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."