More than 40 million people globally take an SSRI antidepressant, among them many writers and musicians. But do they hamper the creative process, extinguishing the spark that produces great art, or do they enhance artistic endeavour?
Twenty-five years after pharmaceutical giant Eli Lilly unleashed Prozac on the red-braced 80s, SSRIs are still the world's most popular antidepressants. They are swallowed by more than 40 million people, from Beijing to Beirut, knitting a web of happiness from New York to New Caledonia. Selective serotonin reuptake inhibitors, of which Prozac is the best known, are the defining drug of the modern age, the crutch of choice for the worried well. In the US, where one in 10 takes antidepressants, you can buy beef-flavoured Prozac for your dog, trademarked Reconcile. The Prozac revolution has not only changed the way we think about depression (aided by Eli Lilly's mammoth advertising campaign); it has also changed the way we think, full stop.
In his 1993 book Listening to Prozac, the psychiatrist Peter D Kramer explored the ethical issues around the rise of what he termed "cosmetic pharmacology". With a daily pill people could now banish social awkwardness or the unhappiness of relationship break-ups, forge brassily assertive personae from their once shy selves. Like the Soma of Aldous Huxley's Brave New World, Prozac was making people "better than well". Kramer wrote of the "personality transformations" that occurred in a substantial minority of those taking the drug, briefly pausing to speculate as to what impact this might have had on their creativity. While we know, thanks to Kay Redfield Jamison's Touched with Fire, that poets are up to 30 times more likely to suffer from bipolar disorder than the national average, we have no idea how or if the pills they take to treat the disease affect their creative output.
The French writer Henry de Montherlant said that happiness writes white. For me that whiteness was the colour of a 20mg Cipralex pill – a close cousin of Prozac – taken at the breakfast table. With the depthless chemical happiness of the drug, a thin layer of snow seemed to fall over my mind, blocking access to strong feeling, cutting me off from the hidden impulses that drove me to write. Sometimes I did feel "better than well", but more often I was haunted by the uncanny feeling that I was skimming over the surface of my life. Looking back, those Prozac years have a curious, occluded feel, as if viewed through a gauze.
To celebrate the drug's quarter-century, I spoke to other writers, artists and musicians who have taken SSRIs, trying to establish whether they have been a bane or a boon for our collective creativity. I've deliberately concentrated on the arts, rather than the sciences. This is partly because, while we've all seen Carrie Mathison in Homeland and John Nash in A Beautiful Mind, there is significantly more literature on artists and writers taking antidepressants than on chemists and economists. It's partly because the arts are my bailiwick: I'm not on "are you on drugs?" terms with that many scientists.
We expect our artists to be, in Baudelaire's words, touched by "a breath of wind from the wings of madness". In his book Poets on Prozac, Richard Berlin speaks of "an entire generation of writers who became famed for the dramatic excesses of their psychiatric disorders". Sylvia Plath sits at the head of a pantheon of artists who took their own lives – Virginia Woolf, Alexander McQueen, Ernest Hemingway, David Foster Wallace– and who battered their bodies into submission with drugs and booze (see also Roberto Bolaño, Amy Winehouse, F Scott Fitzgerald, Billie Holiday). It's easy to agree with Dryden when he says, "Great wits are sure to madness near allied, / And thin partitions do their bounds divide."
From Heinrich Heine to Edvard Munch, many resisted treatment for their depression, fearing a loss of creative urges. When offered psychotherapy, the poet Edward Thomas replied: "I wonder whether for a person like myself whose most intense moments were those of depression, a cure that destroys the depression may not destroy the intensity – a desperate remedy?" Sigmund Freud – who also killed himself – argued that artistic creativity is a product of neurosis. We deal with the conflicts in our subconscious by making objects out of them. If this, grossly simplified, is the theory behind the link between mental illness and creativity, then the worry for artists is that in banishing their black dogs they are also dousing the flames of inspiration, blunting the edge of their genius.
