TERRY GROSS, HOST:
This is FRESH AIR. I'm Terry Gross, back from my vacation. I want to thank Dave Davies for hosting while I was gone. Today we're going to talk about psychotropic drugs - drugs that alter brain chemistry to treat problems like mood disorders and anxiety. Antidepressants and medications for bipolar disorder can be life-changing, even life-saving. But over time, they can cause side effects both mild and severe.
The new book "Blue Dreams: The Science And The Story Of The Drugs That Changed Our Minds" by my guest Lauren Slater is about the history of psychotropic drugs, how they work and the benefits and consequences for people who take them. Some of the book is devoted to new research experimenting with the use of psychedelic drugs in treating issues like post-traumatic stress disorder and fear of death in patients with terminal cancer. Slater writes that psychedelics are providing a new model of how psychotropic drugs might work and a new way to think about them. Her book is written from her perspective as a journalist, practicing psychologist, and patient. She's been taking medications for 35 years to treat depression and bipolar disorder. She's the author of eight previous books, including "Prozac Diary."
Lauren Slater, welcome to FRESH AIR. So you've taken some of the drugs that you write about. You've taken them for depression, OCD, bipolar disorder. Some of the medications have been very helpful and enabled you to live and find pleasure in life, but you've also suffered with side effects. Can you give us a brief personal overview of some of the pros and cons of the medications you've taken over the years?
LAUREN SLATER: The first drug I took was imipramine, which is a tricyclic antidepressant. I took it for many years, from the age of about 17-21 or 16-21, which was not helpful - and then the SSRIs, which have been incredibly helpful in terms of dealing with depression and anxiety. I also have found the antipsychotic Zyprexa to be incredibly helpful.
But those drugs have also taken a real toll on me, and probably the most significant toll has to do with the metabolic syndrome that they've - that specifically the Zyprexa has caused. I suffer - I'm about 60 pounds overweight. I have diabetes. My triglycerides are at 800. I basically don't have a good chance of making it to - into old age, and that's the tradeoff that I've had to make. Do I want a healthy mind or a healthy body? I can't have both.
GROSS: Is the metabolic syndrome typical of the drug you've been taking, or is that something that happens to few people like you?
SLATER: No, it's - Zyprexa causes metabolic syndrome, which then becomes diabetes - Type 2 diabetes. So no, it's very common, and it's one of the most best-selling - it's one of the best-selling antipsychotics in this country right now.
GROSS: Why did you want to write a book about the history of psychotropic drugs and how psychedelic drugs are being used now to treat mental disorders?
SLATER: I didn't start wanting to talk about the psychedelic drugs. I discovered that as I did my research. I wanted to bring each drug alive. I want - my goal was to - each chapter focuses on a different drug, and my goal was to almost try to make the drug into a character in and of itself. I talk about the drug's flaws. I talk about the controversies that surround them. I talk about their inventors, how they were made.
I wanted to bring these drugs alive, and I wanted to unveil them because as a nation, we are consuming them. We're gobbling them down, and we don't really know what we're taking into our bodies. And I think it's incredibly important that we have a real intimacy with these drugs, and yet they're cloaked in mystery for us. And I wanted to remove the mystery.
GROSS: When do scientists start subscribing to the theory that mental illness is - that, you know, mood disorders, schizophrenia likely have a biochemical basis and that we can come up with medications that address the biochemical basis of these disorders?
SLATER: There's two parts to my answer. We have long believed that mental illness is biological or biochemical in its basis. The - psychoanalysis was really the oddity. It was a brief blip in what has otherwise been almost a purely biological source - search for the source of mental illness. But no one had really conceived of a drug to treat mental illness until Thorazine came along. And Thorazine was so spectacularly successful that it shifted our paradigm, and we began to think maybe we can use medicines to treat the mind.
Before Thorazine, people thought that mental illness was the result of what are called humors - blood, phlegm, bodily fluids - that had gone out of whack. It's - it was an old, old belief. They also believed that it could be the result of hereditary - genes gone wrong. But then Thorazine was invented, and that sort of was the kick-start to a whole bunch of other drugs being invented and to doctors and, later, the public at large thinking that mental illness was biochemical in nature.
