?”</P>
<P></P>
<P>“Do you make careless mistakes?”</P>
<P></P>
<P>I answered yes to every one. Then again, so did my father. And my mother. And
my sister. Not only was I a candidate for ADD, but so was everyone else in my
home.</P>
<P></P>
<P>Satisfied that I was suffering from ADD, Dr. Titrate gave me samples of
Ritalin.</P>
<P></P>
<P><BR><BR><B>Winter 2001</B><BR><SPAN class=text4>Metadate, Dextrostat,
Dexedrine Spansules, Adderall, Adderall XR, Strattera</SPAN></P>
<P></P>
<P>Discovering that I had a recognized syndrome brought my parents tremendous
relief. The news was comforting to me too. All I had to do, I thought, was pop a
few pills and I’d be as focused and success-driven as everyone else in my
school. I’d be normal.</P>
<P></P>
<P>But the Ritalin made me feel spacey. Classes were easier to sit through, but
if a teacher asked me a question, I’d answer with a disoriented “Whaaat?” When I
explained this to Dr. Titrate at our next session, he turned pharmacist. Over
the next few months, he plied me with a small galaxy of ADD drugs: Metadate,
Dextrostat, Dexedrine Spansules, Adderall, Adderall XR, and Strattera, alone and
in various combinations. The non-stimulant, Strattera, had no effect on me. The
stimulants turned me into a tweaked-out whiz kid. It was as if I had been
nearsighted and now had X-ray vision.</P>
<P></P>
<P>Adderall XR was my drug of choice. It turbocharged my brain during the school
day, but when I got home, I crashed hard. Sometimes I’d lie in bed for hours and
sob. To supplement the Adderall XR, Dr. Titrate prescribed the short-term
amphetamine Dextrostat for after-school studying. Taking so many stimulants made
it hard to sleep more than six hours a night. It also made me rapidly lose
weight. At first, I liked this side effect. But when my classmates started
calling me Anna Rexic, the thrill faded. I always felt queasy, and food tasted
like sand.</P>
<P></P>
<P>Hopped up on stimulants, I gained confidence. After Dr. Titrate wrote to my
headmaster that I had ADD and needed more time on tests, my performance at
school improved dramatically. A C student in tenth grade, I was pulling A’s by
the eleventh. After Dr. Titrate wrote the same note to the College Board, I got
a near-perfect score on my SAT. I turned from a basket case into an
overachieving young adult. But I was dimly aware that the ADD medication was
also doing something else, something I didn’t like. I felt impatient, irritable,
explosively angry. I’d scream at my father for buying me the wrong toothpaste.
I’d scream at my sister for borrowing my hairbrush. I’d scream at my car for
running out of gas.</P>
<P></P>
<P>When I told Dr. Titrate about this, he nodded empathetically and said,
“Remember to take your medicine.” To be honest, I didn’t always. My only friend
with ADD took Concerta, a kind of slow-release Ritalin. Occasionally, we’d have
“no-medicine days” when we’d skip our daily doses and giggle and act random. The
problem with skipping the meds was that I’d want to sleep all the next
day.</P></DIV>
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<P></P>
<P><B>Spring 2002–Summer 2003</B><BR><SPAN class=text4>Adderall XR, Dextrostat,
marijuana, Tylenol PM, Effexor, Zyprexa</SPAN></P>
<P></P>
<P>During my junior year of high school, I hooked up with a pudgy stoner, a
senior. If I took stimulants and finished all my homework, I’d smoke a joint
with him in the evening. Smoking weed took me out of my usual speedy state. I’d
get blissful and drowsy and amused by gravity, and finally I could sleep. What
perfect titration, I thought.</P>
<P></P>
<P>This system worked very well until Pudgy Stoner graduated and enrolled at a
party school a thousand miles away. My source of herbal titration was gone, and
the pressure to get into college was on. At first, I called Pudgy every night.