Creativity and pharmacology have a troubled past. Chloral hydrate, used as a sedative for the first half of the 20th century, left patients feeling sapped and sluggish. The playwright Antonin Artaud accused it of lowering his "mental water level", causing a "diminution of my morality and my intellect". He finally died of an overdose of the drug. In an unpublished letter discovered in 2001, Ted Hughes revealed that Sylvia Plath was taking a monoamine oxidase inhibitor (MAOI) in the days leading up to her suicide. She'd had a negative reaction to a similar drug as a teenager and in the letter, Hughes blames the MAOI and the doctor who prescribed it for her death.
Plath's antidepressant was remarkably similar to Nardil, the drug with which David Foster Wallace struggled for many years. Making little headway with the novel that would be published, incomplete, after his death as The Pale King, Wallace began to wean himself off Nardil. His biographer, DT Max, said "he thought that removing the scrim of Nardil might help him see a way out of his creative impasse". Instead, he remained blocked and, as his friend Jonathan Franzen put it, "when his hope for fiction died, after years of struggle with the new novel, there was no other way out but death".
This is not the essay in which to debate in depth the efficacy of SSRIs. Irving Kirsch claims – to my mind convincingly – in The Emperor's New Drugs that their benefits have been substantially overstated. What is clear is that their side-effects have not. Apart from stifling the libido, SSRI use has consequences that are particularly significant for artists. A 2009 study by Oxford University, published in the British Journal of Psychiatry, found that those taking SSRIs reported "a general reduction in the intensity of the emotions that they experienced". They described themselves as feeling "dulled", "numbed", "flattened", or "blocked". If poetry is (as Wordsworth claimed) "the spontaneous overflow of powerful feelings… emotion recollected in tranquillity", then could Prozac bring artists too little feeling, too much tranquillity?
I spent most of my 20s on SSRIs of one sort or another. I was a difficult teenager, expelled from school and lurching from one illegal chemical high to the next. I was prescribed Prozac in the wake of one particularly manic episode and continued to take it on and off for eight years. My GP at university persuaded me to quit for a while, but when I moved to London I found a pharmacy that would sell me my SSRI of choice over the counter, no questions asked. What should have been a temporary buttress ended up forming part of the architecture of my young life.
Writing on SSRIs was like swimming in mud. Words came slowly or not at all; emotions were perceived as if at a great distance, alien and remote. Even at a sentence-by-sentence level, I was aware of a certain lag in my writing, a syntactic sluggishness – the imprint of a brain that was failing to catch up with itself. I missed the hectic moods of my teens where I'd write great (I mean clearly terrible, but great in my mind) stories on my father's ancient Amstrad, caught up in the flow of words. Fuddled and frustrated, I quit writing altogether and didn't start again until I'd given up the pills.
In a recent Radio 4 documentary, Will Self considered the legacy of Prozac's first 25 years on the planet. What he didn't say on air, but admitted to me in a subsequent email, was that he'd had his own run-in with SSRIs. I'd mentioned "Inclusion", a surreal story in his book Grey Area that satirises the psychopharmacological brouhaha surrounding Prozac. "I was prescribed Seroxat (I believe wrongly)," he wrote in reply, "to help me with withdrawals from a bad crack habit (what's a good crack habit?). After being on it a couple of weeks, I borderline intentionally took a heroin overdose and nearly died... so, I have a negative view of the drugs." Self, however, didn't blame the SSRIs for obstructing his artistic flow: "Heroin, cocaine, marijuana and alcohol were really the drugs that ended up fucking my creativity; the Seroxat was just a way station on the escape ramp to abstinence."
Other writers identified with the creative hamstringing I'd experienced on SSRIs. The novelist Amanda Craig was an early adopter of Prozac in Britain. Suffering from profound depression, she found SSRIs unhelpful, even damaging, despite the brief lift they gave to her mood. "Prozac enabled me to function, but dulled everything," she told me, "including the shafts of joy that gradually pierce depression. It changed who I was and that included who I was as a writer." She finally stopped taking the pills and turned her experience of depression into a bestselling novel, In a Dark Wood.