GROSS: How did Thorazine affect the people who took it? You know, you hear two things about Thorazine that it was, like, an incredible step forward in the chemistry of mental health. At the same time, you also hear a lot about how Thorazine was used to basically, like, drug patients in mental health institutions and - instead of more directly addressing the problems that they had, that it was a way of just, like, allowing them to just be...
SLATER: Chemical straightjacket.
GROSS: ...Yes, exactly, exactly.
GROSS: Just be kind of passively sitting there, not bothering anybody working at the facility.
SLATER: You know, that's something that confused - confuses me as well. In my research, I found that - and I did a lot of research. I found that Thorazine was a spectacularly successful antipsychotic, that it awakened people who had been in deeply schizophrenic states - catatonics who had been catatonic for years and years, you know, people who didn't have names or identities who were just sunk in madness, that it awoke those people and allowed those people to assume identities and jobs in the real world.
At the same time, if you take too much Thorazine or if you take it for too long a period of time, you will develop what's called tardive dyskinesia, which is a disturbing movement disorder. Thorazine made its way into the mental institutions in the United States, and I think what happened, Terry, is that they started giving it in larger and larger doses. And in really large doses, you're going to get what's called the Thorazine shuffle, or you're going to get people sunk in dayrooms, smoking cigarettes, blankly staring at the walls. And so that's where that idea, the sort of Thorazine shuffle, comes from. It was used to manage large swathes of mental patients, to kind of put them - you know, to put them out to make them easier to handle.
GROSS: So many Americans are on antidepressants. You quote a CDC statistic. Twenty-three percent of women 40-59 years old are on antidepressants. That's really a lot. And I don't have a statistic in front of me for men, but you say more women than men are on antidepressants. And you ask the question, if antidepressants affect the libido as they often do, what does it mean if so many people are antidepressants and may have, as a result, lowered libido? Is that a question you've thought about a lot?
SLATER: Oh, yeah, definitely. I credit Prozac and Effexor - I'm on - I've been on - I was on Prozac for 20-25 years, and then I was switched to Effexor when the Prozac stopped working. But they're both serotonin-specific drugs. I credit them in part with the demise of my marriage. For me, these drugs have not dampened my libido. They've eradicated it. And I know that I'm certainly not the only woman who feels that way. And if, you know, millions of women are taking these drugs, we have to wonder what it means from a social and personal perspective if millions of women's libidos are either dampened or eradicated. What does that have to do with a rising divorce rate and with a woman's ability to find an appropriate mate? If she can't feel attraction to a man or a woman depending on her sexual orientation, how is she going to be able to pick a mate who's suitable for her?
GROSS: You wrote a column for The New York Times' "Modern Love" series back in 2008. And in that column, you wrote, sex interests me about as much as playing checkers. And you describe how it made for difficulties in your marriage because your husband wanted hot sex, and you rarely wanted any sex. When you wrote that column, were you attributing your low libido or lack of libido to medical side effects?
GROSS: So how did you resolve it? I guess the answer is divorce (laughter).
GROSS: I shouldn't be laughing, yeah.
SLATER: I mean, that's not the only reason we got divorced, but it had a - but it's a big reason. It's a big reason why. And it wasn't - I would revise that statement that I made in "Modern Love." I don't think it was just that my husband wanted hot sex. He wanted a sexual relationship - an ongoing sexual relationship. He didn't want me to dress up in, you know, some kind of weird costume and, you know, do funky things. I mean, he just - he wanted to feel an erotic, romantic connection with me that went on through time, and I wasn't able to give that to him.
GROSS: But you had to stay on the medications.
SLATER: Right. I - the only way I would be able to do that would be to go off my medications, and then I would be able to feel attracted to him. I know I was attracted to him and that I would be again if I was off the medications. The problem is I wouldn't be able to function, though. I'd be able to have sex, but I wouldn't be able to function. So these are the very steep, difficult, even dangerous tradeoffs that millions of women are making even though they're not necessarily admitting it.
GROSS: OK. Well, I'll tell you what. Let's take a short break here, and then we'll talk some more. If you're just joining us, my guest is Lauren Slater. She's the author of the new book "Blue Dreams: The Science And The Story Of The Drugs That Changed Our Minds." And it's all about drugs that treat mood disorders and schizophrenia. And these are psychotropic drugs, but you also write about new experimental ways of using psychedelic drugs. And we'll talk about that after a break. This is FRESH AIR.
