Generation Rx

Picture a nuclear family, a family with deep roots in the Truckee Meadows. They live in the middle house on a cul-de-sac in an older suburban neighborhood near the Truckee River in Reno. Their neighbors are college professors, lawyers and casino execs, with a smattering of retirees.

Picture the house. It’s a 2,200-square-foot split-level home with bedrooms built over a two-car garage. It’s a lemon-chiffon color with white trim around the windows and brick to about four feet off the ground and a matching brick flowerbox and mailbox stand. There are one, two, three Chevrolet SUVs parked in the three-space driveway.

The dominant feature of the front of the home is a picture window. If a stranger, perhaps one of the many who walk their dogs in the neighborhood, were to look inside, the stranger would see a house with a surprising amount of vanilla on the walls. Here and there is a small painting, color like paint flicked off a brush, but from the window to the opposite wall there is vanilla carpeting, vanilla wall paint and a hanging lamp and fan with vanilla blades.

Approaching the house up the gray pressed-concrete sidewalk, there’s a sound of rock ‘n’ roll music—something emo—coming out of one of the bedroom windows.

The family, too, is vanilla. (Some details have been changed to protect identities.) Sitting at a table in the raised dining room are the four Brandons, father Phil, 40, a professional, mother Sarah, 38, another professional, their 15-year-old daughter Nicole, who is a high-school sophomore, and their son Damien, 13, a seventh-grader.

This family is so normal, so middle-class, so damned off-the-rack that it’s hard to imagine there’s anything worth writing about them. They’re mildly conservative looking—no wild hairstyles or pierced eyelids.

Really, the only thing that’s different about them is that they are all on drugs. Not illicit drugs, mind you, but prescribed drugs meant to alter some basic chemical equations in their brains. All four of them. Does that seem, well, strange? Unusual, anyway?

It’s not. Not really. If you look at the statistics regarding psychotropic drug therapy around the country—last year, 51 million prescriptions for selective serotonin reuptake inhibitors, or SSRIs, were written—you understand just how common such medications are. These folks could easily be your neighbors. And they would be the first to tell you that, despite media hysteria about an epidemic of adult depression prescriptions and over-diagnosis of attention deficit/hyperactivity disorder, the drugs help them get through an increasingly insane life.

These days it’s not difficult to find whole families managing their lives with doctor-prescribed get-along drugs—mood stabilizers, anti-depressants, stimulants, hormones, sedatives. That doesn’t even include the glass or four of red social lubricant at parties.

Phil Brandon began taking Celexa,an anti-depressant, after an extended period of isolation left him feeling disconnected from society. He began seeing a psychiatrist hoping to alleviate the feelings of friendlessness, depression and worthlessness that were beginning to affect his home life.

“I thought I might give anti-depressants a shot after my dad—who I thought had never had a depressed moment in his life—and my sister started taking them,” he said later. “Actually, my brother started taking Wellbutrin about the same time. So I took them for a couple months, then we cut the dose in half, and then I started breaking a 20 [milligram dose] in half and just taking it when I felt like I was dropping back into depression, sometimes after I had a few too many drinks.”

Phil said the drug had some beneficial side effects, including helping with his sleep and his sex life. While he wasn’t particularly interested in announcing to the world that he’d taken an anti-depressant, he also didn’t feel it had the negative connotations it did when he was younger.

“I don’t think it’s very realistic to pretend these advancements in medicine don’t exist,” he said. “If there’s a way to solve or something you can grab onto long enough to resolve some of these emotional issues, then isn’t it more irresponsible not to take advantage of them?”

The symptoms of Nicki’s emotional problems—bleeding scratches and bathroom visits immediately after meals—have been somewhat alleviated by the anti-depressant Zoloft. At one time, she’d wanted to stop taking her anti-compulsive-behavior aid because she wanted to control her own emotions. In reality, Phil said, it was because the Zoloft effectively kept her from wanting to exercise whatever muscle flexes when she sticks her finger down her throat, indulging her anorexia with bulimic overtones.