Children's author Lucy Coats is another who found herself blocked by SSRIs. "I've been depressed all my life," she told me, "but it came to a head with postnatal depression after my second child. I was badly depressed and my doctor put me on Seroxat." Although the drugs offered some relief from her symptoms, it was at a heavy price – her creativity. "I took it for six months and I felt as if I was walking through this grey world, with all the joy totally stripped out of it. I could feel neither happy nor sad. It was absolutely vile. As a writer, I need to feel emotion of some kind. The creative spark was completely extinguished for me. I had a deadline and I had to ask the publisher to give me more time because I could not write. Everything I wrote was kind of lumpy, disgusting clay and I couldn't shape it into anything."
It's not just authors who have suffered creatively from the effects of SSRIs. I spoke to my brother, Sam, better known as Preston from the Ordinary Boys. Or, if we're honest, better known for going on Celebrity Big Brother and marrying Chantelle Houghton, one of his fellow housemates. He's since forged a successful songwriting career. I knew he'd been on Prozac throughout his time in the Celebrity Big Brother house and asked him how it affected him – creatively and otherwise.
"More than anything," he told me, "it made me really sweaty. And it seems a banal thing, but it was debilitating, particularly as it was a time I was in the public eye. As for creativity, Prozac just makes you a bit 'Yeah, OK, fine, whatever' about stuff. You lose the inner critic. And that goes for life as well as art. I got married to someone I'd met on a TV show and didn't really know. I think if it hadn't been for the haze of the drug, I might have made better decisions."
I can relate to this (and not just because he's my kid brother). With my creative blockage came what I later identified as a kind of moral blockage. Because actions didn't feel like they had consequences – in that nothing seemed able to shock me from the pallid world the drugs had wrapped about me – I pushed myself into more and more extreme situations, desperate for a spark of authentic feeling. I was haunted by the sense that I was living in the third person. This inability to feel implicated in my actions had its own creative repercussions – the characters in my novels seem to lack agency, are buffeted by forces beyond their control (as several reviewers have pointed out). I gave Charlie Wales in This Bleeding City a Valium addiction, but actually what I was describing was life on SSRIs: "With dead eyes and dead hands, I navigated the world. On the way to work in the mornings I pressed a pill into the furry lining of my cheek and felt it melt, bitter and comforting as I sat on the fusty orange seats of the tube and watched flares of electricity light up the darkness of tunnels. I had stopped reading. Instead, I just watched."
For other artists, Prozac has been a life belt thrown as they drowned in a sea of depression. In an exchange of letters with the historian Roy Porter, Zoë Heller speaks of how, after taking Prozac, "I stopped lying in bed in the middle of the day. I stopped crying all the time. I began to entertain visions of my future that were, if not entirely rosy, then at least not entirely gloom-laden." The original Prozac pin-up, Elizabeth Wurtzel, is another who claims to have been rescued by the drug (although a careful reading of her memoir Prozac Nation might give the credit to the rather less zeitgeisty lithium).
Wurtzel's book has not aged well – it is stuck in the 90s, po-faced and narcissistic. It lacks the note of authenticity that characterises the best books about mental illness. Wurtzel is also unsure exactly how she feels about the drug. At one point she gushes, "Prozac was the miracle that saved my life." Several pages later, though, she admits that "the secret I sometimes think that only I know is that Prozac really isn't that great". Writing about depression is difficult precisely because it is a disease that strips us of words, of narrative. One of the most impressive works on the subject is by the Welsh poet Gwyneth Lewis. Her memoir, Sunbathing in the Rain, joins Lewis Wolpert's Malignant Sadness and William Styron's Darkness Visible, three books sent back by emissaries from deep within the abyss of depression. Gwyneth Lewis is another who benefited greatly from Prozac.
