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Do you need to know who you’d be without antidepressants?

After years on psychiatric drugs, some ask if they owe it to themselves to try coming off the medication.

Your Mileage May Vary is an advice column offering you a unique framework for thinking through your moral dilemmas. It’s based on value pluralism — the idea that each of us has multiple values that are equally valid but that often conflict with each other. To submit a question, fill out this anonymous form. Here’s this week’s question from a reader, condensed and edited for clarity:

I’ve been on antidepressants on and off (mostly on) since I was in my late teens. I’ve struggled for years with depression and anxiety, and the medication has seemed to help. But I’ve often wondered what it would be like if I tried to stop.

There’s still a lot we don’t know about how antidepressants work. How much of what I felt to be them “working” might have been a placebo? And I’m a very different person now than I was back then. What if I don’t need the medication anymore?

I feel pretty happy in general, way happier than I was in my teens. But I just can’t shake the feeling that I’m medicating myself unnecessarily, without great evidence to back up the decision. Do I owe it to myself to find out what it would be like to be off medication? Did I make a mistake going on meds so early without thinking about how difficult an offramp might be?

Dear Antidepressant Ambivalence,

You’re in good company: One in six adults in the US currently takes antidepressants, and many wrestle with this question. That includes me; I take an antidepressant for chronic anxiety. And the wrestling makes sense, because antidepressants come with a lot of unknowns — both scientific and philosophical.

I have no medical training, so I can’t give medical advice, and decisions about psychiatric drugs should absolutely be made in conversation with a mental health professional. But let me offer you some framing thoughts that might help you get situated in this confusing landscape.

On the scientific level, we do have strong evidence that antidepressants are more effective than a placebo, though their effectiveness varies from person to person. On average, people are 25 percent likelier to feel better if they take the real drug than if they take the placebo.

But we’re not really sure why antidepressants work. The old “chemical imbalance” model, which proposed that depression arises because there’s not enough serotonin floating around in the brain, is not taken seriously today among experts. Instead, scientists now have other hypotheses, like the idea that antidepressants work by boosting neuroplasticity. But you’re right that there’s still a lot we don’t know.

Have a question you want me to answer in the next Your Mileage May Vary column?

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And then there are the philosophical uncertainties. Antidepressants shape our thoughts and emotions, which make up a lot of what we think of as the self. So they can raise big questions about identity, about who we “really are,” especially for those of us who’ve been taking them for years.

Most psychiatrists, with their meager 20-minute appointments, fail to help their clients explore these deeper questions productively. Yet the questions are extremely........

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