“I’d been told the medication makes it so you don’t have the compulsions to binge or purge,” Nicki said, agreeing with her dad’s summation, combing her long, brown hair behind her ear. “I wanted to lose weight, but I figured I wouldn’t be able to do that unless I stopped taking the pills.”

Now, she’s content to take her daily dose, hoping one day to quit the drugs—but beginning to doubt the possibility—and looking for positive ways to control her life, exploring her spirituality and continuing counseling with a psychologist.

Nicki’s aware that several of her friends take drugs to cope with life’s hurdles, and while her close friends know about her little helpers, it’s not something to brag about or a logo she’d wear on her T-shirt. While psychotropic drugs aren’t taboo, they aren’t exactly trendy, either. In fact, despite the growing number of her crowd who are prescribed medications, she’s not altogether certain it’s the drugs that have provided the attitude adjustment.

“I don’t know if the chemicals actually help, but I have fewer relapses. I’ve also been in counseling longer; it’s really hard to say.”

Still, that doesn’t mean everything’s rosy. Nicki’s psychiatrist (like most people receiving this sort of medication, she has a psychologist for counseling and a psychiatrist for prescriptions) recently told her she may have to take the drugs for the rest of her life. That information made her feel as though she’d started taking the drugs under false pretenses.

“They had the information,” she said. “They could have told me. When you administer drugs for chronic depression, it’s usually for the rest of your life. They told me [at first that] I’d have the drugs—I don’t even know what they do to me—in my body for less than a year. It scares me that something is in my system that I don’t know what it is. It seems like I’m not myself. I’m coping with things really well, but I don’t know if it’s me or the drugs, so it scares me to go off them.”

On the other hand, the idea of not being in control of her emotions, being dependent on drugs for the strength required not to hurt or kill herself, isn’t exactly a self-esteem builder, either.

“I hate it,” she said. “I feel like I’m weaker, like I’m not somebody who can cope with issues that everybody has to go through. I’m always going to need that security blanket. I think [getting on Zoloft] was encouraged by people around me, my family. The media portray drugs as the fix-all. My family thought if I was on drugs they wouldn’t have to worry about my life being in danger. They thought that if I was on drugs, they wouldn’t have to deal with my eating disorder. Indirectly, they were using drugs to cope. That’s how I felt.”

Sarah may have been more willing than most parents to convince Nicki that it’s better to take her medicine. She’s been on lithium for nine and a half years. She began taking it because she’d been in therapy for anorexia for three years and wasn’t progressing in her recovery. Her therapist and psychiatrist, after experimenting with several antidepressants that had less-than-stellar results, tried her on the mood stabilizer. It worked.

In part due to her reaction to the lithium, she was diagnosed bipolar II in 1994. She now takes nightly doses, 900 milligrams, of the drug. She takes it at night because, on the negative side, it affects her vision temporarily, but, on the positive side, it helps her sleep.

She said the stigma attached to taking drugs is nothing compared to having untreated and imbalanced brain chemistry.

“It sucked. The thing I noticed the most wasn’t being depressed; everybody’s depressed. Bipolar II’s mania [bipolar is also known as manic-depressive] made me want to drive too fast, talk too fast, but this irritability hits, and I wouldn’t want to talk to people. The littlest thing would piss me off. I’d try not to yell at the kids, but I couldn’t control it. And then, if I would get through a little situation where I didn’t lose it, but I’d have to go to my room and take three deep breaths. It would go on for weeks.

“Before I started taking the medication, I had some kind of weird vibrating energy in my body. The thoughts were constantly racing. Too many thoughts all the time, this incredible noise in my head. It was really hard to tolerate—too many things to attend to all the time. When I started taking the lithium, for the first time I didn’t have all that crap. I thought everybody had that crap. I didn’t know only some people had that.”

She said she never felt any compunction against taking the drug and doesn’t believe drugs for mental illness are any different from taking medication for physical problems.

