Prescribed and forgotten: The story of antidepressants
- Mar 19
- 7 min read
Updated: May 11
How antidepressants reshaped everyday life—revealing changing ideas about distress, treatment, and what it means to cope today.
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Before the pills: A history of melancholia
Long before depression became a medical diagnosis, it was known as melancholia. It was not treated as illness so much as judgement. Sadness was often seen as weakness, poor character, or spiritual failure. People were expected to endure it, pray it away, or simply push through.
The mind was a moral battlefield, not something a doctor could treat.
During the nineteenth century, this began to change. As science started to challenge religion’s hold on suffering, melancholia was reimagined as something that could be observed and studied. Asylums were built with the promise of refuge and rest, yet many became overcrowded institutions where people were managed rather than understood.
Treatment was often harsh. Cold baths, restraints, enforced bed rest, and electric shocks were used in the belief that the mind could be reset through discipline or force. The results were unpredictable.
Alongside this, a quieter understanding began to emerge. Some doctors noticed that kindness made a difference. Fresh air, routine, conversation, and purposeful activity often helped where punishment had failed. It was not yet science, but it was the beginning of care.
The early twentieth century brought confidence and ambition. Mental distress moved fully into hospitals and laboratories. New interventions followed, including induced seizures, comas, and eventually brain surgery. Lobotomies were once seen as breakthroughs, but often left people altered in ways that could not be reversed.
Looking back, many of these treatments appear brutal. They reflect a simple reality. People were trying to ease suffering without understanding its cause. The tools were limited. The intent, in many cases, was to offer relief, even when the methods were misguided.
The chemical revolution: from serendipity to standard practice
By the middle of the twentieth century, approaches to mental distress had begun to shift, but they were still largely external. Treatment involved containment, physical intervention, or, in some cases, surgery applied to the brain. Relief, when it came, was often imposed rather than experienced.
The change that followed was not planned.
In the 1950s, doctors trialling a tuberculosis drug noticed something unexpected. Patients who had been withdrawn and despondent became more engaged. They talked, they smiled, and they appeared lighter in spirit. The drug had been designed to treat infection, not mood, yet it seemed to affect both.
Around the same time, another compound failed in its original purpose but appeared to stabilise mood in people described as melancholic. For the first time, there was a suggestion that distress could be influenced from within rather than managed from the outside.
These early discoveries began to reshape thinking. Depression was no longer seen only as a matter of circumstance or character, but as something that might be linked to the brain’s chemistry. The idea that mood could be altered through chemical processes introduced a different kind of intervention, one that felt less forceful than what had come before.
The timing mattered. Post-war society was marked by confidence in science and medicine. New drugs were transforming physical health, and it seemed plausible that emotional distress might respond in a similar way.
By the late 1950s, new medications began to appear, offering calm, stability, and relief. They would soon shape how both medicine and society approached mental health.
Valium and the age of tranquillisers
By the end of the 1950s, the optimism of modern medicine had found a new outlet, tranquillity in a tablet. Chemist Leo Sternbach, working for Hoffmann La Roche, developed a compound that would change psychiatry once again. The first of these drugs, Librium, arrived in 1960, followed by Valium three years later. They belonged to a new class called benzodiazepines, and they promised something the public desperately wanted, relief without risk.
Valium was marketed as calm in chemical form. Advertisements showed smiling housewives and composed businessmen, all apparently restored to balance by a small yellow pill. Doctors were told it was safe, non addictive, and suitable for almost anyone feeling nerves, tension, or domestic strain. The message was simple. Whatever life throws at you, modern medicine can help you cope.
The uptake was rapid. By the mid 1970s, Valium had become one of the most prescribed drugs in the world. In the UK, prescriptions were handed out widely, and the phrase Mother’s Little Helper, borrowed from the Rolling Stones’ 1966 hit, came to symbolise both its popularity and its quieter consequences.
What few realised at first was that Valium came with a cost. Dependence often developed gradually. A tablet to sleep, another to steady the nerves, and over time, some people found they could no longer function without them. Many long term users, particularly women, experienced both physical and psychological addiction. Withdrawal brought tremors, insomnia, and rebound anxiety.
