Millions Use Antidepressants. We Still Don’t Understand How They Work.
Here’s how psychiatrists like me think about the most promising hypotheses.
Sophi Miyoko Gullbrants
Dr. Awais Aftab is a practicing psychiatrist and writer. This is part of Therapeutic Window, a series exploring the science and the debates behind mental health diagnoses.
Oct. 27, 2026
Lately, the public conversation around antidepressants has focused largely on whether and how to quit them.
Health Secretary Robert F. Kennedy Jr. has made deprescribing, or supervised drug tapering, a focus of policy. Mr. Kennedy and other critics of antidepressants argue that the medications are overprescribed, with dangerous side effects. The medical community, however, views them as effective and necessary treatments for people with a wide range of mental disorders, including depression, anxiety and obsessive-compulsive disorder.
But underneath this debate lies a more fundamental question that science has yet to conclusively answer: How, exactly, do antidepressants work?
For decades, the public understanding of antidepressants has been stuck in a narrative popularized by pharmaceutical advertising in the 1990s: that they work by correcting a chemical deficiency in the brain.
But evidence from research studies has been clear since at least the early 2000s — if not earlier — that this is not how antidepressants work. Doctors prescribe the drugs because decades of study data and patient reports show they can relieve people’s mental health problems. But doctors and scientists don’t have a clear understanding of how they do that. That may be surprising, but it’s the case for many kinds of medications, such as acetaminophen and general anesthetics.
Even so, understanding how antidepressants work is important not only for educating the public, but also for furthering scientific research — into why the drugs are not effective for everyone, and how to develop more treatments.
Scientists today are working with several promising explanations. No hypothesis is settled science, and some may be disproved tomorrow. But together they reflect the strongest understanding medicine currently possesses.
This Kind of Sleep Is Essential for a Healthy Brain
Two particular phases in your nightly routine seem to play outsize roles in cognitive health.
Georgette Smith
A good night’s sleep isn’t just about the number of hours you log. Getting quality sleep — the kind that leaves you feeling refreshed and ready for the day — is critical for a healthy brain.
People with disturbed sleep, like insomnia or sleep apnea, have a higher risk of developing dementia than those with no sleep issues. Poor sleep can harm your brain in other ways, too. One study found that people in their 30s and 40s with heavily disrupted sleep (such as frequent awakenings or movements) were two to three times more likely to test lower in executive function, working memory and processing speeds a decade or so later.
Harvard Mindfulness Professor: The INSANE ways your thoughts control...
Most of us live mindlessly most of the time.
In this unconscious state, we drift into the illusion of certainty. But what if our pernicious attachment to knowing is precisely what prevents us from embracing the freedom that comes with uncertainty?
When we believe we fully understand something, we stop paying attention—and in that unconscious state, we miss the kaleidoscopic nature of reality itself.
My guest today is Dr. Ellen Langer, Harvard’s first tenured female psychology professor and a pioneering researcher who has transformed our understanding of consciousness and its relationship to physical reality. After our initial conversation (Ep. 813), she returns to delve even deeper into these waters.
Dubbed “The Mother of Mindfulness,” Dr. Langer has spent over four decades demonstrating how subtle shifts in mindset can create measurable changes in health, aging, and performance—challenging our most cherished assumptions about what is possible. Her book, “The Mindful Body,” synthesizes these discoveries, showing how simply noticing new things can transform our fundamental experience of being alive.
Dr. Ellen Langer
First Pill for Postpartum Depression Shows Varied Real-World Results
By Pam Belluck
Pam Belluck, who covers maternal mental health, visited and talked with women across the country who experienced postpartum depression.
Some women’s symptoms improved quickly after taking the pill, but depression persisted in others. Doctors are trying to learn which patients benefit, and why some don’t.
Depression descended on Samantha Cohn about two months after her baby boy was born.
He was thriving, but she became convinced she was a terrible mother. “I felt like I wasn’t doing enough, I wasn’t doing anything right,” she said. She began to think her son and husband might be better off without her. When the baby was about 5 months old, she tried to take her life with a gun.
Ms. Cohn, 30, who lives near Fayetteville, N.C., was hospitalized for weeks and underwent surgeries to repair damage to her jaw, nose, tongue and face. But her postpartum depression remained challenging to treat. The hospital’s maternal mental health specialists decided to have her try a medication that had recently become available: the first pill specifically for postpartum depression.
