This post was originally published on April 26th, 2016.
A friend recently told me that they weren’t comfortable with the idea of going on SSRIs to deal with their depression because they didn’t want to have to constantly worry about whether the happiness they were feeling was ‘authentic’. They (and a lot of people) might not get much happiness naturally, but they’d rather that than have to concern themselves with whether their feelings are truly theirs.
This seems a pretty common concern for people considering medicating depression. I have a few thoughts on it. Fundamentally, I’m uncertain that ‘authenticity’ is a productive or positive way of framing our discussion about antidepressants, but saying that straight off the bat isn’t super helpful, so let’s reach that conclusion organically.
A lot of what antidepressants make you feel is a complex product of expectations and chemicals. We’re really not sure exactly how they work, and for people with mild or moderate depression the evidence for their efficacy is pretty mixed. For a lot of people taking SSRIs can mean they’re effectively taking a placebo, so what they think we’re going to feel is a crucial factor in what they actually feel.
As such, the authenticity question is a much greater problem for people who are concerned about it. If you’re scared to go on antidepressants because you think that the happiness they’ll make you feel isn’t real (whatever we mean by real), then, in the immortal words of South Park, you’re gonna have a bad time. This is particularly bad for the kinds of people who tend to be candidates for antidepressants (i.e. depressed people), because we have a tendency to overthink things in creatively shitty ways. This includes emotions: happiness is rarely the child of introspection, and if it is introspection’s offspring then it’s the kind that’s kept in a cupboard under the stairs and is only let out for family gatherings and birthday parties. Whilst depression obviously isn’t something which can be cured just through the power of positive thinking (thanks, mainstream media!), it’s also not totally impermeable to changes in our thought processes. If you’re not constantly worrying about the authenticity of your feelings, then those feelings are considerably less likely to be the kind that perpetuates the cycle of bullshit that characterises depression. People who come on to antidepressants not caring about the aetiology of their emotions – people who just want portable dark cloud of acid rain and existentialist angst perpetually hanging over their head to fuck off – are less likely to have these issues. That means they’re much more likely to draw greater benefit from the drugs.
But the problem with this whole line of reasoning is that it presumes that antidepressants make you happy. That’s not my experience, and from talking to various other members of the Depression Mafia (or Melancholiati, if you prefer) I know it’s not their experience either. SSRIs, rather than making me happy, usually help to blunt the worst of the lows that I would normally feel. If my thoughts are a train, and they normally speed down the tracks towards the broken bridge over Nihilism Valley, antidepressants can act to conveniently shove the train of thought into a disaster-averting siding (though the siding may well lead straight over a cliff into the Sea of Shit and Sorrow and Staying In Bed Until 1).
That is to say, quite a lot of the work done by SSRIs is in maintaining neutrality, rather than promoting happiness. That isn’t necessarily a bad thing: neutrality makes it a lot easier to take advantage of opportunities to feel happiness in a way that you wouldn’t be able to normally, because you’re stuck in bed staring at the space on the wall the entire morning because you can’t bring yourself to muster even enough energy to flop onto the floor like a fish with a deathwish.
Framing SSRIs as ‘happy pills’ is counterproductive: if people with depression go on them hoping to feel happy, then not only are they going to be let down when they learn that the pills don’t work that way (which in itself can make depression worse, as you begin to feel like nothing can make you better), but they’re also susceptible to all the concomitant concerns about the authenticity of their happiness. Because so much of the effect of antidepressants is contingent on expectations, it might help quite a lot of depressed people (and those who love them) to change the way we talk about SSRIs and similar drugs. They’re not happy pills. They’re normal functioning human being pills.