When we first met a couple of years ago at a writing retreat in Norfolk, Lewis was literally wearing rose-tinted spectacles, but the world didn't always have such an optimistic hue. After a serious bout of depression, she found herself incapacitated, a ghost in her own life. Sunbathing in the Rain is her description of journeying into and, eventually, out of her despair, during which time SSRIs offered "some psychic space, a small but crucial distance between me and the horrors". I asked her about her experience of writing on the drugs.
"When I get ill, I get so ill I can't write at all," she told me. "I don't work when I'm wretched, I work when I'm happy. The antidepressants offered a pathway to effective working." But there were drawbacks. She stopped taking the pills during a sailing trip with her husband, finding that they rendered her spaced-out and unreactive (and a poor sailor to boot). "I was distanced and dissociated… I'd see a rock coming towards us and I just wouldn't move." She was also aware that the loss of sex drive so common to SSRI users had creative repercussions. "Part of what you feel as a poet is libido towards language. Being on these drugs will change your language use because they change who you are."
For Lewis it was a decision between writing on Prozac or not writing at all. For Keeril Makan, the choice was rather different. One of America's most celebrated young composers, he struggled for years with a depression that would often find vivid reflection in his work. He describes his music as "informed, almost viscerally, by my depression", and spiky, atonal pieces such as The Noise Between Thoughts attack the listener with a bleak physical force. Finally, though, he reached a point at which he had to step away from the darkness. "Although I was still composing," he told me, "it was such an excruciating process and was putting me in contact with these really difficult emotional places. I couldn't go on with my daily life. I was creating music I was happy with and people were interested in, but I had to live as well."
He started taking antidepressants and meditating and found that his music gained a new depth as he dragged himself out of his depression. "Being on the antidepressants does change the type of emotions I'm experiencing," he said, "but I think they can be just as interesting. If anything, this helps the composing. I was working on an opera recently and I don't think I could have written it before. I was too one-dimensional, emotionally. Things were just dark but now there's both – dark and light." I confessed to admiring the raw power of his early work and he chuckled. "It's true that I'm not as fully immersed in darkness as previously, but I guess I don't care, because I couldn't keep doing that. It was a question of living, or creating this music that was negative and violent. I made my choice."
It shows how little we understand of the functioning of the brain's neurochemistry and SSRIs' effect upon it that a pill that may cause blockages (as it did in my own case) has also been prescribed as a cure for writer's block. In a Late Show documentary aired in 1995, the psychiatrist and author Oliver James gave five artists Prozac to see what effect it would have on their creative output. Two of them – the New Order frontman Bernard Sumner and the poet Alan Jenkins – were blocked when filming began. Sumner, who was working on his Electronic side project with Johnny Marr at the time, was afflicted by a hyper-critical internal voice, and said that the process of writing lyrics was "like breaking a horse". As he wrote, he'd hear repeated in his head: "You can't do this, you can't do this."
I spoke to James about the effect of SSRIs on writer's block. "What the film showed," he told me, "was that once you removed the depression – and Prozac did seem to do that, whether by placebo or not – people could write. When I first met Bernard Sumner he was clearly blocked and by the end of it he'd written some lyrics." There was a hitch, though. "What I couldn't say on the documentary was that he may have done some work, but I'm not sure that it was any good." This seems to be one of the problems with the use of SSRIs to free up the creative impulse. While, as Gwyneth Lewis said, it's very difficult to write during periods of intense depression, it may be that we need to be a bit down on ourselves in order to produce good work.
James agrees. "On Prozac you become more confident, you're less aware of other people's feelings, less worried about what other people might think about you, you're more able to act as opposed to [being] self-absorbed and stuck. You may be talking crap, producing crap, but you don't care and just press on. And that's a real change of personality for some creative types – to stop caring what other people think. It's a dangerous game."
