Antidepressant-Induced Mania: When My Mind Became a Literal Hell
By Reed Grable
I’m OK, it’s OK. Everything is OK. There’s no need to worry. I’m OK.
On a cool January night in 2015, I stood outside my mother’s apartment, smoking cigarette after cigarette, with a head full of thoughts. This year was going to be my year, I remember thinking — it was going to be the year I got my life together and made something of myself. I was ecstatic. When I finished smoking my pack of blue Kools I ran up three flights of stairs to the apartment, quickly opened the door, rushed through the living room, and barged into my mother’s small bedroom. “Everything makes so much sense now! I understand! It all makes sense!” I kept telling her, pacing fervently back and forth.
She was on the verge of falling asleep and saw me with a wide, hardened smile. “It makes sense!” I persisted.
“What the hell are you talking about?” she grumbled.
I continued walking around her room with an intense confidence, eyes darting. “Mom! You don’t have to worry anymore. I’m going to take care of you, Mom. I’m going to work, and you never have to work again!”
She slowly sat up in her bed and looked at me, confused. “Reed, I don’t understand what you’re talking about,” she said with tired eyes.
I leaned my fists into the mattress and stared her straight in the face. “You’re going to be OK,” I said with assurance.
She stared at me dumbly, “OK, uh-huh, that’s nice. Now get out of my room, I have to go to sleep.”
I left to go lie on the living room couch while thoughts passed rapidly through my psyche like bullets in a machine gun. I was going mad.
A month before, on December 6, 2014, at 19 years old, I was diagnosed with depression and put on 10 mg of the SSRI antidepressant Lexapro. At the time, I was struggling with the grief I felt after the death of my grandmother, who’d passed away several months prior. Her cancer diagnosis came unexpectedly, and for six months my family and I witnessed her gradually wither to taut skin and bone as the chemo destroyed her body. To cope, I smoked large amounts of marijuana and cartons of cigarettes each week and I ate very little. My body and mind degraded at the thought of her nearing death.
My diagnosis of depression came not from an experienced psychiatrist but from a general practitioner. I’d gone to a Kaiser Permanente emergency room after tearing a tendon at a concert. I was jumping up and down in the pit as a punk band played when I felt my ankle snap. I removed myself from the crowd and hung onto a bar table as a golf-ball-sized lump swelled on my foot. I couldn’t walk or drive, so I called my mother, who took me to the ER. When we got there, she urged me to inquire about antidepressants, as she knew I was saddened by her mother’s death and swore that they would work because, she said, they’d saved her life. I did so. The practitioner gave me an ankle brace and a prescription for my diagnosis of Major Depressive Disorder. I hobbled out of the ER on crutches and clutching a white baggie of pills, having been told nothing of the side effects they might impose.
Years after I’d burst into her room to exclaim my worldly understanding, my mother told me she’d thought I was developing schizophrenia. My twin sister, Raechel, thought so too. And my aunt Kelly. I did as well.
This essay is an attempt to understand what really went wrong.
* * *
Antidepressants are a class of drugs used to treat a variety of diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders (DSM), ranging from Major Depressive Disorder, Generalized Anxiety Disorder, and Obsessive-Compulsive Disorder to Post-Traumatic Stress Disorder, Manic-Depressive Disorder, and many others. Since the early 1980s, prescribing of antidepressants has skyrocketed, with a 400% increase in their use in the United States between 1988 and 2008. Today, 1 in 6 Americans are taking some form of psychiatric drug, the majority of them antidepressants. Yet it is relatively unknown among the general public that mental health professionals don’t fully understand what these drugs do to the mind, nor are the methods used for diagnosing a person with a mental illness comprehensible.
Antidepressants were introduced to the public as early as the 1950s but were used only to serve the severely depressed and those in mental hospitals. Patients outside of hospitals were prescribed benzodiazepines, “tranquilizers” designed to help them cope with anxiety. However, shortly after their introduction in the 1960s, these drugs were recognized to be addictive. Tolerance to benzos can build up quickly and their efficacy may last only two to three weeks.
