- 1 Acknowledgments: My deepest gratitude goes to the online mental health communities and their member (...)
1Antidepressants are among the most frequently prescribed drugs in the Global North, heralded as a cornerstone of modern mental health care1. However, their hegemonic use has raised critical questions regarding their efficacy, side effects, and the broader implications of their dominance in biomedicine. In OECD countries, the daily consumption of antidepressants nearly doubled between 2000 and 2019, from 30 to 66 doses per 1,000 people per day (OECD 2021). This dramatic rise reflects both the growing reliance on antidepressants as a first-line intervention and the global influence of their use as a model for mental health treatment. Among antidepressants, SSRIs (Selective Serotonin Reuptake Inhibitors) dominate prescriptions, accounting for approximately 70–80% of antidepressant use in high-income countries (OECD 2021, Santomauro et al. 2021). Despite this widespread adoption, antidepressants remain a topic of contention. The serotonin hypothesis of depression, once foundational to their development, has been met with increasing skepticism, and alternative explanations of their biochemical mechanisms remain under scrutiny (López-Muñoz, Alamo 2009). Furthermore, while studies such as Cipriani et al. (2018) report a 60% efficacy rate for antidepressants during the initial six months of treatment, adherence issues and multiple adverse side effects often undermine their long-term effectiveness (Sansone, Sansone 2012; Moncrieff 2018). In response to these challenges, researchers have begun to question the hegemony of serotonin-centric models and advocate for alternative approaches. Frameworks like the biopsychosocial model attempt to integrate biological, psychological, and social dimensions of health but have yet to disrupt the entrenched dominance of reductionist biomedical paradigms (Wade, Halligan 2017).
2This paper aims to move beyond these debates to provide a nuanced analysis of SSRI antidepressants use as lived, embodied, and relational. By examining practices, events, and materialities within the ecologies of antidepressant use, I explore the transformative impact of SSRIs on individuals’ daily lives. Through an interdisciplinary approach that draws from Medical Anthropology, Science and Technology Studies (STS), and Care Studies, I investigate how humans and SSRIs become entangled in mutual becomings, a concept I use following Deleuze and Guattari (1987) to describe the ongoing processes of transformation and relationality through which entities co-constitute one another. These becomings produce benefits and harms that challenge simplistic categorizations of antidepressants as merely medicine or poison.
3This paper opens with a brief historical and critical background overview of antidepressants, examining their biochemical foundations and the growing critiques surrounding their efficacy and widespread use. It then turns to the methodological framework, drawing on digital ethnography and autoethnography to investigate the lived experiences of SSRI users within online mental health communities. Building on this foundation, the analysis delves into the relational dynamics of SSRI use, using the concepts of “becomings” and “pharmakon” to explore how antidepressants shape and are shaped by daily practices, embodied transformations, and the negotiation of care. These findings are further contextualized through a discussion of their broader theoretical and ethical implications, proposing a relational approach to understanding SSRIs as both instruments of care and sources of harm. The paper concludes by reflecting on the significance of these insights for interdisciplinary research, clinical practice, and mental health policy, while pointing to new directions for future inquiry.
4The history of antidepressants has been deeply intertwined with biochemical explanations of mental health, particularly through the serotonin hypothesis. This hypothesis, which gained prominence in the mid-20th century, proposed that depression results from a chemical imbalance, specifically a deficiency of serotonin in the brain (López-Muñoz, Alamo 2009). Early proponents like Coppen and van Praag established serotonin’s central role, leading to the development of selective serotonin reuptake inhibitors (SSRIs) as a cornerstone of depression treatment. Parallel advances in genetic research, such as the identification of the 5-HTTLPR serotonin-producing gene, further bolstered these biochemical frameworks (Eley et al. 2004; Karg et al. 2011). Despite these foundational claims, recent critiques have exposed significant limitations in serotonin-focused models. Meta-analyses, including Cipriani et al. (2018), argue that antidepressants achieve only a 60% self-reported efficacy rate within the first six months of treatment. High dropout rates, with over 50% of users discontinuing SSRIs due to adverse side effects or inadequate follow-up care (Sansone, Sansone 2012; Keyloun et al. 2017), further challenge their utility. Additionally, scholars such as Moncrieff (2018) and Horowitz and Wilcock (2022) have questioned the overprescription of SSRIs and the incomplete understanding of their effects on the brain, leading to calls for alternative approaches to treating mental health conditions.
