At thirty-five, I was a successful physician and family man. Born to a family of humble means, I carved my way into the University of Puerto Rico School of Medicine and joined the U.S. Air Force Medical Corps. After specialty training in nuclear medicine at the University of Arkansas for Medical Sciences, I became part of a unique group of physicians practicing in that field. My wife and I, both born in San Juan, were raising three daughters in suburban Maryland, just outside Washington, D.C. My career combined leadership roles in clinical practice, research, and teaching, while simultaneously fulfilling the demands of military life. We were a shining example of the American dream. But in the early 1980s, that dream began to derail amidst an unexpected emotional whirlwind.
At the time, I was an enthusiastic supporter of the emerging biological psychiatry movement, though not in the simplistic sense that psychiatric ailments were discrete biological diseases treatable with disease-specific antidotes. As a doctor, I knew that psychiatry did not have the tools for accurate diagnoses or definitive cures. What I did believe was that emotional symptoms could be alleviated with psychoactive medications. My conviction grew partly from intuition and was further fueled by the scientific community’s growing interest and progress during the 1980s in understanding how the mind works.
During ROTC summer training camp in the late 1960s, a few years before I became a physician, I experienced my first episode of major depression and anxiety, struggling with a profound dislocation of my social environment and sleeping habits, and having to speak in a foreign language. No antidepressants, no benzos entered the picture. After a few painful months, I recovered fully and went on to medical school.
More than a decade later, while serving as a military medical officer at the dawn of the second psychiatric revolution, I entered the mental health system of my own volition, seeking relief for emotional discomfort and sadness that stemmed largely from the disruption of my work and social environment after the Air Force assigned me to Washington, D.C., following specialty training, forcing me to leave behind cherished friends and colleagues. I led a research division in Bethesda, Maryland, performing studies involving radioactive materials used in nuclear medicine. The work was stimulating but also isolating, all the more so because I spent long hours with a small group of military and civilian personnel in a laboratory located four floors underground. At that point, treatment consisted of psychotherapy, without medication.
Later, a far more serious crisis emerged. A painful family conflict, a business entanglement, the pressures of clinical practice, and the demands of military life converged into my second episode of severe depression and anxiety. I eagerly sought psychiatric counseling as a desperate physician turned patient. Trusting the psychiatrists, military and civilian, whose advice I sought, I unintentionally boarded a ship that would carry me on a decades-long and treacherous journey with psychiatric drugs.
Unlike my first episode, this one followed a very different path: decades of psychopharmacologic treatment. Ironically, if I had not been introduced then to psychiatric drugs, the story that follows might never have needed to be told.
My entry into psychopharmacologic psychiatry featured the anxiolytic benzodiazepine Xanax (alprazolam) and Desyrel (trazodone), an antidepressant from the pre-SSRI era. Desyrel did little for me and became the first in a long list of antidepressants prescribed over the years for my presumably recalcitrant depression.
Xanax was a different story. Newly approved by the FDA, it seemed to dissolve anxiety like no other medication. Within minutes of taking a dose, my anxiety was gone. Regretfully, the relief lasted only a few hours, and I soon found myself trapped in a vicious cycle of rebound anxiety and dose escalation. I had fallen into the “benzo trap”—a trap that is exceedingly difficult to escape from and one that would enslave me for decades.
Meanwhile, my depression persisted. There were days when I must have looked like a dead man walking. Yet, during those dark periods, my daughters remained a source of comfort in many ways, such as when we played “marching” soldiers during outings to nearby parks, the tears in my eyes going unnoticed.
After the failure of Desyrel, a litany of antidepressants came my way. Each carried a price. The tricyclics caused dry mouth, urinary difficulties, and sexual dysfunction. Nardil (phenelzine), one of the earliest antidepressants, brought an astonishing oasis of well-being that lasted several months, only to be followed by a hypertensive “cheese reaction,” severe orthostatic hypotension, a thirty-pound weight gain, and profound erectile dysfunction—and I was only in my early forties.
“Better things are coming, Frank,” my charismatic psychiatrist would say.
A promised breakthrough arrived with the second psychiatric revolution, spearheaded by what I playfully call General Prozac and his SSRI lieutenants. I welcomed the general with optimism. For me, however, Prozac was just a footnote, causing extreme nervousness and agitation even at a fraction of the recommended dose.
The march with antidepressants continued for years, eventually progressing into antidepressant “cocktails” that often included multiple antidepressants, so called “mood stabilizer” anticonvulsants, and even antipsychotics. Over time, my initial symptoms of intense depression and anxiety evolved into chronic fatigue, lingering loss of drive, intermittent sadness, excessive sleep, and others. Something was obviously wrong with me, but was it the disease or the drugs’ ever-rising mountain of side effects? At the time, I did not know. I later came to believe that long-term antidepressant use can transform an acute illness into a chronic debilitating condition, often labeled refractory depression and treated with still more medications. The infamous conundrum: The treatment becomes part of the illness.
After retiring from the Air Force, I joined a colleague in private practice, providing nuclear medicine services to two hospitals in Prince George’s County, Maryland. What began as a promising venture became my albatross. My partner approached life with obsessive adherence to schedules. Over the years, tensions mounted because I could not maintain his rigid pattern. Crushed by fatigue, I developed the habit of retreating to my car for a midday nap, a perilous exercise during the winter, rather than joining him for lunch. It was not eccentricity—I simply lacked the energy required to shuttle between two hospitals while providing twenty-four-hour coverage.