We begin to recognise the precarious high-wire act that most creative depressives undertake, trapped between the unbearable pain of their illness and the equally unbearable blockages brought about by their medication – walking Dryden's "thin partitions". We need the critical voices in our heads (mine is that of a reviewer who gave my second novel a mauling on Radio 4), but they mustn't swamp us with their carping and condemnation. In Touched with Fire, Kay Redfield Jamison looked at manic depressive artists who took lithium, a drug which "inhibits creativity so that the individual is unable to express himself". She found that, overwhelmingly, the artists either gave up the drug or reduced their dosage "in hope of achieving a kind of controlled cyclothymia [mood swings], willing to take the undulations of power and imbecility in exchange for periods of high enthusiasm and flowing thoughts".
In this essay, I've deliberately only quoted artists who would let me use their names in print. This is partly because, post-Leveson, we know that "a close friend" means the journalist made it up, but also because I think it's important that the subject be addressed in the open. One thing that has struck me while researching this piece, though, is the sheer number of artistic friends and acquaintances who have taken Prozac – some of whom agreed to be quoted, some who preferred to remain incognito. I mentioned that I was writing this article on Twitter and was contacted by a host of creative types keen to share their experiences – positive or (more usually) negative – of working on SSRIs. This is far from a clinical survey, but it does feel like our creative industries are smoothing the jagged surfaces of their lives with SSRIs in astonishing – even epidemic – numbers.
My conversation with my brother confirms this impression. "Everyone in music is on Prozac," he says. "It's like it's part of the job description." We know from toxicology reports that Michael Jackson, Michael Hutchence, Heath Ledger and Brittany Murphy were taking Prozac (although for them it was but one of a heady concoction of drugs), while stars such as Sheryl Crow, Robbie Williams and Olivia Newton-John have spoken about their reliance on SSRIs.
"It's partly to do with the stress of the business," my brother tells me. "If you're really successful you have little time to yourself, you're having to sleep when and if you can, you don't have much control of your life. And if you're playing a gig in Tokyo on Friday, you can't commit to therapy, to sitting down once a week and talking through your problems. You never know where you'll be one week to the next, so you just take a pill and get on with it."
There's another factor in the celebrity antidepressant narrative – doctors. "There's a kind of understanding you come to," my brother tells me. "Because most people in the music industry use private doctors and it was certainly the case with me that I went to this one doctor because I knew I'd get the drugs I wanted. I was paying and she knew that if she didn't write the prescription I'd just go elsewhere." Certain doctors would gain a reputation for being particularly laissez-faire with their prescriptions. "I don't think it was necessarily that they were corrupt or anything," my brother says. "It was more that the only people they saw were these neurotic actors and musicians. Now I see an NHS doctor and she's having all sorts in her surgery so when I come in moaning she's just like, 'Come on now, pull yourself together, you'll be fine.'"
One of the effects of the Prozac revolution has been an increasing acceptance that mental illness is caused by chemical imbalances in the brain, a simplified standpoint that has been reinforced by the press and celebrity commentators. In a 2011 Larry King Live interview, Jim Carrey came out with some exemplary bio-babble, both meaningless and pernicious: "Certain elements of the brain like tyrosine and hydroxytryptophan… instead of being a serotonin inhibitor, which just uses the serotonin you have and Prozac and things like that. It just uses the serotonin you have and it doesn't allow it go back into the receptor. But it metabolises your serotonin after a while and you have to keep taking more and more to feel good. This actually creates dopamine and creates serotonin."
Bolstered by heavy drug company spending, the message has been put out there: the brain is an organ like any other; treat depression as you would a stomach upset or broken ankle. This narrative misses the extraordinary complexity of the brain and the very limited understanding we have of its operations. The neurotransmitters which are influenced by SSRIs are intricate and multivalent – indeed the role of these neurotransmitters in the control of mood was only discovered by accident when examining the effect of the anti-psychotic thorazine on the brain's chemistry. In her Prozac Diary (1998), Lauren Slater referred to Prozac as a "revolution in psychopharmacology because of its selectivity on the serotonin system; it was a drug with the precision of a Scud missile, launched miles away from its target only to land, with a proud flare, right on the enemy's roof." Such grandiose claims have faded with time as we come to understand how little we really know about how – and if – Prozac works.
