Prozac Nation

Elizabeth Wurtzel's memoir Prozac Nation chronicles her lifelong struggle with depression, from its gradual onset in childhood through years of therapy, hospitalizations, and failed treatments, to her eventual stabilization on the antidepressant Prozac (fluoxetine hydrochloride). Written when Wurtzel is in her mid-twenties, the book moves between her present-day life on multiple psychotropic medications and the accumulating history of how she arrived there.

The memoir opens with Wurtzel in her mid-twenties, taking lithium, Prozac, desipramine, and Desyrel daily and fearing the drugs can no longer hold her depression at bay. After a large party at the loft she shared with her roommate Jason, she collapsed on the bathroom floor in tears, inconsolable. She had recently stopped taking lithium after a blood test showed abnormally high thyroid stimulating hormone (TSH) levels, though the reading later proved to be a decimal-point error. Her friend Jethro procured cocaine for her, which briefly lifted her mood before sending her into a devastating crash. Friends conferred about her state but appeared exhausted by the familiar pattern; one of them, Julian, physically carried her to bed after she poked at his eyes in resistance. Wurtzel recalls the first time she overdosed, around age twelve at summer camp, swallowing Atarax, a prescription allergy medication. The camp counselors attributed her prolonged sleep to illness, and the incident was never treated as a suicide attempt.

Wurtzel traces her depression's origins to around age eleven, comparing its onset to cancer: invisible at first, then all-consuming. Her parents divorced before she was two. Her mother, a conservative Cornell graduate, raised Elizabeth largely alone on the Upper West Side of Manhattan, the two of them forming a close but financially precarious team. Her father, an apolitical corporate employee who relied on Valium, slept through most of their Saturday visits and contributed little to her upbringing. The couple fought relentlessly during and after their brief marriage. Depression ran deep on her father's side: A cousin attempted suicide, a great-grandmother died in an asylum, her grandfather was an alcoholic, and her grandmother was melancholic. Despite this troubled backdrop, young Elizabeth was precocious and gifted, a "golden girl" who won academic competitions, taught herself tennis, and bossed her classmates around. Wurtzel emphasizes the irony of having once been described as "full of promise," knowing how thoroughly depression would dismantle that promise.

Everything changed around age eleven. Elizabeth had been hiding in the school locker room during lunch, eating cottage cheese from a thermos and cutting her legs with razor blades and nail files, carving shapes into her skin and finding a disturbing sense of control in self-inflicted pain. A math teacher, Mrs. Edelman, discovered her there while she was listening to Patti Smith's Horses and brought her to the school psychologist. The psychologist referred her to Dr. Isaac, her first psychiatrist. Elizabeth developed a secret life of truancy, leaving for school but going to McDonald's and returning home to watch soap operas, her grades plummeting. She became obsessed with Bruce Springsteen, identifying with his working-class despair and wishing her external circumstances might match her internal anguish. Her mother, though arranging therapy, refused to fully acknowledge the severity of Elizabeth's condition, continuing to treat her as her "perfect baby." Wurtzel recognizes that her mother's unwillingness to let her fall apart may have prevented a complete collapse but also denied her the deeper help she needed. At twelve, Elizabeth began a covert sexual relationship with Abel, the seventeen-year-old brother of a friend.

At Harvard, Wurtzel expected transformation but found only more of herself. A persistent sensation she calls "the black wave," a physical feeling of engulfing darkness, followed her across Cambridge. She threw herself into destructive patterns: abusing drugs, cycling through obsessive relationships, and making repeated visits to the university's emergency services. A psychiatrist told her plainly that no pill would fix her problems, that she needed close relationships and long-term therapy. But without adequate financial resources for sustained treatment, Wurtzel was left largely on her own.

The summer after her sophomore year, she took a reporting job at the Dallas Morning News. For a time, the work kept her afloat, but weekends brought the black wave roaring back. She began drinking heavily, and her behavior grew more erratic. By summer's end, her mother agreed they needed to find money for real therapy.

Back at Harvard, Wurtzel began seeing Dr. Diana Sterling, a psychiatrist she came to trust deeply and who proved instrumental in saving her life. The year brought fresh crises, including a fixation on overdue coursework that spiraled into a near-psychotic episode and repeated admissions to the campus infirmary. She fell into an intense relationship with Rafe, a Brown University senior drawn to her pain, who encouraged her to express her despair. His indulgence ultimately worsened her condition, and when the relationship ended, Wurtzel experienced the deepest depression she had yet known. Dr. Sterling prescribed Mellaril, an antipsychotic, which blunted her emotions into a flat affect.

Desperate to escape, Wurtzel traveled to London, where the trip proved disastrous. She could barely leave her bed and spent her days taking Mellaril and calling Dr. Sterling across the Atlantic. Lost in Piccadilly Circus one evening, unable to tolerate even a companion's refusal to ask for directions, she recognized she had reached her lowest point: not a dramatic collapse but an inability to endure the ordinary.

She returned to Cambridge, where Dr. Sterling arranged for her to try fluoxetine, brand name Prozac, a newly approved selective serotonin reuptake inhibitor. The drug took weeks to work, and in the interim, during a session with Dr. Sterling, Wurtzel detailed an elaborate suicide plan. When Dr. Sterling stepped out of the room, Wurtzel swallowed a bottle of Mellaril in the bathroom. She vomited most of the pills and was taken to the emergency room, where she survived without serious harm.

The attempt proved a turning point. In its aftermath, Wurtzel felt a sudden desire to live, thinking not of grand purposes but of small pleasures: ice cream, Springsteen albums, new lipstick. Within days, as the Prozac dosage increased, something shifted. She woke one morning and genuinely wanted to face the day. The change arrived the same way the depression had: gradually, and then suddenly.

Recovery was slow and imperfect. Wurtzel continued to need lithium alongside Prozac, and occasional depressive episodes still broke through. She came to understand that no drug could do the work alone; years of destructive habits required therapy to unlearn. But the totalizing grip of depression lifted. In the book's final pages, Wurtzel reflects on learning to inhabit the emotional middle ground, the ordinary state between euphoria and despair that most people take for granted. She recalls how her mother, when Elizabeth was small, would tell her to think of pretty things before sleep: cats, balloons, stars. At twenty-six, she concludes, the task is not so different.

In an epilogue, Wurtzel surveys the broader cultural landscape of depression in America, noting that by the early 1990s millions had taken Prozac and the drug had become both a lifeline and a cultural phenomenon. She worries that the mainstreaming of antidepressants risks trivializing clinical depression. She closes by affirming that Prozac was not an ending but a beginning, one that allowed her, at last, to start learning how to live.