As Mad in America founder Robert Whitaker and author of Anatomy of an Epidemic told me in an interview, antidepressants became more widely used after drug companies began “reconceptualizing the stresses of those living in a society.” Once benzos were known to be addictive, the American Psychiatric Association released a revised version of their manual, theDSM-III, in 1980. The DSM-III adopted a new disease category, Major Depression, whereas the previous 1968 edition had considered depression to be a subset of the “neuroses.”
The new manual expanded the diagnostic categories from 182 to 265, even as the American public was growing contemptuous of the unreliability of psychiatric diagnosis. This new edition put greatest emphasis on biological and genetic explanations for any form of mental strain. “It takes all the conditions of stress, angst, originally seen as normal, not as a disease, and conceptualizes it as a disease,” said Whitaker. The grief following the death of a family member, the frustration of losing a job, the trauma endured after a robbery, or any life-changing event could now be labeled a disease. “Once something is recognized as a disease,” Whitaker said, “drug companies can get approval” for drugs to treat it.
Then, in 1987, Prozac was introduced and soon became a household name. Sales of the drug soared within its first year, in large part due to how they were marketed: as fixing a chemical imbalance in the brain. Despite the fact that the “chemical imbalance” theory of depression was no more than a marketing ploy, it is still believed by both the public and medical professionals. As Whitaker explained it: “That whole theory arose because they understood that antidepressants blocked normal serotonergic function and increased serotonergic activity, so they hypothesized that maybe people with depression had low serotonin.” How antidepressants interact with the body is now understood to be far more complicated than that. Yet Prozac use exploded in adults, and eventually in teenagers, leading to a buildup of users who’ve never quit.
Had I been misdiagnosed with depression? Should I not have been prescribed antidepressants for my grief?
* * *
On January 18, my Aunt Kelly emailed to ask how I was doing. I wrote back telling her I had begun taking antidepressants, about how great I felt, and that “I have a clear idea of the life I want to live, and I’ve decided that I’m going to begin living it.” I continued by professing how incredibly optimistic I was about my future and how regretful I was about my past.
“I love you so much!” she responded, followed by heartfelt, sympathetic words encouraging me to pursue whatever it was I desired.
My sister said she became concerned about me when I persistently told her to look at a Simpsons parody of Salvador Dali’s The Persistence of Memory. “Lookit, Raechel! Lookit! Do you know what this means?” I asked her ardently, laughing hysterically, shoving the photo in her face.
“No, what are you talking about?” she said, waving me away.
“Just look at it! Tell me what it says to you, don’t you understand? You don’t understand?” I pressed. The photo showed members of the Simpson family slowly melting, with a beer bottle beneath Homer’s head, Maggie morphed into a tree, Bart as a deflated balloon hanging out to dry, and Marge staring aimlessly into the sky. “Just think about it, there’s a lot of meaning behind it,” I continued.
“OK, Reed, whatever, stop bugging me,” Raechel said.
On January 27, my aunt emailed me, again asking how I was. I responded the next day: “I’ve come to recognize the pattern that is life and the cycle that society goes through towards its progression. I’m incredibly optimistic for the U.S.’s future and mine specifically,” I wrote. “When you look at how we went from the disaster of 9/11, the war, the 2008 recession, to how gas prices are only $2.39 (!!!), we’re entering a period of artistic expression,” I continued. I then told her I was going to get a degree in Eastern religious studies and urged her to look at René Magritte’s The Son of Man because “I think it’s one that applies to my generation greatly. It has a great deal of meaning behind it.”
On January 29, Aunt Kelly contacted Raechel on Facebook Messenger. “Don’t be worried, we are going to get it under control. If he starts to talk to you tonight, just agree with him, but if you get scared, call me.” At the time, I was out smoking weed with a friend and had agreed with my sister’s request to come home to talk to my aunt by phone. “Don’t speak to him tonight other than just ‘relax and go to bed,’ make it a safe place,” Kelly told her.
