City of Zombies

TL;DR: Something happened to a whole generation of gay men around 2010. The ones Mike Barr knew — once engaging, funny, endearingly vulnerable — began turning, Body Snatcher-like, into emotional shells. Not all at once. One by one, on the streets of New York, at dinner parties, in chance encounters outside what used to be Barney’s. This post is his attempt to reckon with what was lost — and with his own three years on Celexa, Klonopin, and Ambien, and what those years cost him that cannot be undone.

• The epidemic nobody talks about: Americans represent 5% of the global population but take 50% of the world’s pills — including 80% of its painkillers. Psychiatric prescriptions tripled in the 1990s alone.
• The SSRI myth: SSRIs don’t actually have a significant or lasting effect on brain serotonin levels. So what are they doing?
• The personal: Mike’s own three years on Celexa — the horniness, the silenced voices, the somnolence, the Klonopin spiral — and what it took to get out.
• The reading list: Nine books on integrative and functional psychiatry that changed how Mike thinks about mood, mind, and medication.

[IMAGE: Pill bottles or a medicated street scene — evoking the quiet epidemic of psychiatric over-prescription]

August 2025 Addition: The Veterans Edition

The WSJ ran this absolutely chilling — and courageous — piece a couple of weeks ago: "Combat Cocktail,“ about how the VA medicates veterans to within an inch of their lives — and, not uncommonly, to actually taking their lives. Many of the meds and drug cocktails exactly mirror what I see being prescribed for friends or former friends. I’m pulling this table from ”The POW Next Door" and shamelessly repurposing it here. A couple of these drugs even I had to look up. Most will be, unfortunately, super familiar.

Now back to what I wrote originally in January 2024. Someone slow this not-so-merry-go-round down.

Something Happened

I still can’t quite pin it down. But something happened — maybe around 2010, in the aftermath of the ’08 financial meltdown? Or was it the first meth epidemic? The "end of AIDS" and the corresponding loss of a unifying passion? The post-June 2011 fork in the road — those who chose parenthood versus those who insisted on liberation from the Norman Rockwell ideal? Or did we simply grow old? Newly invisible. Newly arthralgic.

Something though happened.

Each time I returned to the city after leaving in 2006, another and then another of my once engaging, funny, vibrant acquaintances had turned — Body Snatcher-like — into a kind of emotionless shell of his former self.

Americans represent 5% of the global population, yet take 50% of the world’s pills — including 80% of the world’s painkillers.

I get it. We have been through a lot. A lot, a lot.

It took nights and nights of weeping in front of Pose and then Fellow Travelers for me to finally, fully come to grips with everything we’ve been through.

“After” AIDS: 9/11. A financial meltdown. Catastrophic loss of newspapers and community media. Violent invasions of Afghanistan, Iraq, Syria, Libya, Yemen. Trump. Covid. Putin. Netanyahu again. Trump again. Despots just won’t go gentle.

And I was there once too — my nightstand overflowing with anxiety and mood and sleep medications. Somehow I escaped.

I am tempted to credit Gui Pi Tang — “Ginseng and Longan Formula” — a Chinese herbal formula I stumbled across while sampling virtually every formula we studied in school. And yoga. Not because of how yoga helped me (although I love, love, love a good yoga class, preferably with an ample supply of sweaty hairy men’s bodies) — but because yoga made me see how Celexa was affecting the energy in my body. Basically, freezing it up. And killing the endorphin rush from exercise.

The Zombies — and the Maniacs

I ran into an old friend on Seventh Avenue outside what once was Barney’s. He gleefully informed me that his doctor had “finally gotten to the root” of his depression: he was bipolar. I got super sad. He had spent a year in a really dark depression, even thinking about ending it all. Now, out of the gate: Effexor + Abilify. All the gray clouds had magically dispersed.

So why did this sadden me? Because he is no longer who I remember. He is getting by. He thinks he is happy. But he is sleepwalking through life.

Another friend chose the other side of the road: endless stimulation — the Prozac and Wellbutrin antidepressants that have an activating effect. (Recall that before Wellbutrin was Wellbutrin, it was Amfebutamone.) This friend talks non-stop. Has enormous self-regard. Never follows a single conversational thread from your end. Takes nary a slim reed of interest in your life. Goes on and on only about himself. Or his new 20-year-old boyfriend.

I have a female friend, also on Wellbutrin, who acts much the same. These folks are not sleepwalking through life — they’re drag racing through it (not the delightfully colorful RuPaul way, but more like an expensive souped-up car overturned in flames) and missing everything around them.

I could go on. I could talk about David and Shawn and Enrique. Of Jeffrey and Thomas and Eric. But I’m guessing you get the picture.

It makes me even sadder to think that all these once engaging, playful, endearingly vulnerable people will spend the rest of their days sleepwalking — or maniacally prancing, Joker-like — through life.

The Marketing of Misery

Drug companies started direct-to-consumer advertising in the 1980s. By the mid-1990s it was barely regulated. America’s use of all prescription psychiatric medications tripled in the 1990s as a direct result. By 2006, the antidepressant Zoloft had made more money than Tide detergent.

The SSRI licensing sequence, for reference: 1991, Zoloft; 1992, Paxil; 1994, Effexor; 1998, Celexa; 2000, Wellbutrin; 2004, Cymbalta. Then Trazodone, Pristiq, Viibryd, and now Exxua.

Drug companies are spending billions of dollars to turn normal human experiences — fear, sadness, grief — into medical diseases. They aren’t developing cures. They’re creating customers. Four out of five antidepressant prescriptions are written not by psychiatrists but by general practitioners, often for patients without an actual diagnosis of depression. Surveys show GPs routinely overestimate what antidepressants can do.

