The depression treatment that made it worse

Conditions and Diagnoses

Years treated as depression when the condition was something else. Why agitation after the medication needs to be taken to a diagnostic reassessment.

September 21, 20268 min read

Illustration for the article: The treatment for depression that made everything worse

In the third week, she started emptying the kitchen cupboards at two in the morning.

She was not distressed. Quite the opposite: she was delighted. She explained the next day that she had slept badly but woken up feeling wonderful, that she finally had the energy to deal with everything that had been piling up for months. She talked fast. One subject ran into the next. She had three new projects and wanted to start all of them that week.

At home, the first reading was relief. It was working. She had spent almost a year not getting out of bed before eleven, not answering the phone, not wanting to see anyone — and now here she was, like this. Someone even said it was good to have her back.

The relief lasted about ten days.

Then came the purchases. Then the row with her sister over something tiny, with an aggression that was not hers. Then the money that vanished from somewhere nobody had been given permission to touch. Then four weeks in which the whole house stopped working, and several more months before she came back — devastated, ashamed, not really understanding what she had done.

And then, with the same logic as always, someone suggested going back to treating the depression.

By the time this story reaches the consulting room, it is usually on its third or fourth lap. The sentence comes out more or less like this: every time she takes something for the depression, it’s like she loses her mind and this family nearly goes under.

Perhaps you recognized something in that sequence. Or perhaps you thought of someone — a sister-in-law, a friend, a mother — about whom it has been said, more than once, that she “reacts badly to medication”. Either way, it is worth saying this: what the family has observed is not a layperson’s impression, and it is not an exaggeration. It is clinical information, and it is some of the most important that exists.

What the family noticed has a name

There is a phenomenon that is well described in psychiatry: in some people, treatment aimed only at the depression does not correct mood — it destabilises it. Instead of bringing mood back where it belongs, it pushes it to the other extreme, or produces a mixed state, agitated, irritable, with little sleep and a great deal of activity, that nobody at home can put a name to.

This does not happen to everyone. It happens, above all, when the underlying picture was never depression on its own — when what existed was something else, of which the depressive periods were only the visible part.

And it matters to understand why that something else can go so many years without being identified. It is not carelessness on anyone’s part.

Nobody seeks help during the good phase

People go to a psychiatrist when they are suffering. Nobody books an appointment because they have too much energy, too much drive, too many ideas, and are sleeping little without missing it.

So what arrives in the consulting room is always the depressive half of the picture. The person sits down and describes the emptiness with precision. The exhaustion, the absence of will, the weight of getting up. She describes all of it sincerely. And all of it is true.

The other half, when it does come up in conversation, comes in disguise. It gets told as “a phase when I was doing really well”, “a period when I got a lot done”, “a time when I felt more confident”. Nothing in those sentences raises any suspicion. Plenty of people would say them about a good year of their own life.

Add to that one more detail: during a period of acceleration, a person’s read on her own state is usually impaired. It is not experienced as a change. It is experienced as clarity, as finally functioning properly. Nobody reports as a symptom the thing that felt like the best month of their life.

The result is that the decisive piece of information simply never makes it into the appointment — unless somebody asks after it actively, with time, and cross-checks it against the account of the people who were living alongside her.

Why “she reacted badly to it” often means something else

When agitation shows up weeks after a treatment begins, there is an easy reading available, and it is almost always the one that gets taken up: that she could not tolerate that particular substance. So it is swapped for another. Then another. And with each swap the same pattern repeated, and each repetition was filed away as one more isolated intolerance.

But there is an enormous difference between a one-off adverse effect and a pattern that repeats with different substances, always in the same direction, always with the same face. The first is about the medication. The second is about the diagnosis.

What I tend to see is that the family worked this out long before the doctors did. Someone at home had already said the whole sentence out loud, at some point: “every time she takes this, she ends up like this.” Except that observation rarely finds an appointment with enough time in it to be taken seriously — and on its own it is one of the strongest indications that the diagnostic reading needs to be done again.

The cost of the lost years

This deserves to be named without softening, because anyone who has lived it already knows.

We are not only talking about time. We are talking about marriages that did not survive those weeks. About jobs lost through decisions made in a state nobody understood. About debts the family is still paying off. About children who grew up without knowing why their mother was two different people in different months.

And, almost always, about guilt that has been distributed badly: the person believing she has a defect of character, and the family split between anger at what happened and the uncomfortable certainty that it was not a choice.

I cannot promise that naming this fixes the past. It does not. But it changes what gets done with it — and it changes, above all, the question you take into the next appointment.

What a reassessment does with a story like this

I am not going to say here what should have been done instead. That is not decided in an article, not in writing, and not without examining the person. It would be dishonest to suggest there is some simple answer that somebody failed to give.

What can be said is what a serious reassessment actually looks at, and what tends never to have been looked at.

It rebuilds the entire timeline — not the last few months, but the last ten or twenty years. It asks about the good periods with the same seriousness it asks about the bad ones. It asks how long each one lasted, what happened just before, what changed first. It asks what happened in the family, in earlier generations, including the things that never had a name. It lays each attempt at treatment side by side with what followed it, in order, to see whether there is a pattern where before there seemed to be a run of bad luck.

And above all, it listens to the people who were there. Because someone who has been through an accelerated phase has, by definition, an incomplete memory of that period. The people who were on the outside hold the other half.

It is not one more appointment. It is asking the question again from the beginning — and there are situations where that should not wait for another cycle to come round.

If this story looks like yours

You do not have to reach any conclusion today. You do not have to argue about diagnosis with anyone who has treated her, or convince anybody of anything.

If only one thing stays with you, let it be this: what you have observed at home, repeatedly, over years, is not a hunch. It is clinical information that nobody but you has — and it deserves to be taken, whole, to someone with the time to listen to it.

You do not have to conclude anything today.