Though I continued to meet the expectations of referring physicians and discharge my professional duties adequately, I found it increasingly difficult to cope with the demands of the practice. My partner and I never discussed the mountain of issues I was experiencing with psychiatric drugs or his growing discomfort with my irregular work habits.
Then, one day, he abruptly announced his retirement.
Initially, I assumed I would take his place at the practice. It soon became clear, however, that I needed another job—and quickly. An opportunity arose in Puerto Rico. Despite the financial sacrifice, the upheaval of separating from my wife and moving fifteen hundred miles across the Atlantic, and the painful prospect of leaving behind two precious teenage daughters—the oldest was already away at college—I accepted the offer.
For reasons I did not understand at the time, I weathered the unfolding events in a very inappropriate manner. I was in the midst of a personal earthquake threatening my professional, financial, and family life, yet I navigated the most consequential events in my life with remarkable detachment, almost as if I was observing someone else’s misfortune. Only later did I recognize how profoundly my emotional responsiveness had been impaired.
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After relocating to my homeland, I soon discovered that the professional competition in my new setting was fierce and psychiatric practice on the island differed little from that on the mainland. General Prozac was marching here as rampantly as there. Local psychiatrists concocted the same drug combinations and embraced what had become a universal tenet: After one relapse, patients should remain on antidepressants permanently.
By then, my perspective as a physician was also changing. I grew increasingly skeptical of biological psychiatry as I experienced more drug-induced difficulties and delved deeper into the psychiatric literature, searching for the truth about psychiatric drugs and discovering that some of what I had accepted was laced with hyperbolic claims.
The asphyxiating benzo trap led me through the revolving doors of inpatient detoxification programs, none of them successful. Their rapid tapers left me worse than when I entered, often with severe anxiety, nervousness, tremors, and strange bodily sensations. Looking for another way out of the benzo trap, I also attended meetings of twelve-step groups such as Narcotics Anonymous, modeled after Alcoholics Anonymous, but found them equally unhelpful.
An old college friend who had become a psychiatrist with fellowship training in electroconvulsive therapy enthusiastically urged me to undergo treatment at the University of Puerto Rico Carolina Hospital. Twelve treatments under general anesthesia followed. Contrary to the alarming images portrayed in movies, the treatments were administered under the care of an anesthesiologist, and I experienced no physical discomfort. But they did not move my emotional needle at all.
The new millennium brought profound sorrow with the sudden death of my father. At seventy-eight, he enjoyed excellent health and Superman-like stamina. A few days before the September 11 attack on the twin towers, he fell from a tree while harvesting fruit on his farm in Toa Alta. He survived the fall but died a week later in the hospital from a massive heart attack. The funeral home overflowed with mourners. My mother was consumed by sadness, and my sister’s eyes were swollen shut from crying, yet my demeanor was strangely indifferent. I greeted people, chatted freely, and even appeared animated. There was only one explanation for my odd behavior, and it had a name: Wellbutrin. After only two weeks on the drug, my emotions had been placed in shackles. The experience reinforced my growing recognition that antidepressant cocktails were making my condition worse.
At the time, I was Chief of Nuclear Medicine at Teachers’ Hospital in San Juan and lived with my parents in what I affectionately called the Toa Alta Retreat, a haven of peace atop the hills overlooking the mighty river the native Indians called the Thoa. Every day I drove the winding road down to San Juan, but it became increasingly difficult to get out of bed and muster enough energy to go to work. After my father’s death, it was just my mother and me. Ironically, she became my caretaker and therapist of sorts.
Driving to work felt like pushing a boulder up a hill, while negative thoughts haunted me: “You are chronically fatigued. Your emotions have been hijacked. Your manhood has been mangled. Psychiatric drugs have damaged your health, and your career is in danger of collapse!”
I managed to carry on for a few more years until I simply could not do it anymore. My career in nuclear medicine came to a screeching halt. After such a distinguished professional life, it was painful to see it end in such an undignified way.
Then came 2018.
It marked the end of a life of endless generosity when my mother, the light of my life, passed. As if by providence, that same year marked the beginning of my liberation from antidepressant cocktails and the roller coaster of benzodiazepines.
In the shadow of my mother’s loss, another light emerged. Soon after, Luz, whose name means “light” in Spanish, became my beloved wife. But the journey was not over. Another unexpected ordeal lay ahead, one I could never have anticipated.
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I decided to write a memoir for personal reasons: to share with my daughters certain aspects of my life they would otherwise never have known; to reassure them that my love and concern for their well-being remained alive even when my demeanor belied my emotions; to leave them a record of a career that reached professional heights while contributing to medical knowledge through research; and to help them understand how emotional turbulence and psychiatry’s chemical treatments derailed my career. I wanted them to know the father behind the illness and the patient behind the physician. That desire became The Wrong Messengers, a story interweaving the second psychiatric revolution with events in my own life that, as I wrote it, took on a wider significance.
I hoped to enlighten both laypersons and medical professionals about the generally limited effectiveness and potential dangers of psychiatric drugs used to treat depression and anxiety, the need for their judicious use, and the paramount importance of properly informing patients about adverse effects and withdrawal symptoms. I also wished to join the growing choir of voices challenging what I regard as the most widespread medical myth of the twentieth century and beyond: the chemical imbalance theory of depression, a concept that helped fuel the indiscriminate prescribing of antidepressants. Finally, I hoped to become a voice of wisdom and encouragement for those still navigating treacherous waters in search of solid ground.
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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.