What if antidepressants really are a magic pill?

The Mantra exists for a reason

In mental health advocacy, we spend a lot of time saying antidepressants aren’t a “magic pill”.

It’s become almost a mantra.

It’s a direct response to people who say nonsense like, “oh, you’re taking your magic happy pills, are you?”

We repeated it again and again. We do it so people don’t get the dangerous idea a pill can solve their problems. But the words are also painful. Intended or not, they are full of dismissal.

They invalidate our experiences and erase all the work we’ve had to do BEYOND the medication. They make it sound easy, and it’s anything but.

Medication is no ‘easy way out’. It’s a necessary step to getting us to a point where we can do the required work to get better.

For those reasons, it has been an important statement to drill into people’s consciousness.

Have we swung too far?

But maybe we’ve swung the pendulum too far. When we insist on saying antidepressants aren’t a magic pill, perhaps we lose the thread on just how amazing they are.

Recently, a couple of young people in my life started antidepressants. As they kicked in what I saw reminded me of the magic they can carry.

Antidepressants aren’t a magic fix for people’s problems, but what they can do does feel kind of like magic. Maybe that’s the nuance we should be focusing on.

The onset of a depressive episode can be a bit like that old fable about “the boiling frog” (which is a myth, but still a useful analogy). It comes on slowly. You don’t notice it. And by the time you do, it’s all too much to get out of.

There are often (but not always) external factors that lead to a depressive episode. As depression builds, the heavier those become. They become harder to manage. So do everyday things. Eventually, it starts being too much. Every little thing feels a million times bigger than usual, sometimes to the point of feeling impossible.

What antidepressants can do

Starting a course of antidepressants won’t solve any of those external factors. They all still exist.

It won’t magically make school a happy place. No magical fixing of social interactions or taking away the big conflict in your life. The external factors (whatever yours are) don’t magically disappear. But they will become less onerous.

Antidepressants may not take away the existing factors people face, but they bring people to a place where they:

• Don’t feel so paralyzed by every decision they have to make. (They’ll be able to eat again because you won’t be stuck in that place of “What do I want to eat for dinner? I can’t decide. Screw it, I just won’t bother eating.”)
• Can use their brain effectively again. (Depression takes away your ability to think clearly. Study after study tells us this.)
• Are able to remember things again. (Depression kills your memory. You may not recover the stuff from during your depressive episode, but you will start having functional memory again.)
• Can enjoy things again. (Getting a break from life by having a wee bit of joy is highly underrated. Never having any joy is exhausting.)
• Have perspective again. (They won’t magically get perspective that wasn’t there before. Previous cognitive biases still exist. But they’ll have a chance of seeing past them. In my case, I’ve worked hard to move past my ‘all-or-nothing’ thinking and have been quite successful. But when I’m in a depressive episode, all that disappears.)
• Not be so angry/sad/numb all the time. (They differently in different people. Anger has never been part of my depressive profile. Research shows it is far more common in men. That said, it’s a big part of the depressive profile for a couple women I know, so there are no absolutes.)
• Start to get relief from the physical stuff that comes with a depressive episode. (Without body aches, headaches, stomach upset, back issues, sleep issues etc., people are likely to be able to do more.)
• The biggest thing for me was that antidepressants brought me back to myself. When they started working, I started recognizing myself again. Let me tell you, after you’ve been in a depressive episode that feels like magic.

Sure, none of the complicated life stuff is gone, but it starts feeling a million times more manageable.

A ‘compare and contrast’ example

Not convinced? Let’s take an example of a mundane thing — grocery shopping.

When I am depressed, grocery shopping feels like an insurmountable task. It takes untold time and effort. It drains me. Thinking about panics and paralyzes me.

When I’m not depressed? Okay, I still kind of hate it. But I can get it done.