But gradually, he stopped picking up the phone. One morning, before school, he
dumped me over e-mail. I was devastated. After lunch, I asked to be excused from
class and ran to the girls’ room, where I sobbed and slapped my wrists against
the tile floors.</P>
<P></P>
<P>The next day, I dropped off my sister at school and, while searching in vain
for a parking space, decided to end my life. I drove to a pharmacy and bought a
box of Tylenol PM. Then I drove to another parking lot. As Fiona Apple’s “Sullen
Girl” played over the car radio, I swallowed twenty pills. I tore four pages out
of my AP European-history notebook and wrote a dramatic suicide note. Then I
waited.</P>
<P></P>
<P>As I settled into a stupor, I suddenly realized the gravity of what I had
done. I grabbed my cell phone and dialed home. My father picked up. As
hysterical as I was, I still managed to tell him where I was and what I had
done. He found me and drove me to a hospital, where I was given a charcoal
lavage and admitted overnight to the psych ward.</P>
<P></P>
<P>When I was released from the hospital 24 hours later, my parents took me to
see Dr. Titrate. I told him I hadn’t really wanted to commit suicide; I just
wanted to get back at my ex-boyfriend. My mother asked Dr. Titrate if he thought
I might be suffering from depression. “Well, that may be a tiny component of her
condition,” Dr. Titrate said. When my father asked about manic depression, he
said, “That’s another tiny component. She’s also got a little cyclothymia and
phase-of-life issues. She’s a unique case. I hope some day to write about her in
a medical journal.” Dr. Titrate kept me on the stimulants Adderall XR and
Dextrostat and added the antidepressant Effexor to my drug regimen.</P>
<P></P>
<P>But Effexor seemed to have no effect on me, and so the day before I left for
college in upstate New York, my father and I met with Dr. Titrate again. He put
me on a heavy-duty antipsychotic called Zyprexa. Dr. Titrate warned me of side
effects. “Watch out for tardive dyskinesia, acute dystonia, and neuroleptic
malignant syndrome,” he said. I nodded dumbly. “Of course,” he added, “the
possibility is remote.”</P>
<P></P>
<P><BR><BR><B>Fall 2003</B><BR><SPAN class=text4>Adderall XR, Dextrostat,
Zyprexa, alcohol, marijuana, mushrooms, hash, cocaine</SPAN></P>
<P></P>
<P>With my parents eleven toll booths away, and my mind on Adderall and
Dextrostat, I allowed my wildest impulses to take over during my first semester
at Bard. I drank, drugged, and got the world’s most ridiculous tattoo (oh my!)
inscribed on the small of my back. My substances of choice were mellow drugs:
pot, hash, mushrooms. I snorted cocaine once, but it had little effect on me—I
already had quite a tolerance for stimulants.</P>
<P></P>
<P>Stoked by Dr. Titrate’s little helpers, I hosted my own college radio show
and called it “The ADD Hour.” Naturally, “The ADD Hour” lasted just nine
minutes, and I played only the first eighteen seconds of every song. I couldn’t
keep still in class or the library or even my dorm room. I put off starting
assignments until the last possible moment. My classmates pulled all-nighters; I
pulled all-several-nighters. To finish an art-history paper, I once stayed up 72
hours. Which wasn’t that difficult—the stimulants made sleep nearly
impossible.</P>
<P></P>
<P>Bard had a don’t-ask-don’t-tell attitude toward drugs, and a thriving black
market for stimulants. The going rate for Adderall was $5 a pill. After less
than a month at school, I got reprimanded by the dean for giving a fellow
freshman a couple of my Adderall XRs. “I’ve got a paper due,” he had told me,
before selling them to a narc for $10 apiece and ratting me out to save his
skin.</P>
<P></P>
<P>As the semester wore on, I became increasingly erratic. I skipped classes and
disappeared from campus for days at a time. My friends still talk of the day
they lost me in a Wal-Mart: After paging me for twenty minutes, they found me
with no money and a brand-new .22 hunting rifle. (It hadn’t occurred to me where
I would store the gun or shoot it or what I would shoot at.) Another day, my
parents and Daisy drove up to Bard to meet me for lunch, but I was 100 miles
away at a friend’s apartment in Brooklyn, hungover from a night of hard
drinking.</P></DIV>
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<P></P>
<P>Daisy, then a high-school sophomore, was crushed that I had blown off the
visit. She didn’t blame me as much as Dr. Titrate, whom she called my “enabler.”
