Chemical Kiss: A Selection from Johann Hari’s Lost Connections (2019)

“I was eighteen years old when I swallowed my first antidepressant. I was standing in the weak English sunshine, outside a pharmacy in a shopping center in London. The tablet was white and small, and as I swallowed, it felt like a chemical kiss.

That morning I had gone to see my doctor. I struggled, I explained to him, to remember a day when I hadn’t felt a long crying jag judder its way out of me. Ever since I was a small child—at school, at college, at home, with friends—I would often have to absent myself, shut myself away, and cry. They were not a few tears. They were proper sobs. And even when the tears didn’t come, I had an almost constant anxious monologue thrumming through my mind. Then I would chide myself: It’s all in your head. Get over it. Stop being so weak. I was embarrassed to say it then; I am embarrassed to type it now.

In every book about depression or severe anxiety by someone who has been through it, there is a long stretch of pain-porn in which the author describes—in ever more heightened language—the depth of the distress they felt. We needed that once, when other people didn’t know what depression or severe anxiety felt like. Thanks to the people who have been breaking this taboo for decades now, I don’t have to write that book all over again. That is not what I am going to write about here. Take it from me, though: it hurts.

A month before I walked into that doctor’s office, I found myself on a beach in Barcelona, crying as the waves washed into me, when, quite suddenly, the explanation—for why this was happening, and how to find my way back—came to me. I was in the middle of traveling across Europe with a friend, in the summer before I became the first person in my family to go to a fancy university. We had bought cheap student rail passes, which meant for a month we could travel on any train in Europe for free, staying in youth hostels along the way. I had visions of yellow beaches and high culture—the Louvre, a spliff, hot Italians. But just before we left, I had been rejected by the first person I had ever really been in love with, and I felt emotion leaking out of me, even more than usual, like an embarrassing smell.

The trip did not go as I planned. I burst into tears on a gondola in Venice. I howled on the Matterhorn. I started to shake in Kafka’s house in Prague. For me, it was unusual, but not that unusual. I’d had periods in my life like this before, when pain seemed unmanageable and I wanted to excuse myself from the world. But then in Barcelona, when I couldn’t stop crying, my friend said to me—You realize most people don’t do this, don’t you? And then I experienced one of the very few epiphanies of my life. I turned to her and said: ‘I am depressed! It’s not all in my head! I’m not unhappy, I’m not weak—I’m depressed!’

This will sound odd, but what I experienced at that moment was a happy jolt—like unexpectedly finding a pile of money down the back of your sofa. There is a term for feeling like this! It is a medical condition, like diabetes or irritable bowel syndrome! I had been hearing this, as a message bouncing through the culture, for years, of course, but now it clicked into place. They meant me! And there is, I suddenly recalled in that moment, a solution to depression: antidepressants. So that’s what I need! As soon as I get home, I will get these tablets, and I will be normal, and all the parts of me that are not depressed will be unshackled. I had always had drives that have nothing to do with depression—to meet people, to learn, to understand the world. They will be set free, I said, and soon. . . .

Like all epiphanies, it seemed to come in a flash, but it had in fact been a long time coming. I knew what depression was. I had seen it play out in soap operas, and had read about it in books. I had heard my own mother talking about depression and anxiety, and seen her swallowing pills for it. And I knew about the cure, because it had been announced by the global media just a few years before. My teenage years coincided with the Age of Prozac—the dawn of new drugs that promised, for the first time, to be able to cure depression without crippling side effects. One of the bestselling books of the decade explained that these drugs actually make you ‘better than well’—they make you stronger and healthier than ordinary people. I had soaked all this up, without ever really stopping to think about it. There was a lot of talk like that in the late 1990s; it was everywhere. And now I saw—at last—that it applied to me.

My doctor, it was clear on the afternoon when I went to see him, had absorbed all this, too. In his little office, he explained patiently to me why I felt this way. There are some people who naturally have depleted levels of a chemical named serotonin in their brains, he said, and this is what causes depression—that weird, persistent, misfiring unhappiness that won’t go away. Fortunately, just in time for my adulthood, there was a new generation of drugs—Selective Serotonin Reuptake Inhibitors (SSRIs)—that restore your serotonin to the level of a normal person’s. Depression is a brain disease, he said, and this is the cure. He took out a picture of a brain and talked to me about it.

