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Zoloft and The Sacred

Gerbera Daisy by Caitlin McDonagh

We expect antidepressants to make people feel better (or perhaps worse) but are surprised to hear that they make people feel more or less spiritual. Here is the first study of the spiritual side effects of antidepressants.

I vividly remember the first time I ever thought about the relationship between psychiatric medication and spirituality. It was June of 2004, and one of those beautiful, endless summer days San Diego is so famous for. My friend and I were at the beach, and she was telling me all about what it was like to be on Prozac. She said the medication had helped her mood to be more consistent, which was great, but the side effects were that she could no longer cry and that she could no longer have an orgasm. And as hot as it must have been that day, I got gooseflesh. My throat closed in and went dry, and my thoughts became panicky. I tried to hide my intense reaction to what I was hearing from my friend, but I remember thinking: What the heck was in those pills that could prevent both tears and climaxes? These were such sublime aspects of being human that I had always considered them as sacred.

Even if we understand that spirituality is used to cope in times of crisis, distress, and depression, it can be easy to miss the link between antidepressants and the sacred. We tend to see the drugs as biological interventions helping to correct underlying biological abnormalities and neurochemical disorders. So the notion that people are engaged spiritually with their prescriptions is typically outside the explanatory frameworks of prescribers and the pharmaceutical companies.

My own “awakening” at the beach took me years to unpack. It turns out that the emotional and physiological quality of that moment is what Elizabeth Gilbert wrote about in her book Big Magic: When inspiration strikes, chills may run up your arms, and the hairs on the back of your neck may stand up. You may feel sick. You may feel dizzy. It’s rather intense, because powerful inspirations tend to be embodied. That’s very much how it felt the day my curiosity was born—and that’s also why the news of Prozac’s superpowers would ultimately hit me so hard.

Inspiration can come on really strong—WHOOSH—and can change your life. But if you don’t do anything about it, it fades. It was only in 2012, after reading Anatomy of an Epidemic by the science journalist Robert Whitaker, that I responded to its call. Whitaker’s book examines the rapid and astonishing rise in psychiatric prescriptions—from 2.5 million to 30 million today over the last 30 years. As I read, I came across the phrases spiritual murder and lose your soul, in reference to taking the medicine. At that point, I realized with great clarity just how troubled I was at the lack of dialogue around spirituality and psychiatric medication use.

I should note that I have never been given a prescription for my emotional distress—not by choice, just by chance. My teens included several unstable years of suicidal behavior and drug and alcohol abuse, and I received a fair amount of inpatient and outpatient treatment. But the surge in prescriptions had not yet begun. I’m certain that if I had come of age in the early 1990s instead of the late 1980s, I would have been offered an antidepressant as part of my treatment. My friend at the beach was 10 years younger than me, and in the accelerated world of psychopharmacology, those years made a huge difference. There’s a powerful irony in the thought that had I been taking antidepressants, I wouldn’t have experienced that embodied awakening on the beach.

So I knew viscerally that something unforeseen was happening which challenged the oversimplified views being promoted by psychiatry and the pharmaceutical industry. I saw a need for more firsthand knowledge, and I structured my PhD around qualitative research into people’s lived experiences of the medication-spirituality relationship.

The Study

 In contemporary America, spirituality means a lot of different things. For example, spirituality includes religion for some, but for others it excludes religion. So for the purposes of my study, spirituality was exactly what people said it was.

Personally, I think of spirituality as a diamond, brilliantly reflecting different sides of the same gem. What we see depends greatly on how we hold it to the light. I also believe that every spiritual life is unique—even if people share a religious background—because understandings of faith are ultimately based on the never-to-be-repeated contingencies of each person’s life story. Even so, several common themes around spirituality emerged in my study, including feelings of connectedness, the search for meaning and purpose, transformation and growth, creativity and perseverance. Here is a sample of how people described their spirituality, using their own words. Seeing what spirituality means to people helps with understanding how the impact of psychiatric medication was perceived.

Connection to Self: “To me, having this sense of spirituality is very entwined with feeling deeply and experiencing life fully. Being able to be open and access this sense that there is something higher, in the spiritual sense, to me, requires being able to fully feel my emotions.”

—Virginia, 35, creative arts therapist

Connection to Others: “For me, spirituality has to include right relationship, some kind of service. It’s the sense that there’s so much hurt, woundedness, and injustice in our world, that trying to live in right relationship with that is essential, I think, to spirituality. But it’s more than just a ‘justice’ kind of relationship. Being in right relationship has to do with love. And I think that’s what we’re here to learn about: how to love well.”

—Maria, 39, nun and hospital chaplain

Connection to Nature: “I call myself a sacred materialist. What matters most to me, what I would put my life on the line about, is not a belief in some God, but fresh air, clean water, safe food. Those are sacred. I don’t care if my soul is saved, I really just don’t want my body to get sicker.”

—Sandra, 42, journalist, on disability, diagnosed with multiple chemical sensitivity

Connection to the Transcendent: “In terms of spirituality, to me it’s the awareness of things around me, like being at the hospital on a day I wasn’t supposed to be, but there was a reason for me to be there, because there was someone I needed to be present to. To be able to sit and hold a baby in my arms who has just died, and be connected with that baby, and know what an honor it is to sit with it while it’s passing on. Those are the places for me where God is present and I know I’m not alone.”

