It was Michael’s first day at the Tony New Hampshire boarding school that his father thought would be a good idea. They arrived early because they had so many stops to make on the woody campus. First, academics, for the class schedule; then housing, for the room assignment. And then the nurse. For drug orientation. The infirmary had been open only fifteen minutes when they got there, but the line was already out the door and down the hall. After a long wait they reached the nurse, a thirty-year-old guy with long red hair.
“Take any medications?” he asked. “If so, please turn them in.”
Behind the nurse dude was a stack of brown-paper lunch bags. Michael was handed one and told to place all his meds in it, write his name on a label and staple the bag shut. While he followed orders, the nurse recited the school’s drug policy.
No pharmaceuticals were allowed in the dorms. Those students taking stimulants or antidepressants — and Michael was on one of each, Ritalin and Wellbutrin — were required to report to the infirmary for one pill at a time, regardless of the hour. And they weren’t allowed to skip doses.
Michael’s father, Jerry, a lawyer from Ohio, handed over the bag and watched as the nurse added it to the others on a rolling file trolley. He thought there seemed to be an awful lot of bags. Then he looked past the nurse and realized that was the third pile. There must have been 100 bags of medication already, and students had been checking in for less than an hour. Jerry was stunned by the sheer volume of what had been turned in. His son was more surprised, later, by what wasn’t turned in.
“Whoa, lotta drugs going on at that place,” says Michael, who is tall and lean with an angular face and a long jaw like a Modigliani. “They tried hard to keep it like it was controlled, but the kids would still snort lines of Ritalin because they thought it was like cocaine — which it isn’t, but tell them that. There was this kid who could get as many sleeping pills as he needed from his psychiatrist back home. It was Ambien [a fast-acting sleep inducer], which some kids were given to cool down from their regular dose of Ritalin, which can keep you up all night. So he would sell these Ambiens, and everyone would use them, because they made you feel drunk faster. At boarding school, beer is the thing that’s expensive and hard to get. There was also a guy who would crush Ambien, sprinkle it on marijuana and smoke it. He said it made him trip, but I never tried that one.”
Michael had been taking Ritalin on school days since third grade, when he was first diagnosed with attention-deficit disorder, a learning disability. He thought it was probably an accurate diagnosis, even though he wondered why he hadn’t been sent for evaluation until his parents got divorced. But only when he got to boarding school was he educated in the uses and broadening abuses of the pharmacopeia of legal and illegal drugs available to adolescents today.
At school, for instance, he learned the ABC’s of mixing medicine and alcohol. “If you’re drinking and on Ritalin, it probably doubles or triples the alcohol effect,” he explains almost clinically. “When you’re on an anti-depressant, it does the same thing, but it knocks you out. You know, it says so right on the bottle.”
Before long, Michael secretly stopped taking his Ritalin (although he still picked it up at the infirmary in the morning) because he felt it was making him depressed. He then started taking massive amounts of ginseng pills from a health-food store, because they seemed like a more natural stimulant. And he bought some Ambiens from his dorm mate, because he figured they would counteract the racing effect of the ginseng.
Since he had been on varying doses of different medications for nine years, Michael felt fairly confident in his ability to self-medicate without consulting his psychiatrist back home. But as winter break approached, he found himself in a mental whirlpool: panic attacks, paranoia and depressive psychosis.
When his dad brought him back home, Michael’s doctor gave him Xanax, a sedative that also treats acute panic symptoms, and Luvox, an anti-depressant also used to treat longer-term anxiety. Michael came very close to being hospitalized. In all his years of psychiatric treatment, it was the first time he felt like he was losing his mind.
When the drugs started working and he began to feel better, his doctor switched him to another anti-depressant, Paxil. Within a few days, he experienced a side effect that nobody had warned him about. He couldn’t get it up. “My penis was … well, specifically, it was limp,” he says sheepishly. “Also, I was not interested in sex for a couple of weeks after taking the medicine. During that period, there were times I wouldn’t have wanted to be with a girl.”
The childproof cap is off the pill bottle. Prescribing medications to kids as freely and haphazardly as to adults is no longer taboo. And a new drug culture has emerged, the legal one most familiar to kids today. This is the first generation ever to practice chemical manipulation of the brain with parent-approved medications long before being exposed to the standard illegal recreational substances.
And we’ve moved far beyond Ritalin, which is still one of the few psychoactive medications specifically approved for use in patients under 18. Today, drug companies are in the home stretch of the race to get Food and Drug Administration approval to market Prozac and other anti-depressants directly to kids — possibly even through TV ads.
When Prozac was approved for adult use in the late 1980s, it changed the way Americans felt about the use of psychiatric medicines. The same thing is likely to happen when the drug is approved for patients under 18. And kids being treated for serious mental illnesses will increasingly be joined by young patients who aren’t that sick, or might not be sick at all. But teens will still be asked to try some of the most powerful and expensive psychiatric drugs available — in part because the HMO-driven treatment market often views pills as more cost-effective than therapy or counseling.
Michael’s inability to get it up isn’t likely to be included in any managed-care cost/benefit analysis. Of all the questions unanswered — even unasked — about the side effects of anti-depressant use for children and adolescents, the ones about sexual development are among the most provocative. Nobody knows how psychiatric medications will alter a teenager’s emerging sexuality.
“We are so quick to criticize somebody who would drop a pill in somebody else’s drink,” says California research pharmacologist Dr. James Goldberg, who is a co-author of the only comprehensive textbook on the effects of drugs on sexuality. “But a lot of times the doctor is dropping a pill into the adolescent’s drink, and dropping it in every day.”