(SOUNDBITE OF LOOP 2.4.3.'S "ZODIAC DUST")
GROSS: This is FRESH AIR. And if you're just joining us, my guest is Lauren Slater. She's a psychologist and writer. Her new book is called "Blue Dreams: The Science And The Story Of The Drugs That Changed Our Minds," and it's about drugs that treat mood disorders and schizophrenia, like how they work, how they're helpful, what side effects they cause, what their history is. And she also writes about new experimental uses of psychedelic drugs to treat mood disorders.
So let's talk about psychedelic drugs and what you've learned about that. I've been surprised learning recently about the fact that psychedelic drugs are being used experimentally to treat mood disorders. How new is this?
SLATER: It's very new. And the researchers who are using them are very, very, very cautious. They have an abundance of caution because they are so worried about the excesses of the '60s, and they don't want to be tainted in any way as hippies or - they just don't want to be misunderstood. It's only - it's just a matter of years - a few years since psychedelics have been resurrected for use with mental health problems although in the 1950s, '60s and early '70s, they were being investigated for mental health problems as well as anxiety relating to cancer and other terminal conditions. But then the DEA put a stop to it because the drugs flooded into the streets, and people started using them just for their own purposes. And it was all shut down, and everything became illegal. It's just been very recently that these drugs have been looked to for their possible uses in mental health.
GROSS: So do you need a special - do you need special permission from the Drug Enforcement Agency to use these illegal drugs experimentally for treatment?
SLATER: Yes (laughter). You definitely need permission. And the - and part of that permission involves stating where the drug will be stored, under which conditions. You know, it has to be stored under a lock and key. You can't tell people where it's stored. I mean, it's - the conditions - in order to get approval for a study, it's really, really hard to get approval to do a study with psychedelic drugs.
GROSS: So let's talk about MDMA, whose street name is ecstasy. It was a big clubbing drug. It was a big just, like, feel-good drug. So how is it being used therapeutically now?
SLATER: It's being used therapeutically to treat severe post-traumatic stress disorder, and it's also being investigated to treat social anxiety in autistic patients. It's very important to make the distinction. It's not being investigated to treat autism although it seems like it should be. But it's not being investigated to treat autism but rather autistics who have social anxiety.
GROSS: It's also being used experimentally to treat people who have been traumatized.
GROSS: Like, PTSD.
SLATER: And then - severe - right now, it's only being used for severe PTSD that - for people who are decimated by PTSD, people who can't go out of their houses, who haven't held a job in decades, who have been violently raped or veterans who have seen the worst of war. And the results have been incredible.
GROSS: So what's the theory about how it's helping people who have been traumatized?
SLATER: Well, the theory is that MDM - when you're traumatized and you tell your trauma story to somebody, you retrigger yourself. All the fear comes back. Your amygdala, which is the fear center in the brain, goes into overdrive. You start sweating and trembling, and you might have flashbacks. MDMA - when you take MDMA, your brain is marinated or soaked in oxytocin. So you're with a therapist. This is the way those studies are set up. You're with a therapist. You take the MDMA. You're loaded up with oxytocin, and you tell your trauma story. Only, this time, you tell it in a chemical state that is entirely different from how you are - have previously told it. You feel full of love and empathy, not for your - for the people who perpetrated the trauma. But you feel full of love and empathy towards your psychiatrist, towards the world in general.
And it's thought that telling the story in a wholly different frame of mind with a wholly different set of feelings actually almost literally moves the trauma out of the part of the brain that's been traumatized, say, out of the amygdala and into a new narrative stored in a different part of the brain, probably stored in, like, the frontal lobes of our brain. It - so that's one of the theories as to how it might work for the treatment of trauma.
GROSS: You know, when people say, well, you know, these psychedelic drugs are dangerous, they shouldn't be used even in these kinds of settings, what do you say to that just knowing the kind of really bad health side effects you've had from antidepressants and other, you know mood disorder drugs?
SLATER: I would say that the psychedelics are far less dangerous than the drugs that I'm currently on. That's my belief. As long as set and setting are taken into account - meaning that you are adequately prepared for the drug, that you've prepared yourself, that you take it with a guide who knows what he or she is doing and that you have, you know, the right setting and that you're supported both throughout the trip and after the trip, and so long as the drugs aren't gotten off the street, of course - I think the drugs are safer.