“Would you put down a diabetic for taking insulin? Everything had been so horrible; I wanted it to be better. The psychiatrist was very helpful. This wasn’t something I was doing on purpose. Within a few months, I could concentrate on the eating disorder.”

The Brandons’ son, Damien, 13, is somewhat disinterested in the entire topic. He’d been on Cylert, a drug used to combat attention deficit hyperactivity disorder, for about a year. The doctor switched him over to Concerta when the effects of Cylert seemed to be waning. In the days before Cylert, the boy couldn’t complete his in-class assignments, often spending hours at home in the evening trying to concentrate on his math but unable to do so, The Simpsons, the dogs, the telephone or the breeze outside enough to disrupt the slog through homework. His dad says he’s a changed boy now: fewer problems at school, fewer discipline problems at home. He likes himself a lot better; not so many people are constantly telling him how he’s all screwed up—a bad boy.

Damien is one of an average of 7.5 percent of kids in schools who are tasting the rainbow of pills with names like Cylert, Concerta, Adderal, Strattera and Ritalin.

Damien can barely recall what he was like before he began on the medication.

“I remember I was hyperactive. I would have one subject, or be thinking about one subject, and I would wander off. Sometimes I’d forget what I was talking about and start saying things at random. Most people didn’t really care or notice, although I’m sure sometimes they got irritated by the fact that I was constantly hyperactive.

“I think it helps when it’s working. When I focus on something, I can actually get it done. Then I can focus on the next thing, and I can get that done and focus on the next thing.”

Damien doesn’t have an opinion on whether there are more children having their attention augmented than there used to be. He said that even if there are a bunch of kids taking drugs, it doesn’t matter to him.

“In my experience, normal is relative,” he said. “The way I am is normal for me. Sometimes when people say they’re taking Ritalin or whatever, people think, ‘Oh this person may not be a good person to be friendly with because they have to take something just to be a normal person.’ I think those people are just ignorant.”

Damien doesn’t believe anybody thought less of him when he began taking drugs to cope with his disorder; in fact, some may have been relieved.

“My family was looking out for what was best for me. Friends didn’t really care. Everyone has their own quirks and weaknesses, and that’s what makes everyone unique and interesting.”

There is no doubt that psychotropic medication has improved an enormous number of lives. Chemical-imbalance-based diseases that had little hope of cure just a few decades ago now have at least the hope of a quicker fix. Society has been improved by the potential that a pill or two can diminish psychosis, depression, anger, anxiety, inattentiveness, hyperactivity, lethargy, insomnia, delusions, phobias, obsessions, compulsions—the list sounds like the commercial line-up on Friday-night network television.

But with all the positives, can there be negatives? A simple search of Ritalin on the Internet will yield hundreds of thousands of hits (so to speak) of concerned parents, groups, politicians, doctors who believe children, especially boys, are being medicated unnecessarily. Can it be that the pendulum has swung too far? Surely, this sort of chemical manipulation could never become mandatory.

There are those who say it already has and that advances in science have moved beyond a hidden shame and beyond an accepted method of medication to a form of chemical incarceration for society’s most vulnerable.

Bob Woerner of Reno said his wife is one such person. Woerner considers himself an advocate for the mentally ill, particularly in areas of forced medication. His wife killed a hitchhiker in Washoe Valley 10 years ago while in the throes of a schizophrenic episode. She was found incompetent but has spent all these years in a mental hospital.

He said there are reasons his wife has spent all these years committed to the hospital, reasons that have little to do with getting better. First, he believes that by keeping patients locked up, the mental hospitals benefit from government payments, Social Security or Medicare, that are based on occupancy. Hospitals, he said, have a 5-1 worker-to-patient ratio. That may have made sense before these drugs came along to modify patients’ behavior, but now the high level of staffing only serves to increase costs to taxpayers and behoove the hospital not to release patients.

Most of all, though, long hospitalizations and forced medication benefit the pharmaceutical companies. Woerner claimed mental-illness disability is a new form of permanent welfare that neither the government nor pharmaceutical interests are interested in seeing people free of.