When her concentration began to wane in school, she, too, had seen him. She,
too, had been diagnosed with ADD and prescribed Adderall. But she stopped taking
it after a few months. “It changes my personality,” she said. “It makes me
mean.”</P>
<P></P>
<P>I stayed on Adderall, but I stopped taking recreational drugs: Downers only
brought me down.</P>
<P></P>
<P><BR><BR><B>Spring 2004</B><BR><SPAN class=text4>Adderall XR, Dextrostat,
muscle relaxants, Ambien, Abilify</SPAN></P>
<P></P>
<P>Four weeks into my second semester, my parents received a late-night phone
call from my roommate. I had OD’d again. I vaguely recall staggering around
campus in a speedy, woozy haze. I later learned a classmate had found me
unconscious and called for an ambulance. An EKG revealed I had come close to
cardiac arrest.</P>
<P></P>
<P>The next morning, my father signed me out of the hospital and we met with the
college dean. Still in a haze, I rabbited on about all the hard drugs I had
taken. My father was horrified. So was the dean, who kicked me out of school. By
afternoon, my head had cleared and I realized I had been regurgitating what I
had read in <I>Naked Lunch.</I> “I didn’t know what I was saying,” I told my
father. He believed me. We met again with the dean, who didn’t.</P>
<P></P>
<P>When I got home, I saw Dr. Titrate in an emergency session. He kept me on
Adderall XR and Dextrostat and added Abilify to stabilize my mood. Two days
later, the toxicology report came back from the lab—on the night of my overdose,
nothing had been in my system except my prescribed stimulants, an Ambien, and
muscle relaxants. Now I remembered: I had self-medicated for menstrual cramps.
The combination of drugs must have caused the overdose. After Dr. Titrate called
the dean to plead my case, I was allowed to return to school. Conditionally.</P>
<P></P>
<P>I submitted to random urine screenings, and passed every one. I got a new
boyfriend, a straight-arrow lit major. Soon after that, Dr. Titrate took me off
Abilify, but not Adderall XR. The following year, health regulators in Canada
would suspend Adderall XR following the deaths of twenty people, including
fourteen children, who had taken it between 1999 and 2003.</P>
<P></P>
<P></P>
<P></P>
<P><BR><BR><B>Fall 2004</B><BR><SPAN class=text4>Adderall XR, Dextrostat,
Lexapro, Advil</SPAN></P>
<P></P>
<P>Feeling anxious at the start of my sophomore year, I phoned Dr. Titrate from
college to ask if he knew of a potent antidepressant called Lexapro. My new
boyfriend was on the drug for depression. Dr. Titrate said he recommended
Lexapro for anxiety, and had a prescription faxed to my off-campus pharmacy. His
only warning: “Let me know if it starts making you feel manic. ” I was unsure
what Dr. Titrate meant, but I swallowed my daily Lexapro with my daily Adderall
XR and my daily Dextrostat.</P>
<P></P>
<P>Over the course of my sophomore year, I did not get any less anxious. I spent
day after gloomy day in bed, feeling dizzy and nauseous and paranoid, getting
stomachaches, driving my friends crazy, and wanting to kill myself. I became
more and more unstable: sometimes moored to my bed, sometimes restlessly
ricocheting around campus. I had a couple of scary panic attacks—each followed
by sudden eerie moments of composure and lucidity. I became terrified of being
alone.</P>
<P></P>
<P>One night, after my boyfriend told me he needed more “alone time,” I went
back to my room and screamed and cried and beat my walls for three hours. I
phoned Dr. Titrate, who suggested I “dial down” my Adderall use and increase my
dosage of Lexapro.</P>
<P></P>
<P>That summer, on an art-class trip to Italy, I imploded. Convinced that my
classmates hated me, I tried to slice my wrists with broken glass. When that
proved inefficient, I swallowed a handful of Advil with a glass of wine. After a
night in the Venice psych ward, I was put on a plane back to the States.</P>
<P></P>
<P>When I finally got home, I threw a huge tantrum—body thrashing, head whipping
from side to side. My mom grabbed my shoulders and hugged me, but I struggled
against it. “Why are you doing this to me?” I shrieked.</P>
<P></P>
<P>Daisy begged my parents to fire Dr. Titrate. “He can’t read people,” she
said. “He doesn’t listen.” But my parents still trusted him, or at least wanted
to trust him. And so they took me to yet another emergency session.</P>
<P></P>
<P>Dr. Titrate said he doubted I had “suicidal ideations” and recommended that I
be sent to a substance-abuse-treatment facility. He told my parents, “You can,
of course, seek a second opinion.” But there didn’t seem to be time for that.