Clinical trials had found that the drug, zuranolone, marketed as Zurzuvae and taken daily for 14 days, can ease symptoms for some women in as little as three days, while general antidepressants can take weeks. For Ms. Cohn, its impact was swift and striking. On her fourth day of taking it, she said she suddenly “felt so much clarity in my head, like I didn’t have nagging thoughts about not being good enough.”
Now, a year and a half after the drug became available, thousands of women have tried it, and their experiences have run the gamut. For some, symptoms improved remarkably. Others described a modest benefit that didn’t last or said their depression persisted. And others didn’t complete the two-week regimen because profound drowsiness, a common side effect of the drug, interfered with their ability to care for their babies or to fulfill other responsibilities.
One in eight women in the United States experiences depression during pregnancy or in the year after giving birth, the Centers for Disease Control and Prevention estimates, and effective treatments are crucially needed. While the fast-acting pill shows promise, doctors say the challenge now is to determine which patients will benefit and why some don’t.
Clinical trials of the drug found that postpartum depression improved in about 60 percent of patients. “It’s not everyone,” Dr. Samantha Meltzer-Brody, a leader of the trials and director of the Center for Women’s Mood Disorders at the University of North Carolina at Chapel Hill, said at a National Institutes of Health conference. “So, what is it about the people that are going to respond versus those that don’t?”
Why Does My Mind Keep Thinking That?
The psychiatrist Mark Epstein shares his insights about the mind after decades of working with patients and practicing Buddhism.
The psychiatrist Mark Epstein shares his insights about the mind after decades of working with patients and practicing Buddhism.
By Ezra Klein
I’ve had a meditation practice for about 15 years now. I have a bit of a highly tuned nervous system, and I went into it thinking it would calm me down. And it has done that.
But over time, and in the periods when the practice is a bit deeper, when I have a little bit more grit under its tires, the thing it really seems to do is alienate me from my own mind.
I watch what is playing on the projector of my psyche, and I think: Why? Why did I — or some part of me — load up that particular film and, at least in the way my mind works, do so again and again and again and again?
There are people who have been thinking about and exploring the strange way the mind performs for a very long time. One of them, Mark Epstein, is someone whose work I’ve long been interested in.
Epstein is a Buddhist and a psychotherapist. His first book, published in 1995, was called “Thoughts Without a Thinker.” His 2022 book is “The Zen of Therapy.”
Now a lot of people go to therapy. The fact that today it might have all these dimensions of mindfulness and awareness in it would seem normal and natural. But some people built that bridge, and Epstein was one of them.
I’ve thought for a while that it would be interesting to ask him, after his decades of therapeutic practice and intense meditation, what he has learned about the mind. How does he think about how the mind works?
What is the relationship you have to your own thoughts when you realize you’re not the one controlling them?
This is an edited transcript of an episode of “The Ezra Klein Show.” You can listen to the conversation by following or subscribing to the show on the NYT Audio app, Apple, Spotify, Amazon Music, YouTube, iHeartRadio or wherever you get your podcasts.
‘Modern Love’: Why Boys and Men Are Floundering, According to Therapist Terry Real
The Daily
A session with Terry Real, a marriage and family therapist, can get uncomfortable. He’s known to mirror and amplify the emotions of his clients, sometimes cursing and nearly yelling, often in an attempt to get men in touch with the emotions they’re not used to honoring. Real says men are often pushed to shut off their expression of vulnerability when they’re young as part of the process of becoming a man. That process, he says, can lead to myriad problems in their relationships. He sees it as his job to pull them back into vulnerability and intimacy, reconfiguring their understanding of masculinity in order to build more wholesome and connected families. In this episode, Real explains why vulnerability is so essential to healthy masculinity and why his work with men feels more urgent than ever. He explains why he thinks our current models of masculinity are broken and what it will take to build new ones. This episode was inspired by a New York Times Magazine piece, “How I Learned That the Problem in My Marriage Was Me” by Daniel Oppenheimer. For more Modern Love, search for the show wherever you get your podcasts. New episodes every Wednesday. Unlock full access to New York Times podcasts and explore everything from politics to pop culture. Subscribe today at nytimes.com/podcasts or on Apple Podcasts and Spotify.
How to Stop Being So Hard on Yourself
Cultivating self-compassion can actually help you cope better with life’s struggles.
Hoi Chan
If a friend is struggling with a big challenge or feels defeated, it’s usually our first instinct to offer words of comfort and understanding. But often it’s not so easy to do this for ourselves.