Grocery shopping when I am in a depressive episode:

• Having trouble making decisions. (Should I get the usual brand or the one on sale? Or maybe try this new one? What if I make the wrong decision?)
• Thinking through mud while figuring out what the household will eat for the week and what should go into those meals. (Cognitive difficulties make it hard to remember all the different pieces involved.)
• Forgetting to put things on a list. (And then remembering to take the list. And if I forget it, the ensuing panic.)
• Getting stuck on the idea that things must be a particular way. Worried someone will freak out if they don’t get a specific thing, etc. (Not able to step back with perspective, getting caught up in cognitive distortions.)
• Trudging through a grocery store while in physical discomfort (my body is aching and I probably have a headache.)
• More decisions when I get home (Trying to decide where things go because I don’t really remember, or am second-guessing their ‘home’.)
• The whole process takes forever and is extremely draining — both physically and mentally.

Grocery shopping when I am treated with meds:

• For me, it meant having the ability to problem solve and come up with more effective solutions. The grocery store is a sensory hell place for me at the best of times. Now I order online and either pick them up or have them delivered. It circumvents SO much for me. But if I do have to go to the store it means:
• Decisions are easier. There are patterns I stick to. It helps with everything: what meals might be in the week, what to buy, and what choices to make around individual products.
• Add to the list throughout the week because my memory works more effectively. Also, more likely to remember to bring the list. (If I’ve forgotten it, I’m more likely to remember what was on it, so it won’t feel like the end of the world. I’ll be frustrated but not panicked.)
• More flexible about what is available and what isn’t. Still a pain but not a big deal.
• Moving through the grocery store is easier. I’m in less pain, have a clearer idea of where things are to plan my route and haven’t spent time agonizing over each item. I get in and out of there far quicker.
• When I get home, I know where things go. They have a home, and I know where it is.
• The whole process takes far less time and is both physically and mentally FAR less draining.

Think it’s a superficial example? Okay, think of it this way: Antidepressants don’t take away the need to grocery shop. I still need to get food. But they make it more manageable.

Once the antidepressants took care of the underlying depressive episode, I could approach the process more effectively.

Now I get them done more quickly and efficiently. The whole thing is significantly less overwhelming.

It works the same way with more complex and challenging things in a person’s life.

Casting antidepressants in the right role

Antidepressants don’t take away the issues people need to deal with. They bring people to a place where they can manage them better.

I suspect anyone who is reading this knows that maintaining mental health, and overcoming mental illness, requires a whole set of tools.

But when you are in the middle of a depressive episode, those things aren’t accessible. Someone is being stubborn by not doing those things. We try. I promise. Depression often makes those things virtually impossible.

Plus, depending on how intense the depressive episode is, it may not matter. There are depressive episodes you cannot pull out of without medication. It doesn’t matter how much self-care you manage to do.

Sometimes all the self-care in the world isn’t enough

Healthy eating, exercise, meditation, journaling, regular psychotherapy, CBT, etc. can absolutely shift your brain chemistry, but only to a point. Sometimes, even if someone somehow manages to do all that in the middle of a depressive episode, they will continue to be depressed. Some situations need more significant intervention.

Antidepressants get people to a point where they can access those other tools.

So, where’s the magic?

A pill that makes things that makes the previously virtually impossible now accessible? Well, that sounds kinda magic to me.

Antidepressants aren’t gonna fix someone’s life. They aren’t a magic solution. But I think it’s important we give those suckers credit where credit is due.

Standard PostScript for my posts on depression

Mental health resources vary depending on community and country. If you landed here hoping to learn how to get a diagnosis, or to access antidepressants, I’m sorry I wasn’t able to help.

Your best bet is to head to a medical professional. Nothing I suggest should ever take the place of medical advice.

In North America, the two major diagnostic tools for depression are ‘inventories’. Folks self-report what is happening with them on these questionnaires and being honest is vital. These days you can find these online if you want a headstart before talking to a doctor.

They are the Beck Depression Inventory-II (BDI-II) (you need to score by hand), and the PHQ9 (self-scoring). Self-scoring versions of the BDI-II are few and far between. But I found this self-scoring one based on the Beck Inventory if scoring separately feels too overwhelming.