Purely just my opinion on antidepressants:
It's not meant to make you happy but keep you from being non-functional with your daily routine. There are many reasons why these don't work and from my own experience at the clinics, most patients fall under these common conditions:
They expect results too soon
The meds are expected to work for like 4-6 weeks on average. It's not like paracetamol that reduces fever when taken after a few hours. This stuff takes commitment to follow through and when you're not in your best state of mind and no reliable support system, trying to get a quick fix on your mental state is an unreasonable expectation.
They lie about taking it
Some of the patients come in with the intention to fake their symptoms and get some medical certificate to rest from work. It happens far more common than you think and it they come in with a sad sob story just to move you. The dead giveaway is claiming they're perfectly fine just after 2 weeks on the meds (remember the therapeutic effects are appreciated around 4-6 weeks on average) during follow up. I'm not saying every patient that comes in fitting the profile is faking it but I've seen more of my fair share to be skeptical about every time someone claims they're suicidal.
These types just undermine the people that actually do suffer from major depression and that's just sad. Some would intentionally or unintentionally blow off their symptoms out of proportion just to get some prescription (adds proof to their employer they need the break). Note I said unintentionally as I do think some people really do want some attention and use the depression card to be manipulative to their significant other, see Borderline Personality.
Having fed the wrong advice
It ties up well with the first condition of having false expectations on the meds. Patient comes in with a preconceived notion after a friend or family's experience about the meds. Psychiatric disorders can have a strong familial factor that's why it's not new to hear an entire family does come in for consult. Some people just come in thinking that this X antidepressant worked on their kin so it might work on them.
I wish it was that simple but I have to weigh in whether the person that's going to take them has other medications that might interfere with the meds given, hepatic/renal impairments, comorbids like diabetes and etc.,
ChatGPT MDs and Google MDs
I'm not surprised that people can get information easily online. If they acquire the wisdom to use that information quicker, then that's more amazing. The fact that looking up your own symptoms and getting a bucket list of possible disorders on you is just fueling your anxiety, you may be a hypochondriac or delusional without the insight to know you have a problem. We acquire knowledge faster than the wisdom to actually use that knowledge. Let this sink in whenever you learn something as from my experience at the wards:
Patients don't usually present like textbook case examples, some would have their own unique ways to manifest the same problems and it can be quite tricky to tell until you get more experience facing several cases overtime. For a person that only focuses about "knowing themselves", I don't think people are wrong about assuming stuff about how they really know themselves but by Johari's Window, there are parts of the person that even they don't know about themselves but others do and these are the blind spots. I made a post about insight into one's own condition.
They're stuck with the trigger
Quite common with rape victims who developed PTSD. They still live in the same neighborhood or compound which forces the victims to relive the memory or trigger anxiety. This is why a change of environment isn't just a simple mental health support but a necessity. The meds are there to help people control the symptoms but if they continuously expose themselves to the triggers, that ruins the point. Unfortunately, not many can have the option to be move from their stressful environments. This also goes for work environments where BPO agents develop anxieties but are functional from a WFH setup.
Antidepressants aren't magic that makes the anxiety and depression go away. They do help you regulate your emotions making you capable of being functional. I ask patients about their feelings of like their minds just "floating", not in pain nor in happiness.
Which one mental state do they prefer? in a turbulent state that makes them want to commit suicide or just have this neutral state where they feel like a robot. Guess the answer.
I think it has partly to do with inner strength where patients can make the most about their condition while on meds and in turn sets them up to be happy. Meds are just tools and the healthy attitude towards their own condition influences their outcome more.
Thanks for your time.
This reminds me of the show House MD where Dr. House would say that patients lie all the time... and apparently true. Thankfully clinicians are trained to see those lies lol.
I think that the pill's purpose is to make them happy is quite a common misconception and I've heard that a lot. They seem to think it didn't work or it's giving them "negative side effects" is because they didn't see life in colors like they expected. I've heard the "robot" and "kills creativity" effect a lot of times and honestly one of the reasons why I delayed going to a psychiatrist for help. It is indeed a lot better to feel neutral than being on the negative side.
Pills can't solve everything.
I used to be suspicious but when I got in the training, I became more trusting and it backfires a lot and it's charged to experience. For artists that make money out of their depressive state, the pills may actually affect their creativity because now they are stuck with feeling nothing and it reflects on their art and their art is noticed by their patrons that want to see those depressive themes. This is the part where people need to decide whether they actually enjoy being depressed or want that neutral state. I think being in a neutral state is zen mode and when people are so used to having turbulent lives and thoughts, it may be an unpleasant experience.
Ohhh
So antidepressants put you up in a neutral state.
I always thought that it makes you happy....
The scenarios you listed are quite easy to see...
Especially those who are craving attention and the depression leeway in work.
I've seen quote a few who use such in schools....
They help not put you on the edge of constant suicidal ideation. Feel nothing or feel dying, pick an outcome. And the results don't mean being on neutral all the time, some people can significantly improve that they end up being happier.
I’ve heard for years that the clinical benefit range of those things is so narrow that most people have little to no benefit from them but end up getting the placebo effect more than anything.
It’s certainly a complicated problem in a day where things are so fast paced. I think unfortunately these things are going to lead to more invasive treatments in the future like brain implants to attempt to address it, yet cause crazy side effects.
Even still - are the people getting any exercise and outdoor exposure? Very often their issues are because those 2 scenarios are minimized.
I think it's a difference in the perspective on the way lay people vs people in health care see it. I know some claims about these stuff don't work on them but those claims can further be investigated as having unique cases where the drugs specifically don't work cause of their genes, drugs made in poor quality, non compliance, or resistance. A lot of possible reasons can come up when we're talking about why they don't work but if I were to just get the number from my own experience, I'd say out of 100 patients, there's going to be one that needs a bit of adjusting to their meds to work, given with these hypothetically numbers, would you say the meds don't work if they can't cater to that 1%? and 1% can mean 10 out of 1000 patients. I don't know, it just depends on how one frames it I guess.
It's sad that ADULT people fake being sick because they are too lazy to do their jobs.
I get the appeal of lying to a doctor to make your life easier, but in reality it's just pathetic.
It happens quite often that it makes me a little more immune to sad stories. People google the signs of major depression before the interview but forget some parts to get their act together. They will look sad initially then be animated as the interview goes on forgetting their role, have inconsistent stories, and my favorite tell is how they "remarkably improved" while on 1 week use of the medication that is expected to work a few weeks later. Usually when they tell that their HR is following up on when they'll be coming back to work and threaten to let them go do they suddenly improve want to hurry you to clear them for work.
@adamada, I paid out 0.783 HIVE and 0.249 HBD to reward 4 comments in this discussion thread.