Dr. Titrate spoke with great urgency: He wanted me in the facility within 48
hours. I crumpled in hysterics on his office floor.</P></DIV>
<DIV id=story>
<P></P>
<P></P>
<P></P>
<P><BR><BR><B>June 2005</B><BR><SPAN class=text4>Lexapro, lots of
Lexapro</SPAN></P>
<P></P>
<P>Dr. Titrate recommended a consultant, and the consultant recommended a
treatment program in Utah. It cost $450 a day and was not covered by my parents’
insurance. The next morning, I was shipped off to a remote campsite in the High
Uinta Mountains. This wilderness program was designed specifically for drug
addicts and alcoholics. Dr. Titrate had assured my parents that although I
wasn’t technically an addict, the treatment would be beneficial.</P>
<P></P>
<P>But the field therapist—a recovering alcoholic in battle fatigues—and her
staff of instructors didn’t seem to be in on the secret. They treated me like
the worst kind of addict: one who was in denial. “Acknowledge your addiction, or
you’re not getting out of here,” one of the instructors told me.</P>
<P></P>
<P>My attitude baffled the instructors, and I was routinely disciplined with
silence and the withholding of hot food. When informed of my resistance, Dr.
Titrate upped my daily intake of Lexapro again, to three times the normal
dose.</P>
<P></P>
<P>I should note that I was over 18 and technically could have left the program
at any time. But leaving was not really an option. Dr. Titrate had given my
parents strict instructions: If I phoned and said I planned to come home, they
were to say I wasn’t welcome. I would be stranded with no money in the mountains
of Utah.</P>
<P></P>
<P>I had little to no contact with the outside world during this time. My mother
and father had weekly hour-long phone conversations with the field therapist,
who, in turn, had weekly hour-long phone conversations with Dr. Titrate. My
parents could send e-mails to the center, but anything deemed “nontherapeutic”
was withheld from me.</P>
<P></P>
<P>The letter that did get through was one they were required to write: an
“impact letter” that I was to read aloud in group therapy. My parents later told
me that it was the hardest thing they ever wrote. They debated. They agonized.
They revised the text endlessly. They wrote that they were desperate that I be
accountable for my life, that they had sent me to the treatment center because
they had no idea how to help and this seemed the best option. They wrote,
“Instead of taking responsibility for your life, you are foisting that
responsibility on others. But the price is terrible. From middle school on, we
have seen you struggle to forge friendships. But this is not the way to make
lasting relationships. In fact, it’s just the opposite. We are terrified.”</P>
<P></P>
<P>I was terrified, too, but I didn’t know how to stop. My mental state still
swung violently between extremes.</P>
<P></P>
<P>As the Utah program came to an end, Dr. Titrate’s consultant arranged to have
me sent to a 90-day “aftercare” program in Southern California. This program,
too, was designed for recovering addicts and alcoholics. To get in, I was
required to “admit” my addiction in a phone call to the center’s director. After
a tearful hour of trying to be honest, I lied and said, “Okay, I’m an
addict.”</P>
<P></P>
<P>When I was released a week later, the Utah field therapist said, “I don’t
think we can do much else for you, but at least you’ve admitted your
problem.”</P>
<P></P>
<P></P>
<P></P>
<P><BR><BR><B>August 2005</B><BR><SPAN class=text4>Lexapro, Lamictal, Provigil,
Wellbutrin, Cymbalta, more Lamictal</SPAN></P>
<P></P>
<P>In California, I had a brief honeymoon. Now, in addition to a large dose of
Lexapro, Dr. Titrate prescribed the mood stabilizer Lamictal and, for focus,
Provigil, a non-stimulant used to keep narcoleptics awake. I went to twelve-step
meetings, body-image meetings, risk-assessment, and love-addiction meetings. I
did t’ai chi, I meditated, and I wrote daily “letters to God.”</P>
<P></P>
<P>But the honeymoon didn’t last. The Provigil made me faint and frenetic. I got
dizzy and had frequent stomachaches. I experienced sudden, overpowering moments
of terror. Whenever I refused to get out of bed all day (often) or refused to
attend group meetings (even more often), I was grounded, which just gave me an
excuse to retreat even further into myself.</P>
<P></P>
<P>I did befriend a girl my age, a recovering heroin addict who had been in
similar programs half her life. Go through the motions, she told me, and no one
will pay attention. Instead of letters to God, I jotted down Ludacris lyrics and