You only need to take them once, twice, maybe three times. That's it. So that's way different than someone like me or the millions of other Americans who are once, even twice or three times daily pouring into their bodies these chemicals that make your brain actually function abnormally by boosting levels of serotonin so that, again, your brain is actually functioning in an abnormal fashion and continues to do that 24 hours a day.
GROSS: My guest is Lauren Slater, author of the new book "Blue Dreams: The Science And The Story Of The Drugs That Changed Our Minds." After we take a short break, we'll talk about experiments using the psychedelic drug psilocybin in treating overwhelming fear of death in end-stage cancer patients. And jazz critic Kevin Whitehead will review two compilations of Nina Simone's early singles. I'm Terry Gross, and this is FRESH AIR.
(SOUNDBITE OF PATRICK CORNELIUS' "THE INVADERS")
GROSS: This is FRESH AIR. I'm Terry Gross back with Lauren Slater, author of the new book "Blue Dreams." It's about psychotropic drugs - drugs that treat mood disorders and schizophrenia by changing brain chemistry. The book is part history, part science, part memoir. Slater is a journalist and practicing psychologist. She's also taken psychotropic drugs for many years to treat bipolar disorder. Part of the new book is about current experiments using psychedelic drugs, like MDMA and psilocybin, to treat problems like post-traumatic stress disorder and fear of death in patients with terminal cancer.
So let me ask you about psilocybin, which is also being used experimentally. And explain what psilocybin is.
SLATER: Well, psilocybin is the active ingredient found in what's called magic mushrooms, otherwise known as God's flesh. And it's being used currently in the United States to treat anxiety in end-stage cancer patients. I mean, they take the most anxious people, and they've given them psilocybin. And they carefully control for what's called set and setting.
So before you take the psilocybin, you meet with a treatment team and you go over what your goals are for the session. There can be many goals, but one of the primary goals would be coming to terms with your death. And then the setting is set up. It's set up very carefully. You go to a well-appointed, comfortable, safe-looking room in the research institute. And you're encouraged to bring mementos that mean a lot to you, photos of family members, what have you. You're given the psilocybin and you wear headphones. Music is pumped in, very carefully chosen music. And you have a trip. And if you get scared or if you become overly anxious, you have two guides with you. And then after the trip, you process it with the treatment team. Those studies, like the MDMA studies, have been very successful in helping people come to terms with their death. And at all three of these centers, the cancer patients have more or less come to terms with their death.
They tend to say that they realize that death is not the end. They - it's not like they come to believe in an afterlife with, like, the pearly gates, what you read in the New Testament or whatever. They just have a sense that there's something bigger than they are, that there's something beyond what we normally see and feel. The psilocybin has allowed them to feel like there's much, much, much more to the world than we can normally experience and that they're not ending. They are changing. Death is a change, not an end.
GROSS: Do the researchers have any theories about why that feeling stays with them 'cause that could be a transient feeling. Like, they could take the drug and feel very transcendent on the drug and then feel real lousy a day or two after that and have all the anxiety return.
SLATER: That's a good question, why it is that they're able to retain that feeling. I don't know what the answer to that question is, what theories Roland Griffiths or Charles Grob or Stephen Ross at NYU would have about why they're able to hang onto those feelings. But they are able to hang onto them. It has something to do with, again, what they call set and setting, that they're so prepared so carefully for their trip. In fact, I know that they're not just released back into the world after they take the psilocybin.
The treatment team follows up with them. And then those follow-ups, I would bet, they are consolidating and re-consolidating the lessons learned while on psilocybin. But psilocybin is such a powerful psychedelic that you don't just forget. I mean, even people who take it recreationally don't forget what it is they've seen and learned. People will commonly say after taking psilocybin, I saw reality. I saw what's real. And now I know that when I'm not on psilocybin, I'm not actually seeing what's real. Psilocybin showed me what is really real about the world.
And they retain that.
GROSS: What are some of the other psychedelic drugs that are being used experimentally now to treat mood disorders, anxiety, other mental health-related issues?