He was saying that depression was indeed all in my head—but in a very different way. It’s not imaginary. It’s very real, and it’s a brain malfunction. He didn’t have to push. It was a story I was already sold on. I left within ten minutes with my script for Seroxat (or Paxil, as it’s known in the United States).

It was only years later—in the course of writing this book—that somebody pointed out to me all the questions my doctor didn’t ask that day. Like: Is there any reason you might feel so distressed? What’s been happening in your life? Is there anything hurting you that we might want to change? Even if he had asked, I don’t think I would have been able to answer him. I suspect I would have looked at him blankly. My life, I would have said, was good. Sure, I’d had some problems; but I had no reason to be unhappy—certainly not this unhappy.

In any case, he didn’t ask, and I didn’t wonder why. Over the next thirteen years, doctors kept writing me prescriptions for this drug, and none of them asked either. If they had, I suspect I would have been indignant, and said—If you have a broken brain that can’t generate the right happiness-producing chemicals, what’s the point of asking such questions? Isn’t it cruel? You don’t ask a dementia patient why they can’t remember where they left their keys. What a stupid thing to ask me. Haven’t you been to medical school?

The doctor had told me it would take two weeks for me to feel the effect of the drugs, but that night, after collecting my prescription, I felt a warm surge running through me—a light thrumming that I was sure consisted of my brain synapses groaning and creaking into the correct configuration. I lay on my bed listening to a worn-out mix tape, and I knew I wasn’t going to be crying again for a long time.

I left for the university a few weeks later. With my new chemical armor, I wasn’t afraid. There, I became an evangelist for antidepressants. Whenever a friend was sad, I would offer them some of my pills to try, and I’d tell them to get some from the doctor. I became convinced that I was not merely nondepressed, but in some better state—I thought of it as ‘antidepression.’ I was, I told myself, unusually resilient and energetic. I could feel some physical side effects from the drug, it was true—I was putting on a lot of weight, and I would find myself sweating unexpectedly. But that was a small price to pay to stop hemorrhaging sadness on the people around me. And—look!—I could do anything now.

Within a few months, I started to notice that there were moments of welling sadness that would come back to me unexpectedly. They seemed inexplicable, and manifestly irrational. I returned to my doctor, and we agreed that I needed a higher dose. So my 20 milligrams a day was upped to 30 milligrams a day; my white pills became blue pills.

And so it continued, all through my late teens, and all through my twenties. I would preach the benefits of these drugs; after a while, the sadness would return; so I would be given a higher dose; 30 milligrams became 40; 40 became 50; until finally I was taking two big blue pills a day, at 60 milligrams. Every time, I got fatter; every time, I sweated more; every time, I knew it was a price worth paying.

I explained to anyone who asked that depression is a disease of the brain, and SSRIs are the cure. When I became a journalist, I wrote articles in newspapers explaining this patiently to the public. I described the sadness returning to me as a medical process—clearly there was a running down of chemicals in my brain, beyond my control or comprehension. Thank God these drugs are remarkably powerful, I explained, and they work. Look at me. I’m the proof. Every now and then, I would hear a doubt in my head—but I would swiftly dismiss it by swallowing an extra pill or two that day.

I had my story. In fact, I realize now, it came in two parts. The first was about what causes depression: it’s a malfunction in the brain, caused by serotonin deficiency or some other glitch in your mental hardware. The second was about what solves depression: drugs, which repair your brain chemistry. I liked this story. It made sense to me. It guided me through life. . . .

By the time I was in my early thirties, I had a kind of negative epiphany—the opposite of the one I had that day on a beach in Barcelona so many years before. No matter how high a dose I jacked up my antidepressants to, the sadness would always outrun it. There would be a bubble of apparently chemical relief, and then that sense of prickling unhappiness would return. I would start once again to have strong recurring thoughts that said: life is pointless; everything you’re doing is pointless; this whole thing is a fucking waste of time. It would be a thrum of unending anxiety. . . .

