"Will Antidepressants Change Who I Am?" Understanding What Antidepressants Actually Do

One of the most common concerns people raise when we discuss antidepressant medication is surprisingly simple.

"Will it change who I am?"

Some people worry that medication will alter their personality. Others are concerned that they will become emotionally numb or somehow less themselves. I also meet people who are uncomfortable with the idea of needing a tablet to feel happy, particularly if they have always thought of themselves as someone who should be able to manage difficulties without medication.

These are reasonable questions.

Starting psychiatric medication can feel very different from taking an antibiotic or a tablet for high blood pressure. Our thoughts and emotions feel closely connected to our sense of who we are, so it is understandable that people are cautious about taking something designed to influence them.

In practice, the aim of antidepressant treatment is not to create a different personality.

It is to help someone feel more like themselves again.

Antidepressants Don't Make You Artificially Happy

The name "antidepressant" can be slightly misleading.

People sometimes imagine that these medications work by creating happiness, almost as though taking a tablet should make someone cheerful regardless of what is happening in their life.

That isn't how they work.

Antidepressants influence neurotransmitter systems involved in mood, anxiety and emotional processing. Different types of antidepressants do this in somewhat different ways.

The aim is not to produce an artificial high.

If somebody is grieving, an antidepressant will not make the loss disappear. If they are unhappy in their job, it will not suddenly make them love going to work.

What treatment may do is reduce the symptoms of a depressive or anxiety disorder sufficiently for the person to begin functioning more normally again.

What Does Improvement Actually Feel Like?

One of the interesting things about antidepressant treatment is that improvement is often less dramatic than people expect.

People rarely wake up one morning and suddenly feel completely different.

Instead, the first changes can be quite subtle.

Perhaps getting out of bed feels slightly easier.

They start replying to messages again.

Concentration begins to improve.

They notice themselves laughing at something they would previously have ignored.

Tasks that had felt enormous begin to feel manageable.

Sometimes other people notice the change first.

A partner might say, "You seem more like yourself."

For me, that is often a much better description of successful treatment than simply saying somebody is "happier".

They Take Time to Work

Antidepressants are not immediate treatments.

Although side effects can sometimes appear relatively quickly, the therapeutic benefits usually develop more gradually over several weeks.

This can understandably be frustrating.

Someone may have finally made the difficult decision to start medication and naturally wants to know whether it is going to help.

It is important not to judge an antidepressant too quickly, while also reviewing treatment appropriately to make sure that the dose, medication and diagnosis remain suitable.

Sometimes a medication works well at the first attempt.

Sometimes the dose needs adjusting.

Sometimes a different antidepressant is needed.

Psychiatric prescribing often involves finding the treatment that works best for the individual rather than assuming that one medication will suit everyone.

Are Antidepressants Addictive?

This is another question I am asked frequently.

Antidepressants are not considered addictive in the same way as substances that produce craving, intoxication or compulsive drug-seeking behaviour.

However, the body can adapt to taking them.

If certain antidepressants are stopped suddenly, particularly after being taken regularly for some time, people can experience discontinuation symptoms. These might include dizziness, nausea, sleep disturbance, unusual sensory experiences, anxiety or flu-like symptoms.

This is one reason why antidepressants are usually reduced gradually rather than simply stopped overnight.

Experiencing discontinuation symptoms does not mean somebody is addicted.

It means their body has adapted to the medication and needs time to adjust as it is withdrawn.

What About Emotional Blunting?

Some people taking antidepressants describe feeling emotionally "flat" or less able to experience strong emotions.

This can happen.

The difficulty is that depression itself can also cause emotional numbness, so it is sometimes necessary to work out whether this is part of the illness or an effect of the medication.

If emotional blunting appears after starting treatment or increasing the dose, it is worth discussing with the prescriber.

Depending on the circumstances, adjusting the dose or considering an alternative medication may help.

The goal should not be to remove normal emotions.

Feeling sadness, excitement, disappointment and joy is part of being human.

Successful treatment should ideally allow someone to experience a healthy emotional range rather than eliminating it.

Side Effects Matter

Like all medications, antidepressants can cause side effects.

The exact effects depend on the particular medication, but they may include gastrointestinal symptoms, headaches, sleep changes, sweating, sexual side effects or changes in appetite.

Many early side effects improve as the body adjusts, although some can persist.

This is why prescribing should be a conversation rather than simply handing someone a prescription.

If a particular side effect would be especially problematic for someone, that can influence which medication we choose.

And if a medication is causing significant difficulties, people should discuss this with their prescriber rather than simply assuming they have to tolerate it.

How Long Will I Need to Take Them?

There isn't one answer that applies to everybody.

Treatment usually continues for a period after someone has recovered because stopping medication immediately after feeling better can increase the risk of relapse.

For somebody who has experienced a single episode of depression, medication may eventually be gradually withdrawn after an appropriate period of stability.

For someone who has experienced repeated or particularly severe episodes, longer-term treatment may sometimes be recommended.

The decision should take into account the person's history, preferences, response to treatment and risk of becoming unwell again.

Taking medication for longer does not mean somebody has failed.

Equally, starting an antidepressant does not automatically mean taking it forever.

Medication Is Only One Part of Treatment

I think it is important not to present antidepressants as either miraculous solutions or something people should avoid unless absolutely necessary.

They are a treatment.

For some people, they make an enormous difference. For others, psychological therapy may be particularly important. Many people benefit from a combination of approaches.

Sleep, relationships, physical health, work, stress and the circumstances that contributed to someone becoming unwell still matter.

Medication does not remove the need to understand those things.

Sometimes it simply gives someone enough improvement to begin addressing them.

A Final Thought

When people worry that antidepressants will change their personality, I often think the more useful question is what their mental health condition has already changed.

Has depression taken away their motivation?

Has anxiety stopped them doing things they previously enjoyed?

Have they become withdrawn from friends or family?

Do they no longer recognise the person they have become?

The aim of treatment is not to replace your personality with a medicated version of it.

It is to reduce symptoms that may have gradually obscured parts of who you already are.

Antidepressants are not right for everyone, and decisions about medication should always be individualised and discussed with an appropriate healthcare professional.

But when they are helpful, the change people describe is rarely, "I became someone different."

Much more often, it is something simpler.

"I started feeling like myself again."

Dr James Glass
MBChB MRCPsych
Medical Director, WMI Psychiatry