5Amidst these critiques, the study of pharmaceuticals has become an increasingly important area of inquiry in Anthropology and Science and Technology Studies (STS). Since the mid-1990s, anthropologists and STS scholars have explored pharmaceuticals not only as chemical interventions but as powerful, transformational substances with social and cultural significance (Hardon, Sanabria 2017). In Medical Anthropology, the field often termed the “Anthropology of Pharmaceuticals” has framed medicines as objectifications of healing ‒ commodities imbued with meaning and cultural narratives (Pool, Giessler 2005). Van der Geest and Whyte (1989) pioneered this approach, proposing that pharmaceuticals occupy multiple roles across their “life cycle,” from production and marketing to prescription, consumption, and efficacy (van der Geest, Whyte, Hardon 1996).
6More recent discussions in Anthropology of Pharmaceuticals and STS have shifted from an object-centered perspective to a process-centered approach, emphasizing how medicines function as assemblages, articulations, and fluid arrangements (Hardon, Sanabria 2017). This aligns with broader STS frameworks, exemplified by works such as Mol’s studies on atherosclerosis and patient care (Mol 2002; Mol, Law 2004; Mol 2008), Epstein’s research on AIDS activism (1996), and Greene’s exploration of how drugs and chronic disease categories shape one another (2007). Actor-Network Theory (ANT) has also informed analyses of pharmaceutical technologies, from digital adherence tools (Hurtado‐de‐Mendoza et al. 2015) to the abortion pill (Campbell 2018). Pharmaceutical markets, particularly the marketing practices of drug companies, have also received considerable attention. Moynihan, Heath, and Henry (2002) argue that pharmaceutical companies actively shape disease definitions and promote them to prescribers and consumers. Similarly, Dumit (2012) highlights how these industries influence concepts of health and illness. In the specific context of antidepressants, Ecks (2005, 2014) examines their marketing as solutions to social marginality in India, exploring how they are understood by patients and doctors in settings where non-biomedical treatments coexist with pharmaceuticals.
- 2 My paper focuses on what they would consider the consumption and social afterlife stages. I am spec (...)
7While much of this scholarship focuses on production and marketing, my research shifts attention to the latter stages of the pharmaceutical life cycle: consumption and efficacy, in line with the work of van der Geest, Whyte and Hardon (1996)2. These phases are particularly significant for understanding the entanglements between humans and pharmaceuticals. Applying Karen Barad’s (2007) concept of entanglement, this study explores how humans and SSRIs co-constitute one another, creating dynamic, relational ontologies. Barad’s framework suggests that entities do not exist as separate or static; instead, they emerge through their interactions and relationships. This lens offers a powerful way to examine how antidepressants mediate identities, practices, and perceptions of health and illness. This paper situates itself within the largely unexplored terrain of lived experiences with antidepressants. While biomedical research has extensively quantified the efficacy of SSRIs, and social sciences have focused on pharmaceutical markets, ethnographic approaches to the everyday realities of antidepressant use remain limited. By investigating these lived experiences, this study aims to “think with” SSRIs as matter that simultaneously produces care and harm, fostering a deeper understanding of their complex relational dynamics.