From when I was a little kid, I have memories of bottles of pills laid out on the kitchen table, waiting, with inscrutable white medical labels on them. I’ve written before about the drug addiction in my family, and how one of my earliest memories was of trying to wake up one of my relatives and not being able to. But when I was very young, it wasn’t the banned drugs that were dominant in our lives—it was the ones handed out by doctors: old-style antidepressants and tranquilizers like Valium, the chemical tweaks and alterations that got us through the day.

That’s not the curious thing that happened to us. The curious thing is that as I grew up, Western civilization caught up with my family. When I was small and I stayed with friends, I noticed that nobody in their families swallowed pills with their breakfast, lunch, or dinner. Nobody was sedated or amped up or antidepressed. My family was, I realized, unusual.

And then gradually, as the years passed, I noticed the pills appearing in more and more people’s lives, prescribed, approved, recommended. Today they are all around us. Some one in five U.S. adults is taking at least one drug for a psychiatric problem; nearly one in four middle-aged women in the United States is taking antidepressants at any given time; around one in ten boys at American high schools is being given a powerful stimulant to make them focus; and addictions to legal and illegal drugs are now so widespread that the life expectancy of white men is declining for the first time in the entire peacetime history of the United States. These effects have radiated out across the Western world: for example, as you read this, one in three French people is taking a legal psychotropic drug such as an antidepressant, while the UK has almost the highest use in all of Europe. You can’t escape it: when scientists test the water supply of Western countries, they always find it is laced with antidepressants, because so many of us are taking them and excreting them that they simply can’t be filtered out of the water we drink every day. We are literally awash in these drugs.

What once seemed startling has become normal. Without talking about it much, we’ve accepted that a huge number of the people around us are so distressed that they feel they need to take a powerful chemical every day to keep themselves together. . . .

When I was thirty-one years old, I found myself chemically naked for the first time in my adult life. For almost a decade, I had been ignoring my therapist’s gentle reminders that I was still depressed despite my drugs. It was only after a crisis in my life—when I felt unequivocally terrible and couldn’t shake it off—that I decided to listen to him. What I had been trying for so long wasn’t—it seemed—working. And so, when I flushed away my final packs of Paxil, I found these mysteries waiting for me, like children on a train platform, waiting to be collected, trying to catch my eye. . . . We have been systematically misinformed about what depression and anxiety are.

I had believed two stories about depression in my life. For the first eighteen years of my life, I had thought of it as ‘all in my head’—meaning it was not real, imaginary, fake, an indulgence, an embarrassment, a weakness. Then, for the next thirteen years, I believed it was ‘all in my head’ in a very different way—it was due to a malfunctioning brain.

But I was going to learn that neither of these stories is true. The primary cause of all this rising depression and anxiety is not in our heads. It is, I discovered, largely in the world, and the way we are living in it. I learned there are at least nine proven causes of depression and anxiety (although nobody had brought them together like this before), and many of them are rising all around us—causing us to feel radically worse.

This wasn’t an easy journey for me. As you will see, I clung to my old story about my depression being caused by my brain being broken. I fought for it. I refused for a long time to see the evidence they were presenting to me. This wasn’t a warm slide into a different way of thinking. It was a fight.

But if we continue with the errors we have been making for so long, we will remain trapped in these states, and they will continue to grow. I know it might seem daunting to read about the causes of depression and anxiety at first, because they run very deep in our culture. It daunted me. But as I pressed on through the journey, I realized what was on the other side of it: the real solutions.

When I finally understood what was happening—to me, and to so many people like me—I learned there are real antidepressants waiting for us. They don’t look like the chemical antidepressants that have worked so poorly for so many of us. They aren’t something you buy, or swallow. But they might hold the beginning of a true path out of our pain.”—Johann Hari, Lost Connections: Why You’re Depressed and How to Find Hope (2019)