Abilify — originally formulated to treat schizophrenia — expanded into the depression market and became America’s top-selling medication overall. America’s number one money-making drug is an antipsychotic. As a psychiatrist colleague once told me: this is insane. There is an ancient Greek word, pharmakon, that held disparate meanings — sacrament, medicine, and poison. Sometimes the treatment is worse than the disease.

We want to function in this world, I get it. We want to feel even-keeled. But is this really functioning? Is this really living?

My Own Three Years

It was shortly after Peter Kramer’s "Listening to Prozac" came out. Not long after the super depressing Berlin AIDS conference. Then in 1997, a big break-up. Totally out of the blue. I found my work suffering at St. Vincent’s — a job I loved. My lovely, lovely MD suggested I might be dysthymic, or cyclothymic: I had weeks of productivity and then stretches of struggling to get anything done. Surely today I would be diagnosed bipolar — even though I never had any true manic episodes. And I can pretty safely say that zero of my friends now on bipolar meds ever experienced any either.

He suggested Celexa.

I had just gone through a pretty traumatic break-up. St. Vincent’s was in its death throes. My doctor suggested I might be “cyclothymic.” He suggested Celexa. Little did I know he had recently taken up a bit of a friendship with the Forest Labs rep.

I’m not saying that’s what drove his enthusiasm. Maybe he would have liked and prescribed it non-stop without the new wining-dining-flattering friendship. But that is pretty much the exact script from the pharma sales playbook. I’m assuming you’ve watched Dopesick.

Within 24 hours I was horny as hell. Hard and yet orgasm impossible. What cruel joke was this?

I became so, so sleepy. All I wanted to do was sleep.

Within three to five days, that chorus of negative voices in my head — silenced. Gone.

But how could this be? And where I would typically say no to every invite, now I only said yes. I would follow people I didn’t even particularly like for dinner or drinks or parties. Where I once felt like I belonged nowhere, suddenly I belonged anywhere and everywhere. This wasn’t serotonin. Oxytocin maybe. But more likely an entirely altered neural circuitry. And just a little bit scary. How do they let GPs prescribe these drugs after only a 15-minute consult?

My entirely personality and decision-making were undergoing a fundamental makeover — and no one anywhere was overseeing this. You get the script and are then free to fly and fall on your own. This is care??

My (absolutely lovely, really lovely) doctor had also prescribed me Ambien for occasional insomnia. Eventually, after the initial somnolence from starting Celexa, I began waking — joltingly — at 4 or 5 a.m. with zero chance of getting back to sleep. He had also prescribed Klonopin, which I grew to love. I would solve the rebound insomnia from Ambien with a healthy dose of Klonopin. Soon I was taking Klonopin every night. On one visit, he offered to write me a script for a thousand Klonopin. A two-year supply. “What a friend we have in Jesus!”

By 2011 I was off all of these drugs. And I am only now realizing how their unappreciated effects at the time influenced the trajectory of both my professional and personal lives — and what they led me to lose. Losses that cannot be undone.

What SSRIs Are Actually Doing

I have become a little obsessed with the marketing and misrepresentation of the entire SSRI class. But also with what now seem like much more plausible explanations for what these drugs actually do — which has almost nothing to do with serotonin.

There is a growing and convincing body of literature to support the contention that SSRIs/SNRIs have only a fleeting — if any — effect on brain serotonin or norepinephrine levels.

The official guidance to doctors and patients was “expect to wait two weeks for any improvement, and about a month for real change.”

So why was I horny as a goat the very next day? Why did the voices disappear by week’s end? Why the crushing somnolence almost immediately?

It made no sense — and there’s now good reason to believe it wasn’t serotonin at all. I credit Bethesda-based psychiatrist Robert Hedaya — whom I was lucky enough to meet through the IFM — for first legitimizing my suspicions about this.

Two Quick Things, and a Reading List

First: There is a large and growing body of literature to back all of this up. I will highlight one or two key papers in coming weeks.

Second: My zombie friends. Yes, some of them will tell you how much these medicines have helped them. I would more than likely have told you the same thing when I was taking 40 mg of Celexa in 1999, 2000, even 2001. I will also post case studies of people who were lucky enough to find real medical detectives — doctors who worked with them to figure out and fix (without drugs) the actual reason their mood or mind was struggling. Here is a provisional link to an abbreviated sampling of such approaches. Fuller discussion to follow.

For now, here are my favorite reads on this topic, more or less in the order I encountered them:

1. Hyman, UltraMind Solution (2009)
2. Mayer, The Mind-Gut Connection (2016)
3. Arango, Viadro, Underwood, Bugs, Bowels, and Behavior (2013)
4. Fasano, Gut Feelings (2021)
5. Hedaya, Understanding Biological Psychiatry (1996)
6. Greenblatt, The Breakthrough Depression Solution (2011)
7. Anderson, Cryan, Dinan, The Psychobiotic Revolution (2017)
8. Hedaya, Depression: Advancing the Treatment Paradigm — A Functional Medicine Monograph (2008)
9. Valenstein, Blaming the Brain (1998)

Mike Barr, a longtime POZ Contributing Editor and founding member of the Treatment Action Group (TAG), is a science writer, functional medicine practitioner and herbalist in NYC. Reach out to him here. Or sign up for his curated, professional-grade supplement dispensary — 30% off your first order, 25% off all auto-refills — here.

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• #antidepressants
• #antipsychotics
• #anxiety
• #bipolar disorder
• #depression
• #insomnia
• #prescription drugs