A patient recently came to me for help after a family tragedy. The tragedy had changed this patient fundamentally. She was struggling. She didn’t know how to continue. She struggled with sleep. Her appetite was nonexistent. She couldn’t function. She had inflicted minor self-injuries. Fortunately, she was already doing self-care and counseling, but still, she was struggling, and the road ahead looked difficult and painful.

I suggested she start an antidepressant. In reply, she said something that was a good reminder to me: the way most people look at antidepressants is very different from how I, as a medical provider, look at antidepressants. With sad tear-stained eyes, the patient told me, “I don’t want to be happy right now.” That was a very wise response. It is normal to be sad. In times of tragedy, we should be sad. It would be unnatural to be happy in times of tragedy. 

However, antidepressants are not supposed to make you happy. They are aptly named antidepressant medications and not happy pills. The goal of these medications is simply to turn depression into manageable sadness. What is the difference? Depression is when sadness is taking over your life. There are multiple criteria that help differentiate between sadness and depression. However, I would like to offer four simple criteria that I believe help differentiate between normal sadness and depression. 

The first is nutrition. People who are depressed often have a suppressed appetite, or sometimes an increased appetite. Often people with depression over- or under-eat. 

The second is sleep. Like appetite, depression can cause too much sleep or not enough. Either is unhealthy. 

Third, antidepressants are supposed to make it so someone with depression can function. This is a very subjective goal, but essentially means that they are able to do daily tasks. Without medications, sometimes depression can make daily activities like going to the store or going to work insurmountable tasks. Sometimes people with depression struggle to focus, or sometimes they operate so slowly it affects basic interactions. 

The last and most important goal of an antidepressant is safety. If someone is so depressed that they are not safe, then they should discuss starting medication with a qualified medical provider immediately. 

It's OK to be sad. But if sadness progresses to depression, causes problems with nutrition, sleep, daily tasks or not being safe, then you need help. Sometimes the best treatment for depression is medication. The goal of that medication is not to create unnatural happiness, but to keep you healthy.