SLATER: Well, I should say, psilocybin is also being used in Britain. And it's possible that there are some studies somewhere in the United States. It's being used for the treatment of treatment-resistant depression with very good results. And LSD is being used in I think it's Switzerland for anxiety in end-stage cancer patients and also as an analgesic. Low dose, sub-perceptual doses of LSD have been used to treat cluster headaches, which is just a terrible form of a headache that a person can get. It incapacitates you.
And for some reason, taking one or two, maybe three sub-perceptual doses of LSD seems to cure a cluster headache. So LSD is being used, psilocybin is being used. Ayahuasca is being used to treat addiction, and they've had success with that. I'm not exactly sure where it's being used. I think it might be in Canada. But it appears to illuminate to addicts the errors of their ways and people go into - commit to abstinence. Now, the question is how long does that last? That I don't know. I don't know a lot about ayahuasca.
But there are a number of psychedelics that are being used. And I personally believe that these psychedelics are going to be - Thorazine and imipramine, the tricyclics and the SSRIs, those were all called the golden era of psychopharmacology. And it started in the 1950s. And lithium should be added to that. And then there have been really not a lot of new drugs that have come down the pipeline that have been significantly different from the old drugs. I think psychiatry is going to have a new golden era of psychopharmacology, but I don't think it's going to come from Eli Lilly or from any big pharmaceutical or small pharmaceutical company.
I think it's going to be the re-discovery of these drugs that were shut away in the dustbin of history because they were misused in the 1960s. I think the psychedelics are going to open up a whole new world for psychiatry.
GROSS: Let's take a short break here, and then we'll talk some more. If you're just joining us, my guest is Lauren Slater. She's a psychologist and writer and author of the new book "Blue Dreams: The Science And The Story Of The Drugs That Changed Our Minds." We'll be right back after this break. This is FRESH AIR.
(SOUNDBITE OF THE WEE TRIO'S "LOLA")
GROSS: This is FRESH AIR. And if you're just joining us, my guest is psychologist and writer Lauren Slater. Her new book is called "Blue Dreams: The Science And The Story Of The Drugs That Changed Our Minds." And the drugs that she writes about are, like, the psychotropic drugs that are standard prescription drugs but also new experimental therapeutic uses of psychedelic drugs.
So, you know, I was reading some of your articles from the past. And I read an article from 2008 from The New York Times' "Modern Love" series that you'd written about. And the article, as we discussed earlier, was about how as a result of taking antidepressants, you'd lost your libido. And that was the cause of great stress in your marriage. And in this column, you wrote about - I'm just going to quote a little bit of it. You wrote (reading), I'm captivated by things, by solid, actual concrete things that can be assembled, made, whether books or babies.
For me, sex does not even come close to the thrill of scoring gorgeous glass for a window I will use, of hearing the grit as the grains separate and the cut comes clean and perfect. Sex cannot compete with the massive yet slender body of granite I excavated last week, six feet long. This stone packed with time and stories, if only it could speak. I'm going to spend months carving it with a silver chisel. I'm going to figure out a way to make this stone into an enormous mantle under which in the home I share with my husband and the babies we made our fire will flicker.
And you go on to write about how these stones mean way more to you than the idea of sex.
GROSS: But I also read in your new book that when you had a breakdown seven years ago and you got caught up in this manic episode, your manic behavior was polishing and grinding stones. And I have a feeling that what you're writing about in the "Modern Love" column is the same thing that became this manic episode in which you totally crashed afterwards and had a breakdown.
GROSS: Yeah, you're right. You're a good reader. You traced the (laughter) - you - that's absolutely right. I started becoming interested in - this is just embarrassing to talk about. I mean, I started becoming interested in stones and in grinding them, honing them, carving them. They fascinated me. And eventually, that sort of took on a speed and a life of its own. And eventually, what happened is that I had so many stones in my study on the third floor - I would lug them up to the third floor. And then when I couldn't store them anymore in my study, I stored them in closets.
I mean, you'd open a closet to get a coat and stones would come, you know, pouring out. They were everywhere. I would, you know, walk up and down the sidewalks looking for - I was especially taken with stones that had any kind of - you'd be surprised how many stones are pink if you grind them. So I would look for pink stones. And it was part of the manic episode. It started out not being but it became part of a manic episode where my behavior was definitely peculiar. So what's it like for you to read that article now because you were so kind of proud in a way that you preferred - like, you were proudly stating that you preferred grinding stones and finding their beauty to having sex. And then that became a kind of manic episode that led to a breakdown. So when you read that piece now or when you hear me read excerpts of it, what do you think about?