8To explore the daily practices and lived experiences of individuals undergoing SSRI treatment, I am engaging with grassroots online mental health support communities on the social platform Discord through a digital ethnography. Discord provides semi-public and moderated spaces where individuals share their experiences with mental health, including medication use, while avoiding the stigma often associated with discussing such topics in offline settings (Corrigan 2004; Naslund et al. 2016). These communities allow participants to openly discuss their struggles, exchange coping strategies, and navigate tensions between personal autonomy and medical authority. The communities I selected were identified on the basis of their active engagement, membership size, exclusivity to users aged 18 and over, and specific focus on mental health peer support. These spaces, moderated by community leaders, enforce strict guidelines to maintain safety, inclusivity, and respect, thereby creating a “safe space” for vulnerable members to connect. Their members include users from diverse countries, ethnic backgrounds, and ages, with a tendency toward younger individuals. The common points among them are their shared language (though not necessarily native) and common experiences with mental health. The focus of discussions is not exclusively on mental health, and often extends to broader topics, offering insight into how users balance their daily lives while managing mental health concerns. These communities provide a unique opportunity for research on SSRI-related practices, as open discussions about antidepressant use remain rare in offline spaces due to stigma.
9This research employs a mixed-methods ethnographic approach combining participant observation, in-depth interviews, and autoethnography.
10Online Participant Observation: Observations focus on the culture of semi-public Discord communities dedicated to mental health peer support. I engage in disclosed observation, ensuring participants are aware of my role as a researcher to maintain transparency and avoid power asymmetries. My field notes document group dynamics, recurring themes, and cultural norms, while respecting the privacy of individual participants by not recording or quoting specific messages.
11Online In-depth Interviews: To gain a more nuanced understanding of lived experiences with SSRIs, I conducted text, audio, or video interviews with participants who voluntarily agreed to share their stories. These interviews, conducted in private Discord chats, explore how SSRIs influence participants’ daily lives, relationships, and self-perceptions. Participants act as co-ethnographers (Mol, 2002), reflecting on their practices and offering firsthand accounts of their SSRI journeys. This implies that participants are not conceived as passive subjects but as active contributors to the knowledge production, with ethnographers engaging collaboratively in understanding practices and perspectives (Mol 2002). The sampling strategy is driven by themes of lived experiences (Behar 1996) and the testing of concepts rather than aiming for statistically representative data, with similarities to theoretical sampling (Glaser, Strauss 2017). Given the limitations of verifying demographic dimensions in an online-only research setting, the strategy does not focus on traditional categories such as age, gender, ethnicity, or geographical location. Instead, it prioritizes participants whose experiences are most relevant to the research themes and conceptual framework.
12Autoethnography: My personal reflections and diary entries as a past SSRI user complement the ethnographic data. These insights have been instrumental in shaping my understanding of the field, informing both my approach to participant observation and the interpretation of findings. By comparing my experiences with those of participants, I aim to highlight shared patterns and divergences while maintaining a critical reflexive stance.
13Given the sensitive nature of mental health research, ethical considerations are paramount. I regularly disclose my role as a researcher within these online spaces through public chats, in collaboration with moderators and using the status interface on my Discord profile. Participants for in-depth interviews receive a participant information leaflet and are asked to sign informed consent forms. This study has been reviewed and approved by the University of Warwick Humanities and Social Sciences Research Ethics Committee (HSSREC), under the approval code HSSREC 51/23-24.
14Participants provided informed consent, fully understanding the study’s purpose, data usage, and their right to withdraw at any time. To protect privacy, no individual messages or direct quotes were recorded from the group chats; only those from the in-depth interviews were recorded. Additionally, all data was anonymized. These measures align with ethical standards to ensure the safety and privacy of participants.
15This section presents early findings from my on-going ethnographic research on the lived experiences and daily practices surrounding SSRI antidepressants. Drawing from participant observations in Discord communities, in-depth interviews, and autoethnographic reflections, these findings explore the entanglement of humans and SSRIs through the concepts of “pharmakon,” “becoming,” and “antidepressant journeys.” By focusing on the relational and transformative dimensions of SSRI use, this research challenges biomedical models that emphasize efficacy as an isolated and static measure.
