Paulina Porizkova, the 46-year-old supermodel and actress, was devastated in 2007 when she was thrown off the television reality show, "Dancing With the Stars," and said she felt engulfed by a wave of anxiety.
The Czechoslovakian beauty -- the second woman after Christie Brinkley to be featured two years in a row in 1984 and 1985 on the cover of the Sports Illustrated swim suit edition -- turned to antidepressants for help.
"My ego had traveled back to ninth grade, when I was the least popular kid in school and just couldn't figure out what I had done wrong to be so disliked," she writes this week in Huffington Post.
In what she calls a "midlife affair with meds," Porizkova said she hoped that medication would calm her nerves and make it easier on her husband of 24 years and two children. Instead, she said, over two years on the drug killed her sex life and wrapped her in a "thick, warm comforter, insulated against the sharp pangs that came with living."
Porizkova said that when she confessed her "dirty little secret" to a girlfriend, she learned she was not alone. "Women in their late 30s and 40s were all having the same affair," she writes.
The number of Americans using antidepressants has doubled in only one decade. According to the a study published in 2009 in the Archives of General Psychiatry, about 10 percent of all Americans, or 27 million people, were taking the mood-altering drugs in 2005, the last year for which there were statistics.
Like Porizkova, half of those patients are being prescribed these drugs not for depression, but for back and nerve pain, fatigue, sleep difficulties or other problems.
Doctors argue that these medications are effective, especially if used in conjunction with behavioral therapy. In mild cases of anxiety or depression, lifestyle changes such as exercise, good sleep hygiene and social contact and "fun" can be powerful mood enhancers.
"I agree with [Porizkova] that medication alone is not enough," said Dr. Sudeepta Varma, clinical assistant professor in the department of psychiatry at New York University's Langone School of Medicine. "But don't throw the baby out with the bath water."
Women also need to look closely with their doctor at what is causing the worry and anxiety in their lives. "If you have marital problems, you need to fix them," said Varma. "In a profession where youth and beauty in important to you, of course the loss is going to be a big stressor."
The supermodel said she had experienced anxiety attacks before, but they subsided as she had children. But by the age of 40, they returned to "cripple her."
"I couldn't get in a car, a bus and certainly not an elevator without panic overwhelming me: a crippling, terrifying sense of dread," she wrote. "I couldn't draw a proper breath, my heart pounded and heat flashed through my body, making me break out in sweat."
Porizkova said that she had always been opposed to taking medication and had given birth to both her children naturally. But the short bouts of anxiety were stretching to two to three weeks at a time, coupled with depression and irritability.
Her doctor prescribed the antidepressants to "reboot the system," according to Porizkova, and suggested talk therapy. After a few months, she said, "The constant buzz of anxiety became noticeable only by its absence. It was like spending your entire life in a room buzzing with fluorescents, and then, one day, they stop. I wasn't even quite sure what to do with this silence, how to live in it."
When asked to join television's "America's Next Top Model," Porizkova said she couldn't be insured because she was on medication, and worried that she might be perceived as "unstable." But the woman in charge of the paperwork wrote the model a waiver, admitting she, too, was on the same drug.
Paulina Porizkova Experienced Anxiety and Depression
Soon, Porizkova learned that eight of her friends were also on antidepressants. "This shocked me," she said, "It also got me wondering. What was going on here? Was this a sort of universal malaise that hit peri-menopausal women?"
Porizkova said that when the drug's side effects destroyed her sex life and her creativity, she "decided that this affair had all the drawbacks of an affair: the sexual distancing from my husband, the guilt, the lies; and the benefit -- silence from the fluorescents -- didn't seem worth the price."
Varma concedes that antidepressants, like all drugs, come with side effects. Still, doctors can make adjustments in the medications. Some patients will stay on them for a minimum of nine months to a year, but others, who have three or more bouts with anxiety or depression are considered chronic and can be on the drugs for a lifetime.
Though these medications are not addictive, they need to be weaned slowly over several weeks to avoid the side effects of fatigue and some return of symptoms.
"Doctors need to differentiate someone with an adjustment disorder," said Varma. "The kids have left the house or you are renegotiating a career path. That is normal and not depression or anxiety. My job is to get to the correct diagnosis. Will someone get better or is it crippling anxiety?"
Trying to get off the medication wasn't easy for Porizkova. For three tiring weeks she had terrible dreams and then the anxiety crept back.
She wondered if all women experience her anxiety at the crossroad of middle age and is medication not just the "emotional equivalent of plastic surgery?"
"With them, we can stave off the anguish of change; we can take breaks from the afflictions of living," she said. "But is it also possible that through the serendipitous use of these brand new staver-'off'ers, we will ultimately pay a price: the price of going through life anesthetized and smooth with all the self-awareness of a slug?"
But Dr. Holly Swartz, associate professor of psychiatry at the University of Pittsburgh School of Medicine, said that symptoms of major depression should not be ignored. That psychiatric illness, which strikes 1 in 20 in their lifetime, is "under-recognized, under-diagnosed and under-treated," she said.
Swartz said that though some of its symptoms mimic menopause, they are much more dramatic and come in a cluster: loss of interest in usually enjoyed activities, gaining or losing weight, sleep disturbances and suicidal thoughts. Women can also feel, "worthless, guilty and hopeless," she said. "Anything that affects how you function."
"The important thing for women struggling is to work with someone who can figure out what is going on," said Swartz. "The question is whether it is depression or not. Antidepressants are not indicated for mid-life crises."
Porizkova agrees with psychiatrists who say that antidepressants have been lifesavers, but she questions whether women -- and perhaps their doctors -- are looking for a panacea for normal life crises.
"I also think that those who try to take the shortcuts -- the pill to lose weight, the pill to be happy, the pill to be smart, to sleep, to be awake, are just running up their tab," she writes. "My affair with an antidepressant reinforced what I already knew: I'm not one for affairs. I'd rather fight tooth and nail to keep and restore what I have than take a break from it."