We can be our own harshest critics. Practicing a little self-compassion, though, goes a long way. Research shows that when people go through challenges or stressful situations, those who display more self-compassion are more resilient.
“We can say, ‘I made a mistake,’ as opposed to saying, ‘I am a mistake,’” said Kristin Neff, an associate professor of educational psychology at the University of Texas at Austin who has studied self-compassion for more than two decades. “It’s a healthier alternative to self-esteem, because it’s not about judging yourself positively, it’s just about being helpful and kind to yourself.
Relationships 2.0: Keeping Love Alive
By Hidden Brain Staff / April 30, 2025
There’s no magic potion that can make someone adore you. But there are things you can do to promote a deep and enduring connection — and even feelings of passion — between yourself and your partner. In the final chapter of our Relationships 2.0 series, psychologist Arthur Aron shares some techniques for falling and staying in love.
In today’s conversation, we explore:
*The assumption that love fades over time.
*The effects of daily routine on romantic relationships.
*What our choice in a romantic partners says about us
*How successful long-term couples keep love alive
If you love Hidden Brain, please join us for our upcoming live tour! Shankar will be visiting cities across the U.S., and our listeners have the first crack at purchasing tickets. You can get yours at https://hiddenbrain.org/tour/. Use the pre-sale code BRAIN. We hope to see you there!
Resources for Parents Navigating the California Wildfires
Use the resources below to guide your child through processing a natural disaster experience.
Talking To Yourself VALIDATE YOUR EXPERIENCE:
You are going through something unimaginable; there is no “right” way to feel or think. Phrases like these can help you name, process, and validate what’s coming up for you right now.
● “This feels scary. It’s okay to feel that way.”
● “Yes, I feel powerless. And that’s really hard.”
● “I’m allowed to feel upset, I’m allowed to cry, I’m allowed to scream into a
pillow, I’m allowed to feel everything I’m feeling.”
● “I wasn’t expecting this. I didn’t want this to happen.”
ACCESS YOUR STURDINESS:
This is incredibly hard, and you will get through it. These mantras are here for you as you process what’s happening.
● “This is a really hard moment in my life ... and I will get through it. I will.”
● “It’s okay if I don’t know how I will figure this out. That makes sense, and I don’t
have to know right now. That doesn’t mean I won’t get there.”
● “A very large part of me feels shaken. That makes sense. And there is still
another part of me that knows I will be able to get through it.”
● “I’ve gotten through hard things before, and I will get through this hardest
thing right now.”
7 Things Everyone Should Know About Antidepressants
Here’s how the drugs can affect weight, mood, libido and other functions.
Vartika Sharma
Even if you’ve never taken an antidepressant, you’re probably familiar with the criticism and controversy that surrounds these drugs. It’s not uncommon to hear things like: “Those pills are just a placebo.” “You’ll definitely gain weight.” “Once you start, you’ll become dependent on them.”
Is any of this true?
Some of these statements have “a kernel of truth,” said Dr. Gerard Sanacora, a professor of psychiatry at the Yale School of Medicine. And it’s important to set the record straight because the expectations people have about their treatment — whether good or bad — “really do play a large role in how the treatment actually unfolds,” he added.
Dr. Sanacora and other experts addressed some common questions and misconceptions about antidepressants.
Will antidepressants change who I am?
When an antidepressant starts to work, you may feel like a different person in some ways, said Naomi Torres-Mackie, a clinical psychologist in New York City.
6 Self-Help Books That Therapists Read Themselves
Experts recommend these contemplative texts and workbooks to help shift your perspective.
Monica Garwood
Of the thousands of self-help books on the market, which ones are truly helpful? “It’s uncommon to find a self-help book that feels different,” said Vienna Pharaon, a marriage and family therapist in New York City.
But genuinely useful titles abound. The best of the genre invite reflection or offer practical tools to promote emotional, psychological or spiritual well-being. And there are some that therapists personally turn to or suggest to their patients.
“Almost every therapist I know has a whole list of self-help books to recommend,” said Daniel Tomasulo, a counseling psychologist and the academic director of the Spirituality Mind Body Institute at Teachers College, Columbia University.
When sorting through the self-help stacks, who better to help than mental health professionals? We asked seven to share their picks.