16The concept of “becoming,” as derived from Deleuze and Guattari (1987), refers to a process of continual transformation, where entities co-constitute each other in dynamic relationships. In the context of SSRIs, becoming begins even before individuals consume the pharmaceutical, through the entanglement of expectations and access. When considering antidepressants, the expectant user—the prospective individual reflecting on whether to take them or not—becomes entangled with the antidepressant even before starting its usage. Participants in Discord communities at times share stories about their initial perceptions of SSRIs, influenced by cultural narratives, family pressures, and stigma. These narratives frame SSRIs in contrasting ways—from “happy pills” to “zombie-inducing drugs.” For instance, one member of a Discord online community described how family encouragement to visit a psychiatrist led to their eventual prescription, while another expressed scepticism rooted in fears of losing their sense of self.
17A striking manifestation of pre-use entanglements emerges in participants’ pervasive fears of transforming into a “zombie” or “addict,” potent cultural symbols representing the anticipated consequences of SSRI treatment. These recurring metaphors, documented across multiple public Discord chats during my 2024-2025 fieldwork, articulate fundamental anxieties about the potential loss of agential control and irreversible alterations to selfhood. Within these communities, participants consistently conceptualized SSRIs as destabilizing agents, with their concerns focusing particularly on two dimensions: the gradual erosion of personal autonomy and the looming threat of chemical dependency. These narratives demonstrate how culturally-embedded imaginaries actively shape medication hesitancy prior to any pharmacological engagement.
18At other times, albeit less frequently in my non-statistically representative ethnographic observations, positive expectations about being prescribed antidepressants motivated participants to actively seek health services. In some cases, participants even directly requested an antidepressant. These findings resonated unexpectedly in my personal sphere as incidental autoethnographic moments; during informal conversations, two close friends separately disclosed their pre-existing considerations of antidepressant use and actively seeking antidepressant prescriptions from medical professionals. Both friends subsequently obtained SSRI prescriptions. These actions reflect the contradictory ontology of SSRIs. Such pre-use entanglements highlight the ambivalence surrounding SSRIs and the critical role of expectations in shaping the decision to begin usage.
19Access to SSRI antidepressants is another significant factor. For some participants, cost and healthcare access posed barriers to initiating or continuing treatment. One participant from the US shared in an interview how the high cost of antidepressants deterred her from maintaining consistent use because of its costs and pushed her to stop taking them multiple times until she got Medicaid, while other participant recounted long wait times to see psychiatry specialists in the United Kingdom National Health Service (NHS). Similarly, my autoethnographic journal highlights challenges with SSRI access in Melbourne, Australia:
SSRI shortage in Melbourne: The first pharmacy doesn’t have them, and the pharmacist suggests another place. I take public transport for 30 minutes to get there.
At the second pharmacy, they can’t find tablets for the half dose prescribed by my doctor, so I either have to settle for capsules or keep searching at other pharmacies in Melbourne (Autoethnographic journal, Day 1).
20Even before the ingestion of SSRIs, individuals are already entangled with them through these expectations and access issues. These pre-use dynamics transform the ontology of SSRIs as a “pharmakon” ‒ a substance that is both remedy and poison (Derrida 2004). As Derrida’s concept of “pharmakon” suggests, the perception of SSRIs as either beneficial or harmful is fluid, contingent on individual experiences and cultural contexts.
21Once individuals begin taking SSRIs, the becoming process deepens, as the pharmaceutical is incorporated into the body. Taking antidepressants requires constant engagement with daily practices to maintain the intimate relationship between human and pharmaceutical. Both participants and I described ordinary practices such as renewing prescriptions, carrying antidepressants during travels, hiding pills for fear of judgment by others, or experimenting with the timing of doses to manage side effects like sleepiness or insomnia. These mundane but crucial practices reflect the dynamic and ongoing entanglement between human and SSRI, where both entities mutually influence and transform one another.
22As documented in my autoethnographic journal, the physical and cognitive impacts of my consumption of SSRI antidepressant quickly became apparent:
I experienced dizziness right after taking the pill. I also had an upset stomach, but eating beforehand helped control it.
I’m finding it harder to think of words—they don’t come to me as quickly as they used to. They don’t pop into my mind as easily, and I need more time to think about them. Sometimes, the words don’t come at all.
