When my doctor suggested I try antidepressants, I was pretty skeptical. Sure, I understood that there was plenty of solid scientific evidence for their effectiveness, but it didn’t seem like something as simple as a pill taken nightly could solve something that felt so complicated, existential and close to the core of who I was. Living in a drawn-out stretch of depression had also started to constrict my hope, so it was hard to picture myself getting out from under my sadness. Still, I decided to give it a try.
For a while, nothing changed. Then, little by little, so gradually I hardly noticed it at first, normalcy crept back into my life. My head felt clearer and my heart felt lighter. I wasn’t sleeping quite as excessively. My mom noticed something had changed when I started singing to myself while I was cleaning the kitchen or washing my hair—for months, I had been so sick that I hadn’t even felt like humming. I was surprised and grateful, but also a bit bewildered by the whole experience. What had happened in my brain?
Turns out, even scientists aren’t entirely sure how antidepressants help with symptoms. Our minds are complicated, shaped not only by the signals shared internally among neurons but also by external life events and stressors. Even though a little over seventeen million adults in the U.S. have had an episode of depression according to the National Institute of Mental Health, and millions more deal with anxiety, bipolar disorder and other mental health issues, researchers still don’t know much about the underlying biology of these conditions. Part of that has to do with the technology: until recently, we haven’t had the tools to peer into the brain’s activity as it functions in real time. Now that we have forms of imaging like positron emission tomography (PET), single-photon emission computed tomography (SPECT) and functional magnetic resonance imaging (fMRI), new theories, debates and insights are emerging all the time.
We often talk about mental health medications correcting a “chemical imbalance,” but the reality might be a lot more complicated. Even though they increase levels of neurotransmitters— the brain’s chemical messengers—right away, they don’t usually start to ease symptoms for a few weeks. I experienced this interesting effect when I started taking the medication I was prescribed, a type of antidepressant called an SSRI that increases the amount of the neurotransmitter serotonin available to the brain. I could tell that something had changed chemically in my body because that extra serotonin was filtering out in part through my digestive system, making me queasy for a few days. The improvement in my mood, though, didn’t kick in until much later. Some researchers now think that antidepressants help with the process of neurogenesis, which means the production of new nerve cells. Generating new neurons allows better exchange of information through existing brain pathways and promotes the creation of new ones. In other words, it’s possible that my medication helped pull me out of my depression by changing the chemical conversation in my brain, helping me on a cellular level to get out of a cognitive and emotional rut.
Taking medication for my mental health has reshaped the way I view my own feelings and the feelings of others. Each of us is formed by an intricate combination of emotional, experiential, spiritual, and biochemical factors that interact and intertwine over the course of our lives. I know now that I am more than my thoughts and emotions when my neural networks get caught in bad patterns. If you’re dealing with mental illness right now, it might comfort you to know that there’s a real physiological basis for what you’re experiencing—and that you don’t have to be stuck there forever. In the next few weeks, I want to explore mental health medications through dialogue with the people who’ve tried them and the experts who study them. If you have a story to share about your experience with medication, please reach out. It can be so hard to open yourself up to that vulnerability, but your voice matters as we grow together as a community into wider knowledge and deeper empathy surrounding mental illness.