SLATER: The first thing I think about is I feel terrible about writing that, I'll tell you the truth. I feel terrible about writing it even though when you read it, I think it's actually very good writing. But I didn't tell my husband. I didn't ever think it was going to be published in The New York Times. I thought it was going to be published in this obscure anthology no one was ever going to read. And then next thing I knew, The New York Times had picked it up and it became widely read, or at least a piece of it became widely read.
And my husband read it. I hadn't told him that I had written this thing because, again, in my mind, it was going into an anthology that would be around for three months and that would be it. And it was one of the many things that led to the demise of our marriage. He took it - how else is he going to take it but incredibly personally? And when you're going into a manic state, you don't think about the ramifications of your actions.
And this is just one example of the very poor judgment that accompanies manic states.
GROSS: So another thing I was wondering about - and tell me if this is getting too personal, OK?
GROSS: Another thing I was wondering about, you know, you write in this piece and refer to this in the book as well that as a result of the side effects of antidepressants, you kind of lost your libido. But you also wrote a magazine piece about falling in love with a woman and the pleasure that you experience sexually with her.
GROSS: So did the loss of libido from antidepressants not apply to that relationship?
SLATER: No. It does apply to that relationship. It didn't - you know, if a relationship is brand new and you're in the very, very, very first blush of it, the side effects of the SSRIs, the low-libido side effects can be overcome. So when I wrote that piece about Anna for Elle Magazine, I was in the very beginnings, the first blush of that relationship. And I was able to feel arousal. But now we live together, and we've been together for, like, two years, I think. I can't believe it's been that long - maybe even three. I don't know.
We've been together for a while. And Anna is fully aware of the drugs I take and the toll they take on my libido. She has had to make huge concessions sexually to me because I don't feel desire. It's like hunger. You feel - when you're hungry, you feel a drive towards food. And in normal sexual functioning, you feel a drive. In abnormal sexual functioning caused by the SSRIs, you no longer feel that drive.
GROSS: Do you like to know how your medications work? Or are you content just to take them and hope for the best, hope for a good outcome?
SLATER: That's a good question. I think I would like to know how they work. But I would include with how they work, I would rather - I would like to know what the long-term side effects of these medications are. I want to be able to see into my future and to know whether or not I'm going to develop tardive dyskinesia. I already know that my future is foreshortened because of Zyprexa. I know the side effects of Zyprexa all too well.
It's possible, it's very possible that the SSRIs could cause tardive dyskinesia and could cause other neurological problems, could cause Parkinson's syndrome, could cause types of memory deficits, cognitive deficits. And whenever I can't remember something, which happens to me more and more these days, I wonder is it just because I'm aging - I'm 54 now - or is it because of these drugs that I'm taking? I can't tell the difference between what would be normal brain deficit due to aging and what is brain deficit due to, you know, toxicity from these drugs. And I'd really like to know the answer to that question. How are these drugs toxic, and what are they going to do to me in my future?
Knowing that would enable me to make a clear decision about - that's not true, actually. I wouldn't be able to make a clear decision. I have to take these drugs. Prior to taking these drugs, I was hospitalized. Like, I was a revolving-door mental patient. So even if I knew that these drugs were going to cause tardive dyskinesia and Alzheimer's disease - let's just make it really bad - even if I had the worst news about them, I would still have to take them. But I would be able to plan. I would be able to plan my life for the eventual sort of degeneration that was facing me. Right now it's just a big mystery.
GROSS: Well, Lauren Slater, I wish you the best, and thank you so much for talking with us.
SLATER: Thanks for having me.
GROSS: Yeah. And be well.
SLATER: Thank you.
GROSS: Lauren Slater is the author of the new book, "Blue Dreams: The Science And The Story Of The Drugs That Changed Our Minds." After a break, jazz critic Kevin Whitehead will review two compilations of Nina Simone's early singles. She'll be inducted into the Rock and Roll Hall of Fame in April. This is FRESH AIR.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.