Johann Hari: Do I really need this artificial happiness?

For the first few years, I was defensive about any criticism of my beloved antidepressants
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The Independent Online

I belong to the first generation of people who have been antidepressed all our adult lives. I started taking the antidepressant Seroxat when I was 17. I come from the Chernobyl of nuclear families, and it had finally imploded; and together with it, so had my neuroses. I couldn't get out of bed in the morning except in a tearful, uncomprehending rage. A familiar story passed in the suburbs once I had my pills: the toxic black fog of depression parted; it was like wearing glasses for the first time and discovering you had been half-blind since birth. Life went from being a muggy minefield to being a bouncy castle. Now - a decade later - I do not know what life would be like without it, and I am starting to wonder and to worry.

There are millions of people like this, scattered across the developed world, with their blue and yellow and white pills making their minds cleaner, or clearer, or more tolerable to live in. Most of them wonder too if, amidst the glories, there are drawbacks.

For the first few years, I was extremely defensive about any criticism of my beloved antidepressants. I became fond of quoting the writer Andrew Solomon, who in his gargantuan study of depression, The Noonday Demon, compares his need for anti-depressants to a diabetic's need for insulin. "If you discover somebody is diabetic at a party, you don't pat them on the shoulder and say, 'I hope you're off it soon', so why should you do it to somebody on antidepressants?" he asked. Depression, he said, was caused by malfunctioning neurotransmitters. It's an engineering problem in the brain, and SSRIs - the family of antidepressants created in the 1980s - are the crew sent in to fix it.

I was even tempted by the arguments of Dr Peter Kramer, whose book Listening to Prozac argued that SSRIs are actually a way to enhance the human species. He interviewed hundreds of people who had seen their bad tempers or obsessive fears dissolved by the drugs, and concluded that SSRIs are like antiseptic steel knives that cleanly, painlessly slice off the ugly parts of your character, leaving a fresher, more efficient person behind. He called this "cosmetic neuropharmacology", and recommended it even for the non-depressed.

But doubts began to poke through this Promethean optimism a few years ago. I have never regretted taking the anti-depressants to lift me out of depression, and never will, but I began to wonder if they were really a lifetime companion rather than a long fling. I sensed somewhere that they had drawbacks, but I could never really articulate what they were - until I recently read the book Artificial Happiness: The Dark Side of the New Happy Class by Dr Ronald W Dworkin, which has been causing a chemical stir in the US.

He doesn't buy into the hysteria about Seroxat causing suicide, and nor do I: most metastudies show that suicide rates have fallen dramatically in countries after the introduction of SSRIs. No, he has a very different objection. He says that anti-depressants quite quickly create a state of artificial happiness, where your life and your mind slip out of synch. The ordinary signals that you receive from the world - I don't like that, I like this - become blunted, because you feel pretty good no matter what happens. Just as people who lose physical sensation become extremely vulnerable to being burned or bruised without noticing it, people who lose the mental sensations of unhappiness become vulnerable to social damage that they can't feel is happening to them.

Dworkin illustrates this by talking about a fortysomething friend called Kenny who became depressed because every night he would head to bars to chat up beautiful 20-year-old girls, only to find they were no longer interested in him. He would slope home alone at the end of the night feeling rejected and dejected, and began to show the symptoms of mild depression - weepiness, listlessness, despair.

Kenny went to his doctor, who explained that his neurotransmitters clearly weren't functioning properly, and gave him an SSRI prescription. As a result, Kenny kept going to the bars and he kept getting rejected - only now it didn't really hurt. He's still there, still objectively miserable, except with a sweet foam of Prozac to draw the sting.

Dworkin says people like Kenny "don't feel the unhappiness they need to feel in order to move forward with their lives. Sometimes people need a critical mass of unhappiness to push them out of a bad life situation. Artificially happy people lose this impulse to change. When I read this, I recognised handfuls of my SSRI-taking friends, like the smart 27-year-old guy I know still living with his parents, unemployed, in a miserable situation, but kept happy - and stuck - by Seroxat, because he never felt miserable enough to change.

And, I admitted after a few months of jabbing the thought away, it applied to me too. Dworkin believes antidepressants are useful tools for lifting people out of chronic depression, and I suspect he would have supported my initial prescription. But after my depression was soaked up, I kept taking it. All sorts of things came along, as they do in every life, that would have made me miserable and forced me to change if I hadn't been antidepressed: a bad relationship, swollen debts, over-eating. All continued far longer than they needed to because they didn't really make me feel really bad; nothing did.

Yes, I think Dworkin overstates his case. At points he presents the antidepressed as almost alien people, disconnected from the world, conscienceless, "incapable of empathy", people who "don't know what kindness is" - not features I think apply to me or to the dozens of other antidepressed people I know.

But his book - and my sweet decade-long romance with Seroxat that I know now must end - has taught me that although depression is a disease, unhappiness is not. On the contrary, it is an essential state, a signal we all need from time to time to show us when our lives are going wrong. Stripped of that signal, it is easy to lose your way - as many, many people who take antidepressants for too long do. Don't get me wrong: I'm not some Calvinist (or sadist) who believes unhappiness is a good thing, a morally enriching experience. I'm not even a Stoic, who believes unhappiness should be piously endured; I believe maximising happiness is and should be the most basic goal of human ethics.

But we can only steer ourselves towards real happiness if we know when we are going off the road - and an adult lifetime on antidepressants clouds the windshield. That's why I have decided, with one last synthetic tear, to bid the antidepressants goodbye.

j.hari@independent.co.uk

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