“I just want Reed to be well,” my sister replied. “I honestly believe if Reed comes off the Lexapro, he will be better. I have noticed that since he has been on it, he hasn’t been himself. And I believe mixing the Lexapro and marijuana together is not helping the situation. He shouldn’t have been put on that medication in the first place. I just want him to be OK. I hate the thought of him having schizophrenia. I don’t want to believe that. I’m going to pray it’s not.”
I never came home that night.
* * *
Dr. Ronald Pies, a clinical professor of psychiatry at Tufts University and lecturer on psychiatry at Harvard Medical School, told me that psychiatrists aren’t certain why people have varying reactions to antidepressants: “There are pharmacokinetic factors, such as how well the drug is absorbed and metabolized; and there are pharmacodynamic factors, which involve how the antidepressant affects the brain and other organs.” While he acknowledges that psychiatrists aren’t certain how antidepressants “work,” there is strong evidence that they affect brain chemicals, such as serotonin, norepinephrine, and dopamine. All three of these chemicals are known to affect one’s mood, but he also adds that antidepressants affect “various ‘nerve growth factors’ like BDNF, which facilitate ‘communication’ between brain cells and brain networks.”
The antidepressants I was taking seemed to be causing my thoughts to make odd connections that eventually became horrifying. Yet, when they initially kicked in, I felt an extreme surge of confidence and believed my thoughts were the driving force behind feeling so great. I was optimistic, but that optimism itself became overwhelming and felt as though it was never going to die down. Essentially, I became fearful of my own ecstatic cheerfulness.
I eventually decided to take myself off Lexapro after another phone call with my aunt. “Do you know? Do you get what I’m saying? Do you get it?” I asked her repeatedly about all the thoughts in my head.
“No, I don’t,” I recall her saying, calmly. The calmness of her voice terrified me as I spoke frantically on the other end. Why doesn’t she understand? I thought. I began sobbing after she said “no.”
There was something wrong, something very wrong, I began to realize. I decided to cold- turkey myself off the medication immediately.
Two weeks later, while I was decorating a cake on a hot spring day in April at my then-job at Baskin Robbins, my heart suddenly started palpitating and everything around me became incredibly bright. I dropped my cake-frosting tube and began frantically walking around the store. Everything is OK, it’s OK, there’s nothing wrong, it’s OK, I kept telling myself, yet my heart continued palpitating and the store started swirling. I thought I was going insane.
A rush of customers began coming in. Don’t lose touch with reality, don’t lose touch with reality, I kept thinking to myself as I helped each person, shakily scooping ice cream and speaking with a trembling voice as I greeted each one. I couldn’t do it — I couldn’t stay at the store. I left work early and had to have my mother pick me up because I was too terrified to drive. We started calling psychiatrists to see if they could help me, but none were available until a month out. We decided to go to the ER. I sat quietly in my mother’s car, trying mentally to hold on to my sanity.
At the hospital, I was prescribed Xanax, a form of benzo drug, and took one immediately. When we arrived home from the ER, my mother and I stood outside her apartment, smoking cigarettes.
“Why is this happening to me,” I cried to her, tears falling down my face. “Does God hate me?” I asked, shrugging my shoulders up and down with each shallow breath.
My family believed that since I was smoking marijuana while on the medication, that was why I had those experiences. Yet the reason why I decided it would be fine to begin taking the antidepressants in the first place was because a friend of mine — with whom I regularly smoked — had begun taking them several months before I did. I saw major improvements in his general liveliness after he started them.
While I’m not aware of any formal studies about the interactions between marijuana and SSRIs, marijuana is known to affect the dopamine levels within the brain. So do antidepressants. Was my brain hyped up on dopamine? Was this the reason I lost it? As marijuana usage becomes more popular in the U.S. following its legalization, and the use of antidepressants continues to rise, there is certain to be some overlap, and more people are bound to have an experience similar to mine. In addition, a recent study shows that cannabis users have a five-times-greater risk for developing a psychotic disorder.
