“He seems drugged.” On the fear that treatment will erase the person, and what distinguishes sedation from well-conducted treatment.
Sunday lunch is when the whole family sees. During the week everyone is off in their own corner, but on Sunday everyone is in the same room, and everyone is looking.
He arrives and sits in the corner of the sofa. He answers what he is asked, but in one word. He sits in front of the television without following what is on. Someone makes a joke and he smiles half a second after everyone else, as though the sound had arrived late. Mid-afternoon he dozes off sitting up. Lifts his head, looks around, dozes off again.
In the kitchen, an aunt says quietly to her sister: “he’s drugged.” His mother hears and says nothing. That night, on her own, she puts the sentence a different way, one that hurts more: have we traded his sadness for this?
That doubt reaches the consulting room very often, and almost never as a straight question. It comes in sideways, testing the ground. Someone says “I’m not against medication, but…”. Someone asks whether there is another way. Someone, more direct, asks whether the doctor is simply going to prescribe more chemistry on top of the chemistry that is already there.
I think that is one of the most legitimate questions a family can ask. It deserves an answer, not embarrassment.
Perhaps you recognized the scene because it looks like someone in your house. Or perhaps you are the one who has been like that, with that sense of being slightly at a distance from everything, and you never knew whether it was the illness or the treatment. Either way, it is worth saying: that doubt is not unfair suspicion and it is not a lack of faith in anyone. It is a first-order clinical question, and it is meant to be asked out loud.
Sedating and treating are not the same thing
Let us start with the essential point, because the confusion between the two explains a good deal of the fear.
To sedate is to lower the level of alertness. It is the effect that leaves someone slower, sleepier, with slurred speech and slowed thinking. In certain specific medical situations that is the intended aim, for a defined period, with a clear purpose.
Treating a severe depression is something else: it is aiming at remission. What is hoped for is that the person sleeps and wakes at recognizable hours again, gets her appetite back, becomes interested in something again, is able to hold a conversation and a task through to the end. In other words: the target is functioning, not quiet.
Someone who spends the whole day switched off on the sofa is not someone who has been treated. She may be someone who is still ill, she may be someone with an unwanted effect that needs reviewing, she may be both at once. But that is nobody’s aim, and it should not be accepted as though it were the natural price of care.
This needs saying in plain words: blotting the person out was never the aim. When the result looks like that, there is something to be looked at again.
Why it is so hard to tell from the outside
Here is the part that is almost never explained to families, and that changes the way you look.
Severe depression, all by itself, produces slowness. It produces an impoverished facial expression, short answers, slower movements, difficulty following a conversation in a group, sleepiness during the day. It produces what gets described as blunting — the impression that the person is behind glass.
So: the picture that alarms the family at Sunday lunch may be exactly the illness that has not yet lifted. The family looks and sees the medication; what may be in front of them is the depression still in place.
And the reverse happens too: sometimes there really is an unwanted effect present, and it is being put down to the illness.
Telling those two possibilities apart is not done by observation from the outside, and it is not done by reading something on the internet. It is done through an evaluation that rebuilds the timeline: what came before, what changed and when, what the person describes from the inside, what the people who live with her describe. It is clinical work, and it is exactly the kind of work a rushed appointment does not allow.
An unwanted effect is information, not failure
There is a quiet idea that gets in the way a great deal: that reporting something uncomfortable is complaining, being ungrateful, or putting the doctor on the spot.
It is not. Every treatment produces effects that were not the intended ones, and the only way to deal with them is by knowing they are there. What is not reported cannot be taken into account. And what I tend to see is that a lot of people keep quiet about precisely the most important complaints — because they think they are minor details, or because they do not want to seem difficult.
Sleepiness that gets in the way all day, a sense of being anesthetised, slowness that makes it impossible to work, anything the person describes as “I’m not myself any more”: all of that is meant to be said. It is not noise. It is data.
What is done with that data is a clinical decision, taken case by case, by whoever is following the person and knows the whole history. There is no adjustment that can be suggested in general terms, and be wary of anyone who suggests one. What does exist is the obligation that the information reaches the person who can assess it.
And the opposite is worth saying too, because it is also common: stopping a treatment on your own account, because of something uncomfortable, tends to create a new problem on top of the old one. The conversation to be had is with the doctor, not with the box.
What can reasonably be expected
I am not going to promise that every well-run treatment gives you back the person who existed before. That would be dishonest, and you have probably heard more than enough promises.
What is reasonable to expect is something else: that there is a stated target, that the target is functioning and not docility, that there is reassessment at defined intervals, and that when something is not going well it is acknowledged rather than managed with indefinite patience.
Treatment that drags on for years without anyone stopping to ask whether the path still makes sense is not conservative treatment. It is inertia. And there is a point at which the right question stops being “what do we try now” and becomes “are we treating the right thing” — which sometimes means redoing the evaluation from the beginning, diagnosis included.
If you are the one on the outside
You observe for more hours than any doctor ever will. That has real value, and it is worth taking to the appointment in a usable form.
Describing tends to help more than interpreting. What times of day he is worse. How long he sleeps and how he wakes. Whether he eats. Whether he goes out. What he could do three months ago and cannot do now, or the other way round. A concrete description lets the doctor see what the word “drugged” is hiding — and “drugged”, on its own, can mean five different things.
And if, after everything has been described, the impression that something is not right still stands, a second opinion is not a betrayal of anyone. It is common practice in medicine, and where a condition is not responding as expected it is particularly appropriate.
You do not have to conclude anything today. You do not have to decide whether the treatment is wrong, or challenge whoever is running it, or take any action on the strength of reading this. It is only worth holding on to one distinction: someone who is switched off is not, by definition, someone who has been treated — and that alone is reason enough for the question to be taken seriously by a professional.
Related reading
- Depression is not sadness: when the body stops first
- Psychiatrist or general practitioner: who should prescribe an antidepressant — and why it matters
- Psychiatric second opinion: when to ask, how to ask, and why it is not a betrayal of your current doctor
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Dr. Leonardo Sodré is a psychiatrist and psychotherapist in Brasília, Brazil (CRM-DF 14.206 · RQE 14.761). He holds a PhD in Psychiatry from UFRGS and teaches at the University of Brasília School of Medicine. This content is informative and educational and does not replace individual assessment, diagnosis or treatment.