In Daniel Nettle's book Strong Imagination: Madness, Creativity and Human Nature, he turns a scientific eye upon the creative process, looking in depth at the types of mental illness associated with creativity. Of particular interest is his work on serotonin – the neurotransmitter influenced by Prozac. He shows how serotonin systems function to help us to adapt to psychological challenges, reducing anxiety and providing "a carapace against a fickle and confusing world". When I questioned him about the specific impact of Prozac on creativity, he described serotonin-related drugs stimulating "energy, concentration and an expanded mental horizon", although he added that, in the decade since writing the book, he had become convinced that Prozac and related SSRIs were much less effective than once thought.
It is comforting to believe that, to quote Robert Lowell, the lack of a little salt in the brain is all that stands between us and sanity. Irving Kirsch's research for The Emperor's New Drugs suggests, however, that SSRIs are barely more effective than placebos. While the drugs have clearly delivered dramatic benefits to some like Gwyneth Lewis (and, indeed, Oliver James himself, who when he briefly took Prozac in the 90s said he felt "miraculous" on it), it seems to hamper as many creative types as it helps. We need to be sane to work – being an author requires discipline, doggedness, a rhino-hide for criticism – but we must also be open to the insanity of creativity. The state of manic flow when we write, paint, compose or merely play is a kind of cogent madness and antithetical to my experience of the drab fog of SSRI "happiness".
Within three weeks of my own Prozac fog lifting, I was writing again. Yes, I still felt down, so down some days that I couldn't work and buried my head under the duvet, but the trade-off was days when my fingers couldn't move fast enough over the keyboard, my pen struck sparks from the page. In Deborah Levy's Swimming Home, the heroine, Kitty Finch, has just quit Seroxat. "It's quite a relief to feel miserable again," she says. "I don't feel anything when I take my pills." It's been five years since I took my last SSRI. The happiness I get from my writing is deeper seated and more authentic than anything that could be confected in the laboratories of Big Pharma. The drugs didn't work for me and, more importantly, I couldn't work when I was on them.
Prozac world: the rise and rise of antidepressants
1988 The first SSRI (selective serotonin reuptake inhibitor), Prozac, is made by Eli Lilly and launched in the US.
1989 The drug reaches the UK. It hit the covers of Newsweek and New York magazine, which described it as the "new wonder drug for depression".
1991-2001 Annual UK antidepressant prescriptions rise from 9m to 24m.
1994 Elizabeth Wurtzel's memoir Prozac Nation is published, establishing the drug's position in popular culture.
1994 The first of many lawsuits concerning side-effects of the drug goes to trial. Joseph Wesbeckerwent on a killing spree in 1989, killing eight before shooting himself. His violence was claimed to be a side-effect of taking Prozac.
1994 Psychiatrist Peter Breggin's Talking Back to Prozac, critical of the drug, is published.
1995 Prozac is referenced in the Blur song Country House: "He's reading Balzac and knocking back Prozac… It's the helping hand that makes you feel wonderfully bland."
1998Prozac Diary, the candid memoir by Lauren Slater, is published.
2000 Zoloft overtakes Prozac as the most popular SSRI in the US.
2001 Prozac (fluoxetine) loses its patent. Eli Lilly loses $35m of its market value in one day and 90% of its prescriptions in a single year.
2004 Prozac is in our drinking water. The Environment Agency says the drug is building up in British rivers and ground-water supplies, probably via the sewage system, but in quantities so dilute they could have no effect.
2008 Antidepressants are now the third most common prescription drugs in the US.
2009 The Lancet ranks the top 12 antidepressants from 117 studies. Zoloft and Lexapro come in first for their combination of effectiveness and fewest side-effects.
2010 One in 10 people in Europe has now taken an antidepressant