Had I been experiencing psychosis?
* * *
My strange thoughts did gradually subside after I took myself off the medication, but then I became fearful that I was going to stop thinking altogether — having thoughts move rapidly through my psyche and then abruptly stop was almost as terrifying as the rapid thoughts themselves. I remember trying to watch TV, or listen to music, but I couldn’t do it. The anxiety I felt ran heavy, and I was trapped in my head. One day, as I mindlessly stared at the TV, I picked up my cellphone and called my mother.
“Mom, can you take me somewhere?” I said quietly.
“What do you mean, where’s somewhere?” she replied.
On the other end of the line, I wept. I wanted to go to a mental institution or be put under suicide watch, but I was nervous to tell her. “Just somewhere, please.” She didn’t know what I was talking about.
During this time, I began to enter a state that I now recognize would be diagnosed as depersonalization/derealization disorder. This experience is characterized by feeling as though you’re detached from your body. Everyday actions, feelings, even thoughts, feel as though they’re not your own, as if you’re just a bystander watching yourself perform. I felt like a Sims character. I recall waking up each day, spending it in a hazy, dreamy state, and going to bed the same way. I began to think that I wasn’t even real. When I went to bed at night, and then when I woke up, a knife in my father’s kitchen drawer entered my mind. I often wondered if I could prove myself real by slitting my wrists.
By then, I had completely isolated myself from my friends and family. I called out of work frequently and spent most of my days trying to calm myself down and make sense of everything that had happened. I tried to continue without the medication for a month, but I couldn’t do it. I was in a deep mental hole and there wasn’t any end in sight. On May 1, I met with my family physician, who prescribed me 150 mg of Wellbutrin (a different class of drug from Lexapro), because she said it would help ease my anxiety and curb my cigarette addiction. I thought that since I was no longer smoking marijuana, I could give the medication a proper go.
On May 4, I emailed her, “I just started taking the Wellbutrin and I am feeling very edgy. I can’t relax and feel very tense. I had to leave work because I thought I was going to have a full-blown anxiety attack. I feel like I’m going to die and have a hard time breathing. Is there something else I can take to take this edge off??” She recommended cutting the prescription down to 75 mg and told me that we could schedule a talk by telephone in a week. I cut the prescription in half, but never called her. I was too anxious to talk.
My thoughts started to become rapid again, and the strange connections returned. As I was still experiencing derealization, I’d watch these thoughts pass by. This isn’t me, I’d have to confirm to myself constantly.
Dr. Pies has said that “there is a person’s underlying diagnosis and propensity to develop one or another kind of mood disorder” while taking antidepressants. That is, another as-yet undiagnosed disorder may be provoked by the use of antidepressants. Bipolar disorder, which among other things is characterized by manic episodes, is one such undiagnosed disorder said to show itself when antidepressants are prescribed. Mania is defined by racing thoughts, irritability, poor decision-making, and being abnormally upbeat.
It is known that between 6% and 8% of people who are placed on antidepressants for Major Depressive Disorder have manic episodes. Why this is the case is not known, but medical health professionals assume that if a person does experience mania, it means they have bipolar disorder. The DSM-IV, published in 1994, stated that if a person develops mania while on an antidepressant, it is the medication, not an underlying disorder, that is likely to be the cause. Yet for the revised DSM-V, published in 2013, the explanation had changed: An underlying disorder, not the medication, is now said to be the cause of the mania.
Was I — am I — bipolar?
One day in June, I left work early again and drove off to my father’s house. I opened the door, walked inside, stared at my father watching NASCAR on the TV, and quietly walked away into my room. My father soon entered and noticed me breathing shallowly and staring aimlessly at the ceiling.
“What’s wrong?” he asked me with a deep voice — rarely had I ever heard him express such genuine concern about me.
I didn’t know what to tell him. “Nothing,” I said.