The last time I took antidepressants, I experienced the same issue. Completing creative tasks for my assessments was particularly challenging.
The dizziness subsided 2-4 hours after taking the pill. Around 7 hours later, I noticed a strange metallic taste in my mouth, similar to iron.
I can already feel changes in my sexual desire (Autoethnographic journal, Day 1).
23After the first few months of fieldwork, I realized that lived experiences with SSRI antidepressants are so vastly different—and often contradictory—between individuals that any attempt to classify these experiences becomes an inherently challenging endeavor. Both participants and I have noted numerous bodily experiences, often contradictory in nature, including headaches, nausea, loss of appetite, increased appetite, diminished sexual desire, anorgasmia or difficulties reaching orgasm, vivid dreams, drowsiness, insomnia, fatigue or lack of energy, increased energy, changes in speech, emotional numbness, feelings of detachment or a sense of “not caring,” heightened feelings of happiness, improved memory, impaired memory, increased focus, and decreased focus, among others. These accounts illustrate how SSRIs do not simply “treat” symptoms but instead co-constitute new bodily and affective realities.
24As a 21-year-old woman from USA recounted in an ethnographic interview:
I like it [escitalopram]. I had it upped [dosage increased] recently. But I have been on it for a while and had hardly any issues until this year. [...] I think 7 years [on SSRIs]. This year depression has been rearing its ugly head, and it ended up in me being suicidal and a mental hospital stay where the meds got upped. [...] No, it has been upped twice—once from 10 [mg] to 20 [mg] and then 20 to 30—but I forget when the uppage [increase] was from 10 to 20. [...] [After the dosage increase] I had more energy to do things I wanted to do. I didn’t want to stay in bed all day. [...] More emotional [now], easier to get to cry. [...] I still deal with it. Sometimes it is positive to let your emotions [out]. Other times it is negative because I am crying at very little things (Kate, 21, USA).
25My autoethnographic reflections echoed these findings. I observed that my own experiences with SSRIs were marked by contradictions—feeling simultaneously more productive with monotonous tasks while less productive with creative ones, experiencing moments of happiness alongside a sense of emotional detachment. These insights reinforce the notion that the experiences with SSRIs are neither stable nor universal but are instead continually negotiated and redefined. The earlier excerpt about spontaneous crying exemplifies this instability: the same physiological response could signify catharsis or distress, depending on context. These bodily changes also give rise to cascading relationships across various sites “outside” the body. Both participants and I have observed diverse and numerous experiences across multiple domains, including increased or decreased productivity at work, shifts in friendships and family dynamics, changes in romantic relationships, altered expectations for the future and personal goals, and modifications in personal hygiene and appearance. Additionally, participants reported experiences such as being able to return to classes, leaving home more frequently, visiting public spaces, meeting deadlines, or, conversely, struggling to meet deadlines, among others.
26The ambivalence of SSRIs emerged as a recurring theme in participants’ narratives. For many, SSRIs were life-changing tools for managing mental health, yet they also introduced new challenges. Both participants’ and my own evaluations of SSRIs could shift even within the same day, influenced by bodily responses and the broader impact on our daily lives.
27I had a telehealth appointment with my doctor today. We’re doubling the antidepressant dose. The plan is to take the double dose every other day for a week and then switch to taking it every day, as long as the adverse effects are manageable (Autoethnographic journal, Day 68).
28At 3 a.m., in the bathroom, I felt a familiar sensation: increased dizziness and excessive salivation. I got on my knees in front of the toilet and vomited every last bit of last night’s hummus dinner. With tears streaming down my face and the taste of bile lingering in my mouth, I flushed the toilet and stood up. I’m feeling much better now (Autoethnographic journal, Day 69).
29The mixture of desirable and undesirable ontological changes associated with SSRI antidepressants reveals the necessity of ongoing compromises for those who use them. As highlighted through the ambivalence inherent in the concept of the pharmakon, individuals taking SSRIs engage in continuous evaluations of whether the benefits outweigh the drawbacks. These evaluations influence decisions to maintain the relationship with the medication, request an alternative pharmaceutical, or discontinue use entirely, with or without the guidance of a healthcare professional.