“Why does our country have more mentally ill every year? It’s because companies have more drugs to sell. There’s a whole industry building and building. You have all these federal and state mental-health programs, and every year they’re asking for more money, more money, and 50 percent of the money is used for drugs, which benefits the pharmaceutical industry. They call them ‘Big Pharma.’ They’re the third-largest industry in America today.”

While Woerner readily admitted that his wife is delusional and in need of constant supervision, he thinks the best thing for her would be to come home. The decade spent in the hospital forced to endure the side effects of drugs has institutionalized her, making her even less able to cope with the world.

Woerner isn’t far off with his estimation of the numbers of people suffering from mental illness in the United States. According to the National Institute of Mental Health, an estimated 22.1 percent of Americans ages 18 and older—about 1 in 5 adults—suffer from a diagnosable mental disorder in a given year. When applied to the latest U.S. Census estimates, this translates to 64 million people. Also, 40 percent of the leading causes of disability are mental disorders—major depression, bipolar disorder, schizophrenia and obsessive-compulsive disorder.

Woerner isn’t the only one who believes the prescription of medicine has gone too far. Sen. John Ensign (R-Nev.) introduced the “Child Medication Safety Act of 2003” in the U.S. Senate last summer. The legislation is designed to end the practice of coercing the medication of children as a condition of attending school.

“The decision to place a child on medication as a method to treat behavioral problems or learning disabilities should be made by parents and parents only, and undue influence or coercion by school officials has no place in such an important decision,” Ensign said in a press release. The bill is pending in the Senate’s Committee on Health, Education, Labor and Pensions.

Many doctors don’t see a crisis. Dr. Michael Irwin, a Reno psychiatrist, has seen great leaps made in the sophistication of drugs used to treat mental disorders. He said it’s not common for patients to come in requesting unneeded medication, but it does happen sometimes. Some doctors complain that patients see an ad on television and come in with unreal and uninformed expectations for name-brand drugs. Still, Irwin, who’s been practicing for more than 30 years, doesn’t think it’s become somehow stylish to get chemically balanced.

“You see it in cartoons in The New Yorker where people are bragging about what antidepressant they’re taking, that kind of thing, but I don’t see that personally. I see it in the culture, but I don’t go to parties and have people bragging about their antidepressants. Maybe it’s only in Manhattan.”

He said the reason prescription psychotropic drug use has exploded into the national consciousness is pretty mundane: The newer drugs are far superior to those that existed before.

“Starting with Prozac in 1988, as far as antidepressants are concerned, they became much easier to take. The ones that preceded it, although they were effective, had much more difficult side effects—dry mouth, constipation, blurred vision, sometimes confusion. For some people, that didn’t occur; most people, we had to encourage them to keep going. They all wanted to quit. ‘C’mon, keep going, It’s going to help you, even though you feel worse right now.’ That’s what it was like with things like Elavil. That’s changed. Not that the new ones don’t have any side effects, but they’re just easier to take, so that certainly makes a difference.”

Psychologists also see differences with the new drugs. Dr. Jean Bradt, a Reno psychologist, said the emphasis for mental wellness has moved away from conventional techniques of identifying problems and talking out issues toward manipulation of chemicals within the brain.

“Therapy is so much work, but taking a pill is so easy. And so very tempting. Very tempting.”

Even so, the more severe types of mental illness require therapy, and Bradt, who suffers from a mental illness herself and bills herself as “The Bipolar Psychologist,” says she’s not going to lose any sleep over the changing social strata; she’s always going to have a job.

“Recovery is not just a pill. Recovery involves examining your lifestyle, figuring out who you are, working, thinking. Medicine is so important, especially for the more severe disorders, but you’ve got to work with your medicine, and people are forgetting that. They think the pill’s a panacea: pop a pill. Medications have been getting more and more effective for years. They’ve got some fantastic medicines, and I’m very glad that they’ve come up with them.”

The Brandons, with their vanilla lives in the split-level near the Truckee River, would concur.

“Actually," said Phil, "it’s probably far worse talking about these drugs than it is taking them."