A shift has been happening in how many thoughtful psychiatrists, family doctors, therapists, researchers, and ordinary people talk about these medications. The shift is from a “disease-centered” model to a “drug-centered” model. This shift is not ideological. It is about clarity, compassion, and informed consent.
A few things stand out:
- The documentary Medicating Normal came out in 2020 and shows how careless and excessive prescribing can lead to long term problems that clients were never warned about and never expected.
• In 2024 the first psychiatry textbook on deprescribing was published. It is called Deprescribing in Psychiatry by Dr. Swanil Gupta. (And an increasing number of psychiatrists now offer deprescribing as a formal service).
• In the past five years, many people have begun speaking up about feeling harmed or misled by the explanations they were given about these drugs.
The core concern is the same across stories: people were not given full informed consent about how these drugs work, what they do and do not do to the brain, what the risks are, and how withdrawal can unfold.
Do Your Own Research
Your voice matters. Your psychiatrist’s voice matters. Your family doctor’s voice matters. There are also others worth hearing.
- Joanna Moncrieff, psychiatrist in England, is leading the shift from a “disease-centered” to “drug-centered” model. She argues that psychiatric drugs do not correct chemical imbalances but instead create altered mental and emotional states that may or may not help.
• Allen Frances, once described as the most powerful psychiatrist in the country, warns that many people with mild or moderate symptoms stay on antidepressants for years even though their symptoms often would have resolved on their own. He points to two forces. First, misattribution, where people credit the drug for improvements that might have occurred naturally. Second, withdrawal symptoms, which can mimic relapse and make it frightening to stop.
• David Healy, psychiatrist in Canada and the UK, notes that there is little evidence of a biological abnormality being corrected. He suggests these drugs produce psychoactive effects rather than repairing dysfunction.
• Irving Kirsch, psychologist at Harvard, has shown that much of the benefit people report may be due to expectancy and placebo effects.
These perspectives do not close the debate. They open it.
What Is the Real Story about How Psychiatric Medications Work?
The Antibiotic Image
Imagine you get strep throat. You take an antibiotic. A few days later, the infection is gone. A biological invader was neutralized. The underlying physical problem was repaired.
The Insulin Image
A person with Type 1 diabetes injects insulin. They are replacing something the body cannot produce. You can measure the deficiency and the correction. I take Levothyroxine for an underactive thyroid. Same idea. A clear hardware problem with a clear hardware solution.
The Chemotherapy Image
Chemotherapy targets rapidly dividing cancer cells. The mechanism is known. The goal is measurable. The repair is grounded in objective physiology and identifiable pathology.
The Vaccine Image
A vaccine introduces a controlled signal to the immune system so the body can recognize and neutralize a future threat. You can measure the immune response. You can measure the protection gained. The underlying purpose is clear. Prevent a specific biological harm from occurring.
Do antidepressants and anti-anxiety medications work like antibiotics, insulin, chemotherapy, or vaccines?
For about thirty years, the chemical imbalance story was repeated in clinics and exam rooms across the country, as well as throughout media, living rooms and the internet. Many millions of times. Yet there is not now, nor was there ever any evidence of a measurable chemical imbalance that these medications correct.
So the honest question becomes unavoidable: if these drugs do not repair a known physical malfunction, then what do they actually do?
Do anti-depressant and anti-anxiety medications function more like alcohol and marijuana?
It could be the case that anti-depressant and anti-anxiety pills function more like alcohol and marijuana (psychoactive drugs) and less like medications designed to fix biological defects. Not because they intoxicate, but because they blunt emotional intensity. They “take the edge off”, which can be extremely helpful. But it is very different from how we normally understand “medications” that cure illness.
But perhaps the comparison to alcohol and marijuana is an incorrect characterization. If so, it is up to prescribers to explain (in understandable, ordinary language) what the physiological processes involved are, and what the impact on human experience is likely to be, in the short and long term.
Millions of people prefer to use drugs
It can be very useful to blunt emotional intensity in some situations, when used in short-term, targeted ways. The concern is long-term use. Blunting emotional intensity for months or years often becomes less effective over time. And it can create a barrier to the emotional relational work that depression and anxiety require for genuine healing.
None of this means these anti-depressant and anti-anxiety medications should not be used. It serves no one to demonize them – just as it serves no one to demonize alcohol or marijuana. The public simply deserves clarity about how they work and how they impact human experience over time.
Once the public is properly and ethically educated about the real deal, then yes it is up to each person to use drugs/medications wisely.
But to do that the mental health industry needs to get much better at informed consent.
Informed Consent Is Key
Informed consent matters, because the stakes are real human lives in real human families. And genuine informed consent is not a signature on a form. It is an ongoing, honest conversation. It is maximum transparency and acknowledging our ignorance when it exits. Only then can each of us truly make educated choices.
Pros and Cons in Modern Healthcare
Modern healthcare is full of remarkable advances and serious systemic problems. Both are true. The best thing any of us can do is become educated consumers. Listen widely. Ask questions regularly. Decide what aligns with your values. Get second and third opinions. Find the voices of real people who’ve been through whatever you’re facing and listen to what helped and what didn’t. And then you get to decide what is right for you and the people you love.
