Tom Johnstone has
battled drug abuse for much of his life. He started
taking ecstasy in high school, and by the time he turned 30
he was addicted to cocaine.
Now the gay
Houston native is clean and sober and is facing a new
battle: depression. Speaking from inside the
Alternatives recovery clinic in the Silver Lake
neighborhood of Los Angeles, Johnstone said he was diagnosed
in 1999 with bipolar disorder, formerly known as
manic-depressive illness, characterized by mood
fluctuations from extreme highs to extreme lows.
"My friends and I," Johnstone says, "we
all have issues with depression."
It has been
widely reported that the incidence of depression among gay
men is higher than in the overall U.S. population. One
often-cited study reports that more than 17% of
American gay and bisexual men suffer from depression,
compared with 9.5% of all adults. According to a biennial
survey of high school students in Massachusetts, LGBT
teenagers are about four times more likely than their
straight peers to have attempted suicide in the prior
Measures are now
being taken to address the issue. The Medius Institute
for Gay Men's Health in New York City, which has been
studying gays and depression, recently called for
mental health exams to become part of regular checkups
and recommended educational programs to teach gay men
about the symptoms of mental illness. "I see really
great doctors, but my experience is that I get a
mental health exam [only] if I walk into the
examination room and burst into tears," says Spencer
Cox, founder and executive director of the institute.
"The first step is to think of it as part of
normal health care."
According to Cox,
some common factors that cause depression among gays
include lacking a romantic partner, experiencing antigay
violence, not identifying as gay, or feeling alienated
from the gay population. He suggests that gay and
bisexual men face multiple epidemics--depression,
drug abuse, violence, and HIV--that reinforce one
another. "What we have to do is probably tackle
each of these things with some understanding of how
they're connected," Cox says.
Indeed, a number
of recent studies have connected depression with use of
ecstasy, a "club drug" that has been around
for many years and is wildly popular among gay men.
Johnstone believes his mental illness may have
resulted from his many years abusing the drug.
He recalls first
taking ecstasy with some high school friends at a beach
outside of Houston. "I thought it was
amazing," he recalls. "Euphoria."
That night Johnstone drove home, walked into his
parents' bedroom, and woke them up to tell
them, "I found God in pill form."
Johnstone and his friends were taking a half tablet every
three days. Then he began
"stacking"--taking two tablets at once.
Within five years he was taking as many as five hits
at a time. He gave up "X" in 1998, when
he began using cocaine intravenously. But Johnstone, 38,
has been clean since August 2006.
Now he blames his
depression, at least in part, on ecstasy. "I think
taking the amount of ecstasy I started taking at such a
young age definitely has been a factor in my
depression," says Johnstone, who sought help
from Alternatives, a treatment facility that caters to gay,
lesbian, bisexual, and transgender clients. "When
I'm not on Prozac, I'm suicidal.
I've always felt like there was a connection."
McDowell, founder of the Substance Treatment and Research
Service at Columbia University, says the scientific evidence
for a link between depression and ecstasy abuse is
"very strong." "I don't mean to
imply that it always causes depression; it does not,"
says McDowell, who maintains a private practice and
has researched club drugs for 15 years. "But
there is a definite correlation between it and feelings of
depression as well as increased rates of depression."
agrees. The cause-effect findings are challenged by some
scientists, who see the studies linking ecstasy and
depression as flawed. Because many people who use
ecstasy also use other drugs, their depression can be
tough to tie back to one drug. Others see the lingering
debate as a chicken-or-egg exercise, arguing that
undiagnosed depression could have driven people to use
ecstasy as a way of self-medicating.
people who use drugs and alcohol because of a mood disorder,
and there are people who have a mood disorder because they
used drugs and alcohol," says Jim Stolz,
clinical services director of the Pride Institute,
which runs multiple in-patient treatment centers nationwide
focusing on LGBT clients. "The question is always,
Which came first?"
As former ecstasy
users get clean and learn about diagnoses of
depression, they can become angry about what they've
done to their lives. "People oftentimes carry a
lot of anger, a lot of guilt, and a lot of shame
that's directed at themselves," Stolz says.
"Part of the program is learning to accept your
past and learning to move forward."
methamphetamine, ecstasy is a stimulant. The drug's
promise of boundless energy, happiness, and closeness
to others--and the popular myth that it
threatens few bad side effects--often seduces gay men.
"If you have the disease of depression, most
likely if you're given a choice of different
drugs, you're going to choose one of the stimulants
rather than the downers," says Jim Mulligan,
medical director at Seabrook House, a drug rehab
center in New Jersey. "And if you don't have
depression and you use these substances severely over
long periods of time, yes, you now have produced a
chemical depression. It's very hard to treat."
and other good feelings result when ecstasy triggers
users' nerve cells to flood the brain with serotonin,
a chemical that plays a key role in regulating mood.
With their supply of serotonin drained, users often
become depressed in the days after using ecstasy while
the brain replenishes its reservoir of the chemical. Weekend
ecstasy users nickname this short-term despair "Black
Monday" or "Suicide Tuesday."
But long-term or
heavy use appears to change the brain's
mood-controlling system permanently. A number of
studies suggest that ecstasy causes depression and
anxiety that lasts far longer than any initial withdrawal
would. This long-term depression is the result of ecstasy
damaging the brain's serotonin-producing
In March 2006,
Danish researchers concluded that ecstasy causes
depression in pigs, whose brains are similar to those of
humans. In a 2003 study London Metropolitan University
researchers tracked 519 people and found that those
who had used ecstasy were at least four times more
depressed than those not using ecstasy, even if they used
other drugs. And Cambridge University researchers
reported in 2005 that chronic ecstasy users with a
certain genetic makeup experience more depression than
program director at Alternatives, considers it
"absolutely" plausible that long-term
use of ecstasy causes depression. "With ecstasy,
you're creating a chemical imbalance in your body
just by taking it," he says.
But Rizzo is not
dwelling on it in his programs. If a patient is
depressed, they address it as part of their recovery.
"New coping mechanisms need to be
learned," he says. "We offer a structured
sober environment. Not only do we treat them
medically, we treat them socially. Our clients will
see a psychiatrist every other week. They see a
psychotherapist on a weekly basis."
out of Alternatives in mid December and found an
apartment in Los Angeles. He's learning how to live
both without drugs and with depression. And he wants
other gay men to think twice before doing anything
that could cause or add to their risk of depression.
"The rumor was that you weren't going to
pay any consequences for doing ecstasy,"
Johnstone recalls of his first time doing the drug.
"I feel that's a real myth."