Life Examined: ‘The Serviceberry’: Robin Wall Kimmerer’s guide to the gift economy
Potawatomi botanist Robin Wall Kimmerer discusses the philosophy of a “gift economy” in her latest book The Serviceberry, expanding on the theme of reciprocity from her wonderful 2013 book Braiding Sweetgrass.
“The goods and services that economics are meant to provide for us, they are material, they are the things that we need in order to live,” Kimmerer continues. “Those are often commodities, but the things that we hold most precious, like pure water, the taste of wild berries, and the regard of our neighbors — the trust of our neighbors — those can never be commodified. For those, we have a ‘gift economy.’”
Drawing on native beliefs and traditions, Kimmerer explains that the abundant fruits of the humble serviceberry serve as a sweet reminder of our interdependence. It reminds us that all flourishing is mutual, “from bees, to birds, to microbes, to us.”
The Type of Love That Makes People Happiest
When it comes to lasting romance, passion has nothing on friendship.
JAN BUCHCZIK
I think I may have met my future wife,” I told my father on the phone, “but there are a few issues.” To be precise: I met the woman in question on a weeklong trip to Europe, she lived in Spain, we’d only been on a couple of dates, and we didn’t speak a word of the same language. Obviously, I told my amused father, “she has no idea I plan to marry her.” But I was 24 and lovestruck, and none of that stopped me from embarking on a quixotic romantic adventure. After a year punctuated by two frustratingly short visits, I quit my job in New York and moved to Barcelona with a plan to learn the language and a prayer that when she could actually understand me, she might love me.
The Peace of Wild Things
A powerful reminder that if you’re grieving, or anticipating a deep loss, moments of peace are still available to you.
(And how appropriate that they’d come from the more-than-human world.)
Collected Poems
© 1985 Wendell Berry
The Peace of Wild Things
When despair for the world grows in me
and I wake in the night at the least sound
in fear of what my life and my children’s lives may be,
I go and lie down where the wood drake
rests in his beauty on the water, and the great heron feeds.
I come into the peace of wild things
who do not tax their lives with forethought
of grief. I come into the presence of still water.
And I feel above me the day-blind stars
waiting with their light. For a time
I rest in the grace of the world, and am free.
– Wendell Berry
The Cringey Communication Strategy Couples Counselors Love
“I statements” can help reduce conflict and defensiveness — even if you feel silly while using them.
Laura Edelbacher
Imagine telling your partner a story.
You’re just getting to the good part — the crazy thing your boss said, or the irresistible face the dog made — when you realize he is staring at his phone.
Your first instinct might be to pout or get indignant. Or you might try a more therapized tack.
“I feel frustrated,” this enlightened version of you would say, “when you look at your phone while I’m talking to you.”
Congratulations! You have successfully deployed an “I statement” — a communication tool beloved by many couples counselors, who recommend it to clients to help curb defensiveness, have more fruitful discussions and, yes, fight better.
Therapists know the advice is a bit … cringe. Jessica Grogan, a licensed marriage and family therapist based in Austin, said that when she talks to her clients about the merits of “I statements,” she braces for eye rolls.
Attachment Focused EMDR and the Healing of Relational Trauma
What Is Attachment Focused EMDR?
Brian Rea
Attachment Focused EMDR and the Healing of Relational Trauma
- Julien Fyhrie, LMFT
I first became interested in Attachment Focused EMDR while looking for additional ways to address the problems my clients were having in relationships. I came to realize that major themes and challenges in their lives stemmed from early relational or attachment trauma.
This type of trauma was often the result of deficits in the clients’ relationships with their caregivers early on. Sometimes there had been abuse or neglect, the absence of good care like mirroring or a parental attitude that was dismissive to the emotional world of the child, all of which resulted in substantial wounding. The subtle nature of this type of relational trauma means that clients often have difficulty even identifying it.
A big and important part of the therapeutic process starts with discovering and articulating the trauma that occurred. However, a better understanding of the trauma a client experienced doesn’t always translate to different behavior or improved experience. Often we have parts of us that remain stuck at the age when the trauma occurred and as a result we develop a frustrating tension between the adult parts of us that understand the trauma and the child parts that are still stuck in it.
Attachment Focused EMDR is meant to address this tension and to work through the part that feels stuck. The neurobiology of trauma is such that the trauma can get locked in the nervous system with the original picture, sounds, thoughts and feelings. EMDR uses a form of mind-body free association to unlock the nervous system and allow the mind and body to process the experience. The entire process involves both validating what happened in the context of a secure therapist-client relationship, helping the client integrate traumatic memories, and focusing on repairing the original attachment wounds. The hope is that through this work the client is freed up to experience more security and agency in their relationships and in their life’s choices.