He shut my door and I pulled out a journal. I began to write,
I hate anxiety. This is something incredibly frustrating to
have. I just keep believing something is wrong with me.
When there isn’t. My mind has become a literal hell.
I wonder nearly every second if I’m either
going to die or if I’ll just go insane. I just want to wake up
and feel fine again. But that won’t happen.
* * *
I would eventually get better, but years would go by before I could say I felt normal again. I officially came off the Wellbutrin in September of 2015, after slowly weaning myself off it by cutting the pills into smaller and smaller pieces each week over the course of two months. I’d learned after taking myself off the Lexapro that you shouldn’t stop suddenly.
The amount of anxiety I felt during the period I was still on these medications — and for a couple of years after — was so unfathomable it is difficult to describe. My entire body would feel constantly tight, my muscles tense. I felt as though I was trapped in an air-tight vat, constantly gasping for breath. And, of course, my thoughts were guided by my state of constant worry and panic. They triggered anxiety within me and my mind then felt the need to find a reason why, which resulted in my believing it was because I was either going to die or that the world was going to end. But why was I going to die? Or why was the world going to end? My thought process had to find the reason, and this struggle brought me to a mental state that I can only define as delusional.
While I was under the influence of my prescription medication, I never benefited from a psychiatrist’s expertise. As prescriptions for antidepressants skyrocket, I can’t help but wonder how many others are like me, and whether they were diagnosed as bipolar. (I never got the diagnosis due to never having seen a psychiatrist.) Dr. Pies notes that “about 80% of antidepressant prescribing is done by non-psychiatrist clinicians,” who aren’t familiar with “best practice” guidelines. “Some patients are probably given a prescription for an antidepressant after a very cursory evaluation that may mistake ordinary sadness or grief for depression,” he says.
I am not ashamed to admit that I lacked the emotional intelligence to cope with my grandmother’s death. When she was gone, I often wondered, Where did she go? Why had she been here? What was her exact purpose on earth? What is my purpose? I couldn’t think of a sufficient answer.
In later years, I would come to define my experiences as a spiritual crisis. Bereft of someone important to me, my mind was left to wander, searching for anything to attach itself to, to find some form of meaning. Soon, my thoughts wandered into dangerous territory, and with the addition of antidepressants, it became hyperactive in trying to find those answers.
After I took myself off the Wellbutrin, I quit my job to begin a spiritual quest, flying to Europe to walk the Camino de Santiago, a 500-mile pilgrimage through Northern Spain. I was trapped in my head during the 40-day excursion, but being active, meeting new people, and hearing their struggles and reflections on life brought me ease. As cliché as it sounds, I came to realize that people are complicated. How a person copes with death, or any misfortune in their life, is dependent on their capacity to endure pain and what they’ve encountered in their past.
When I returned home to California, I was still trapped in my head and anxiety ran heavy, but I kept at the forefront of my mind the plasticity of the brain and the soul’s function to help guide it. I chose not to return to medication, instead deciding to meditate daily, exercise, change my diet, and learn more. Two years would pass until delusional thoughts subsided and my state of derealization completely faded. I began feeling like myself again, but I’m left with the burden of not knowing what really happened to me.
Was it my fault? I ask myself nearly every day. I am ashamed to say that I showed a lack of responsibility in taking an antidepressant, by mixing it with marijuana, taking myself off it abruptly, and even deciding to go back on it. But I can’t help but wonder if others, too, have been prescribed medication for their inability to cope with emotional pain and were then misdiagnosed with depression. I wonder if others have mixed antidepressants with other drugs and were propelled into mental confusion, then improperly diagnosed with another disorder. I also wonder if it really is an underlying disorder such as bipolar that causes one to become manic when taking a prescribed medication.
I don’t know.
But ever since having this experience, nearly every day I still need to mentally affirm myself by repeatedly thinking, I’m OK, it’s OK. Everything is OK. There’s no need to worry. I’m OK.