—Anne, 52, nun and hospital chaplain

Meaning and Purpose: “Sometimes I worry that the depression will come back, and maybe what I’m doing won’t last. But the difference is that now I do see the point. In whatever period of time I get, it’s worth it. Because I have a sense of purpose now, I can help other people. What I’m doing right now really matters.

Kelly, 25, accounting assistant, helping others to get sober

Transformation and Growth: “I had a spiritual awakening. I felt this strong connection. Now, whether you’re talking to yourself inside, whatever it was, it was just phenomenal to have a moment of clarity where I could see all my faults, and how it’s brought me to where I am in life. And it’s like I blame nobody else—I just need to take total responsibility in life.”

—Jeff, 29, snowboarding instructor

Creativity: “I think creativity is a huge part of expressing my true self. My creativity is an outward expression of my spiritual connectedness.”

—Joan, 37, artist

Perseverance: “If I’m actually facing my fears, then something is empowering me not to just give in and give up, and that thing must be something spiritual. … My spirituality comes through, say, perseverance, rather than through fairy dust or something.”

—John, 49, peer support counselor 

Sunflower - Caitlin McDonagh

“If I’m actually facing my fears, then something is empowering me not to just give in and give up, and that thing must be something spiritual.” 

Spiritual Side Effects

Keep in mind that side effects of psychiatric medication fall into two categories: the pharmacological, or primary effects, and the non-pharmacological, or secondary effects. Primary effects are caused by the chemical properties of the drugs, whereas secondary effects are generated by the unique ways that a person interacts with their prescription. It can get tricky, because a primary side effect like weight gain or sexual dysfunction can lead to secondary effects by affecting a person’s intimate relationships, self-esteem, or sense of identity. SSEs are secondary effects that can shape the course of treatment in both positive and negative ways. 

The Good

Increased Connectedness to Self: “It’s like I was trying to escape from who I was [before medication]. I didn’t like myself, I wanted to be someone else. But now on the medication I feel like I’m better able to relate to myself, like I can forgive myself.”

—Karl, 28, nursing home aide

Increased Connectedness to Others: “There comes a point where I say, spiritually, I owe it to myself and everybody that I serve to take that medication. Because that makes me the person who can sit and listen to you, who can empathize with you.”

—Anne, 52, nun and hospital chaplain

Increased Connectedness to the Transcendent: “I think it’s just made me more open to God, like I’ve been less frantic in my mind and stuff, so it’s greater concentration and more peace—so I’m more able to speak with God and spend time in his presence.”

—Karl, 28, nursing home aide

Inspired Hope: “It’s enabled me to wake up in the morning and not feel, most of the time, like it’s going to be a bad day.”

—Eric, 53, engineer

Enhanced Meaning and Purpose: “During the last eight years [on medication], I got a master’s degree in theology, I got a job as a pastoral associate in a church, and I made my final vows in my Franciscan community. So I’ve been able to do meaningful things with my life.” —Maria, 39, nun and hospital chaplain 

“Now on the medication I feel like I’m better ableto relate to myself, like I can forgive myself.” 

The Bad

Disconnection from Self: “My experience with many medications I was on is that I was emotionally numb. I had times when I felt like I lost some integral part of myself, which is going into a spiritual realm, and not just emotional.”

—Virginia, 35, creative arts therapist

Disconnection from Others: “I do think that eventually the drugs came to reinforce a tendency I have to move toward books and abstraction—and at least indirectly, to move away from engagement with people and social engagement. Over time, I think they [the drugs] were part of this tamping down of emotional, spiritual connection.”

Tom, 52, ecology professor

Disconnection from the Transcendent: “The main thing with the medicine is that it just took away my ability to discern my relationship with God. It took away my ability to sense what feels right and what feels wrong. What I couldn’t feel when I had the psychiatric drugs is what was in my heart.”

—Joan, 37, artist

Decreased Sense of Hope: “And then she [her therapist] said something like ‘People like you, who have chronic depression, often need to be on medication for the rest of their lives.’ That harmed me. The way I took that in was that I’m destined to be miserable, this is my identity, I can’t change it, and I’m going to be medicated forever.”

—Virginia, 35, creative arts therapist

Interference with Growth and Transformation: “The medication has a numbing effect; the best word I can use is stagnate. So it holds you in the same place, it doesn’t help you move forward, you’re stuck. Medication kept my emotions down, rather than letting them out.”

—Laurie, 40, mental health professional

Getting off Drugs Inspires Growth: “As I continued getting off psychiatric medications, I found what I would consider to be spiritual gifts to be growing. I had a stronger ability to go within while doing Reiki on myself or praying.”

—Hillary, 21, college student

Wild Rose - Caitlin McDonagh

The Authentic Self?

Modern formulations of the spiritual path often pivot on finding and being true to one’s “authentic” self, and this process can involve confronting painful emotions and learning ways in which to improve one’s life. Ironically, the desire for spiritual transformation can lead to seeking mental health treatment, which may include a prescription for psychiatric medication, which can in turn alter the self in ways that may be profound and yet impossible to predict. Hence, the unexpected link between antidepressants and the sacred—and the need to further investigate the effects psychopharmacology is having on some of the most sacred and mysterious aspects of our existence. 

“I’ve been able to do meaningful things with my life.”

Morning Glory - Caitlin McDonagh