Psychiatric medications are not magic bullets - and that’s okay

When most people think about psychiatric medications, they imagine a simple fix: “I’m anxious, so I need an anti-anxiety medication,” or “I’m depressed, so I need an antidepressant.” It’s an easy story to believe—because that’s exactly how these medications are marketed. But the truth is more complicated. And honestly, more interesting.

Let’s start with a reality check: psychiatric medications are not precision-guided missiles. They don’t target just one symptom, like sadness or anxiety. They’re more like cluster bombs—affecting multiple systems in the brain, some of which help, some of which don’t, and some of which cause side effects we’d rather avoid.

Why the Labels Mislead

The word “antidepressant” sounds like a medication that treats depression directly. But most so-called “antidepressants”—like SSRIs—don’t just affect mood. They influence appetite, energy, libido, sleep, even how reactive we are to emotional stress. Sometimes those changes help with depression. Other times, they don’t—or they even make things worse.

This isn’t just my opinion. Leading psychiatric researchers, including those behind The Psychiatry Letter, have pointed out that terms like “antidepressant” or “antipsychotic” are more about marketing than science. These drugs do many things, and their actual effects vary depending on the person, their brain chemistry, and the type of mood state they’re in.

When “Antidepressants” Don’t Help—or Make Things Worse

Here’s something I see all the time in my practice: someone with depression that doesn’t feel “typical.” They’re agitated, anxious, irritable, unable to sleep, and feel like their mind is racing—yet they’re still depressed. This kind of depression, sometimes called a “mixed state,” often doesn’t respond to antidepressants. In fact, it may get worse.

Multiple studies confirm this. Antidepressants in mixed depression have been associated with worsened agitation, emotional lability, and higher suicide risk. That’s because these medications weren’t designed to address the instability and overactivation that often lie at the heart of mixed mood states.

What’s the Alternative?

It depends on the specific pattern of symptoms. But in many cases, medications traditionally labeled as “antipsychotics” or “mood stabilizers”—like aripiprazole, lurasidone, lithium, or lamotrigine—are more effective. They may calm the nervous system, stabilize energy, or reduce the kind of inner tension that fuels both anxiety and depression.

This is especially true for conditions on the bipolar spectrum, even if someone has never had a full manic episode. A diagnosis of “bipolar II” or “bipolar spectrum disorder” isn’t always necessary to justify using these treatments—what matters most is the actual symptom pattern.

Why It Matters

If you’ve been prescribed one antidepressant after another and still feel anxious, wired, or stuck, it’s not because you’re treatment-resistant. It may be because the underlying mood state wasn’t identified properly. Your brain may not need “more serotonin”—it may need something that addresses the push-pull of mixed energy states.

And that’s where thoughtful psychiatric care comes in: not chasing symptoms with simple labels, but stepping back to understand the full picture—your energy patterns, emotional rhythms, sleep-wake cycles, and how you respond to different medications over time.

Final Thoughts

Psychiatric medications are powerful tools—but they’re not magic bullets. They influence complex brain systems, and their effects often depend on the unique shape of your mood. Understanding this can help you make better choices, avoid unnecessary side effects, and feel more empowered in your care.

If your depression doesn’t feel “typical,” or your anxiety feels more like restlessness than fear, it may be time for a deeper look. That’s the kind of care we offer at Colorado Mood Center.