By the 1980s, concern was growing. Lawsuits were filed, support groups formed, and addiction clinics began to see increasing numbers of people who had followed medical advice. The medical establishment, once eager to promote tranquillity, began to look for alternatives.
The prescribing paradox
When the tranquilliser era began to falter, medicine looked for something cleaner, a pill that promised stability without sedation. By the late 1980s, that promise arrived in the form of selective serotonin reuptake inhibitors, or SSRIs. Drugs such as fluoxetine, sertraline, and citalopram were promoted as the new frontier in treating depression. They were said to correct chemical imbalance rather than simply take the edge off, and they carried less stigma than the tranquillisers they replaced. Prozac became a household name, the symbol of a culture learning to medicate its emotions with clinical precision.
Four decades on, the numbers reflect a different pattern. Prescriptions have nearly doubled since 2011, yet national mental health outcomes have barely shifted. The promise of modern pharmacology has turned into a reliance that has become increasingly common.
The reasons are complex but recognisable. Therapy waiting lists are long, appointments brief, and social distress is too often reframed as a medical problem. It is easier to prescribe relief than to address cause. Pills do not challenge loneliness, inequality, or exhaustion. They simply make them more tolerable.
We no longer send people to asylums. We send them home with repeat prescriptions, a quieter kind of containment, but one that still limits how people move forward.
The gap between information and understanding
At times, events prompt renewed attention to how patient safety is communicated. Warnings about suicide risk, for example, are included in patient information leaflets for antidepressants. These statements are important, but they rely on something that cannot be assumed, that information is the same as understanding.
For many people, the process of being prescribed medication is brief. A short consultation, a prescription, and a suggestion to return if things do not improve. It is efficient, and often necessary within the limits of the system, but it leaves little room to explore how someone is feeling, what they understand, or what support they may need beyond the prescription itself.
Understanding is not guaranteed by written information. It develops through conversation, context, and the opportunity to ask questions. Without that, important details about side effects, expectations, and how to stop medication safely may not be fully absorbed, particularly at times when someone is already overwhelmed.
In 2024, NICE introduced a patient decision aid for NHS England, Making Decisions About Managing Depression. It is designed to help people weigh different approaches, including medication, therapy, and guided self-help. The guidance itself is clear and balanced, but its impact depends on visibility and use. When tools like this are not widely known or routinely used, their ability to support informed choice is limited.
When life itself becomes the pressure
Depression does not sit apart from everyday life. It often reflects it.
Over time, the pace and structure of life have changed. Work can be less secure, expectations less clear, and the pressure to keep going more constant. Technology has made many things easier, but it has also made comparison unavoidable and rest harder to find.
At the same time, some of the structures that once offered stability have shifted. Communities are less fixed, work is more fluid, and people are often expected to manage more on their own. Loneliness, uncertainty, and ongoing stress can become part of the background rather than something temporary.
In that context, it is not always clear where distress ends and illness begins. Feelings such as exhaustion, grief, or disconnection can become harder to carry when they persist without relief or support.
Medication has become one of the ways this is managed. It can provide important relief, but it cannot change the conditions that contribute to how people feel day to day.
The rise in antidepressant use sits alongside these wider changes. It reflects not only individual experience, but the environments people are living in.
Finding balance over time
For many people, medication becomes part of how they manage difficult periods in their lives. It can provide stability when things feel uncertain, and for some, it plays an important role in helping them move forward.
What is less straightforward is what happens next.
Coming off antidepressants is not always a simple or predictable process. Some people turn to their own research or online communities to guide them, especially when clear follow-up or structured support is not in place. Experiences shared by others can be helpful, but they are not always a substitute for understanding how medication affects an individual over time.
Balance is not fixed. It changes as circumstances change, and what works at one point may need adjusting later. That process is often best supported through ongoing conversation, where medication, wellbeing, and wider factors can be considered together.
Antidepressants can be an important part of care. They are not the whole picture.