dated them. She was right: Nobody noticed the difference.</P>
<P></P>
<P>I suffered panic attacks with greater and greater frequency. One attack was
so frightening that I finally demanded to see a psychiatrist. He decided to
start weaning me off Lexapro, replace it with the milder antidepressants
Wellbutrin and Cymbalta, and increase my dosage of Lamictal.</P>
<P></P>
<P>Around this time, the Utah program mailed me a box of computer printouts—the
e-mails my parents had sent that were deemed “nontherapeutic” and withheld. One
was an article about cognitive behavioral therapy—a treatment Dr. Titrate had
always dismissed. After I read it, I set up an appointment.</P></DIV>
<DIV id=story>
<P></P>
<P>When I related my personal history and described my symptoms to the cognitive
behavioral therapist, she said, “You don’t sound like an addict. You sound like
you’re bipolar II, a form of manic depression.”</P>
<P></P>
<P>She asked for the names of the drugs I was taking.</P>
<P></P>
<P>“Provigil, Lexapro …”</P>
<P></P>
<P>“Lexapro! Do you have any idea what effects that drug can have on bipolar
people?”</P>
<P></P>
<P>At the end of the session, I called home and told my parents. My father found
a Website that cross-indexed syndromes with drugs. Patients detail their
reactions. He typed in bipolar and Lexapro. A sampling: “When first started on
10mg, about 2 hours later felt insane amount of energy, was zooming, felt very
speedy. Then shortly after that same day I crashed and couldn’t get out of bed”
… “I had euphoria/irritability like never before” … “Manic and then wanting to
kill myself all in 15 minutes time.”</P>
<P></P>
<P>He flew to California the next morning. We met at my halfway house and drove
to the behavioral therapist’s office. “Your daughter has been misdiagnosed and
mis-prescribed,” she said. I felt ecstatic and oddly vindicated. She said
antidepressants may be used in adolescent bipolar depression in the acute phase,
but only under cover of a mood stabilizer to calm potential manic storms. She
said Dr. Titrate should have prescribed Lamictal first, then waited for the mood
stabilizer to, well, stabilize me. Then he could have tacked on an
antidepressant, but not Lexapro, one of the more volatile and potentially
mania-inducing of the lot.</P>
<P></P>
<P>According to this psychiatrist, the stimulants used to treat my alleged ADD
may have intensified my bipolar disorder. Adderall, she explained, can cause
dysphoria, a symptom of depression defined as a “generalized feeling of
discontent.” Dr. Titrate had never warned us that stimulants could complicate
depression or hasten the onset of bipolar disorder in kids prone to it.</P>
<P></P>
<P>The behaviorist said the addiction therapy I’d been subjected to was pretty
much a wash, and possibly counterproductive. Five months and $75,000 worth of
rehabilitation, all for nothing. “This is so typical of the so-called treatment
bipolar II patients receive,” the therapist said. “The disorder is usually only
diagnosed after everything else is ruled out.”</P>
<P></P>
<P>When my father and I got back to the halfway house, he called Dr. Titrate. I
listened in while he recounted the recent turn of events. Dr. Titrate was mostly
silent. At the end of the conversation he said, “I admit I’ve made some
mistakes. I have a conscience. But, at this point, what can I do?”</P>
<P></P>
<P><BR><BR><B>January 2007</B><BR><SPAN class=text4>Lamictal</SPAN></P>
<P></P>
<P>I’m back in college now, in my senior year. Since going off Lexapro, I have
been free of manic feelings and suicidal thoughts. I’ve got a new therapist, who
specializes in dialectical behavior therapy. She shows me how certain thinking
patterns cause symptoms by projecting a fun-house picture of what’s going on in
my life. She locks in on what I need to change and what I don’t, then works for
those targeted changes. The therapy is different from any I’ve ever had. I feel
like I’m taking a college course on myself.</P>
<P></P>
<P>Prescription drugs are still a hit-and-miss proposition for me. Last January,
a new psychiatrist prescribed Geodon, a schizophrenia medication used to treat
mania associated with bipolar disorder. In rare cases, it can actually provoke
mania. I was one of those cases. I jittered and shook and could barely sleep.
The only medication I’m on now is Lamictal, the mood stabilizer.</P>
<P></P>
<P>I haven’t heard from Dr. Titrate since an envelope bearing his name and
return address arrived at my home. Inside was a bill for $250, his consulting
charge for my father’s last phone call. My dad and I had a good laugh over
that.</P></DIV></DIV></DIV></BODY></HTML>