Video: Attachment-Focused EMDR – Tools & Techniques to Heal Trauma with Dr. Laurel Parnell - Dr. Laurel Parnell, who developed AF EMDR, discusses discusses tools and techniques.
Podcast: Therapist Uncensored on Attachment Focused EMDR - Tune in for this episode as co-host Dr. Ann Kelley and Dr. Parnell take a deep dive into the evolution and successes of EMDR.
Six tips to turn light chats into deep talks at holiday gatherings
Ask novel questions; try a creative icebreaker; and make talk meaningful. These and other ways can help spark ‘conversation chemistry.’
Six tips to turn light chats into deep talks at holiday gatherings
Ask novel questions; try a creative icebreaker; and make talk meaningful. These and other ways can help spark ‘conversation chemistry.’
Advice by Juli Fraga for The Washington Post
Holiday gatherings are often a time when we reconnect with old friends or make new ones. But for some of us, social events pile on pressure, especially if “small talk” isn’t our superpower.
Here are some ways to make your conversations sparkle.
Meeting someone new? Ask novel questions.
Try these questions: “What is one thing you’re really looking forward to this holiday season?” or “What was one highlight of your year?”Questions like these convey curiosity, which opens up conversations. It also shows that you’re interested in learning more about the other person, which tells them that they matter.
Hoping to reconnect? Try a creative icebreaker.
If you’re hosting a big family dinner or work party, including fun icebreakers such as “If you were a celebrity, who would you be?” or “What’s one song that sums up your personality?” can get the conversational ball rolling, which can be enjoyable for everyone.
Tired of chitchat? Make talk meaningful.
Sharing something purposeful can promote closeness and reduce loneliness. This could be discussing your intentions for the new year or some wisdom that’s changed your life for the better. Or maybe it’s talking about a volunteer project or the best book you’ve read this year.
Shy? Come up with a party plan.
New social scenes can also be an opportunity to take a “safe risk.” This can be something small — saying “hi” to someone new or initiating a brief conversation — even if it’s awkward at first.
While stretching our social muscles can be uncomfortable, it allows us to experience the joy that human interactions can bring.
Looking for happiness? Express care.
For instance, if you’re talking with someone you just met, you might say, “I’ve really enjoyed learning more about you,” or “Thanks for introducing yourself; it was wonderful to meet you.”
Want to convey empathy? Follow up.
Conversations aren’t always joy-filled. You may bump into someone who’s struggling in some way. They may be heartbroken about world events or sad because a loved one died. Or perhaps they’re facing a scary illness or job uncertainty. In these cases, your kindness doesn’t need to stop once the conversation ends. Make a point to check in. Even sending a handwritten note that says, “I’m thinking of you,” expresses empathy, which goes a long way.
Read the full article here.
He Cared About Me, So I Broke Up With Him
For years, Jessica Slice had dumped any guy who was kind to her. Could she break the cycle?
Brian Rea
He Cared About Me, So I Broke Up With Him
An episode of Modern Love produced by The New York Times
For years, Jessica Slice had dumped any guy who was kind to her. Could she break the cycle?
When Jessica Slice started dating a man named David, there was a lot to like about him. They could nerd out about books and board games. He was thoughtful and kind.
But Jessica had a problem. The more caring David was, the more she recoiled. “He’s the greatest!” She texted her sister. “But I doubt I’ll go out with him again.” This wasn’t the first time she’d felt like fleeing from affection, but something about David made Jessica hesitate. Was she finally ready for a new kind of love?
Listen to the episode here.
Perfectionists: Lowering your standards can improve your mental health
Excellencism is a healthy alternative
Celia Jacobs
Perfectionists: Lowering your standards can improve your mental health
By Tracy Dennis-Tiwary for The Washington Post
The relentless pursuit of flawlessness can lead to low self-worth, depression and even suicidality
Research is unequivocal — there is little upside to perfectionism. The relentless pursuit of flawlessness can lead to low self-worth, depressive and anxiety disorders, high stress in the face of failure, and even suicidality. As a result, perfectionists often end up achieving much less than they aspire to because they hold back, procrastinate and even stop taking on challenges altogether — because it’s better to not have entered the race than to have spun out in ignominy.
Excellencism is a healthy alternative
Read the full article here.