30For individuals who continue taking SSRIs, their experiences vary significantly. Some are advised by healthcare professionals to use the medication for a specific, finite period—typically six months to a year. Others, however, remain on SSRIs for decades, often without a clear plan to discontinue use. This prolonged entanglement may result from personal preference, professional advice, or the perceived risks of stopping. When the relationship with an SSRI is deemed unsatisfactory or harmful, individuals often embark on what I conceptualize as “antidepressant journeys,” a form of “care as tinkering” (Mol 2008). These journeys typically involve a process of trial and error, during which individuals and their healthcare providers work to identify the right antidepressant or dosage to meet the individual’s needs. This process reflects continual adjustment and negotiation. Rather than viewing SSRIs as static interventions, participants engage in an ongoing relationship with the pharmaceutical, assessing the changes they experience and re-evaluating their choices over time.
31For many, SSRIs serve as the starting point. If the desired outcomes are not achieved, individuals may first transition to other pharmaceuticals within the SSRI category before exploring alternative antidepressants such as serotonin-norepinephrine reuptake inhibitors (SNRIs) or tricyclic antidepressants (TCAs). This iterative process requires tapering off one medication, initiating another, and enduring a waiting period to assess its effects. The uncertainty and physical toll of these transitions are common, as individuals must often repeat the process multiple times before finding a suitable option. As this 51-year-old woman from Oklahoma, United States, expressed during one of my interviews:
I’ve been taking antidepressants since I was 15 years old. […] I’ve been on probably about 12 different types of medications for from my mental health and I can’t remember them all, it’s been so many, right? But I will have to say that up until Cymbalta I really didn’t see a mark-up of benefits for me individually, you know, um, I did a little bit with the Celexa […] but it didn’t help with my anxiety (Olivia, 51, USA).
32These journeys are seldom straightforward. While some individuals may find a suitable medication relatively quickly, it is not uncommon for those with extensive histories of antidepressant use to describe prolonged and arduous experiences. Participants frequently recount the emotional and physical challenges of switching medications, including withdrawal symptoms, side effects, and the persistent hope of finding an antidepressant that works. As reflected in my autoethnographic journal, the process of navigating antidepressant use has raised complex questions about memory, emotions, and the uncertainty of discontinuation:
I find it difficult to recall how I felt before starting SSRIs. The initial changes were quite intense, but as the effects have gradually subsided over time, I am no longer in the same emotional or physical state as I was prior to taking them. I feel less sad, less happy, significantly less anxious, with reduced sexual desire and less fatigue. However, it remains challenging to clearly remember how things were before. […] These reflections lead me to question the extent to which I can determine when to stop using antidepressants and what the experience of discontinuing them might entail (Autoethnographic journal, Day 92).
33Not all individuals actively pursue these antidepressant journeys. For some, the perceived compromises of continuing medication outweigh the potential benefits, leading to a decision to stop SSRI use altogether. This decision may be informed by medical advice or occur independently, reflecting varying levels of agency and support. The act of discontinuation itself ranges from intentional, well-planned processes to abrupt, unanticipated breaks. For example, some individuals run out of medication before obtaining a refill, leading to unintended pauses in their regimen. Others deliberately taper off their dosage, often in consultation with their psychiatrist, to minimize withdrawal effects and monitor their mental health during the transition. Discontinuation experiences highlight the deeply personal and context-dependent nature of SSRI-human entanglements. Some individuals report a sense of liberation after stopping the medication, while others describe relapses, emotional instability, or a return to pre-treatment states. These outcomes are shaped by individual circumstances, medical histories, and the broader sociocultural frameworks within which antidepressants are prescribed and consumed. Ultimately, the relationship between individuals and SSRIs is characterized by an ongoing negotiation of “compromises,” whether maintaining, adjusting, or discontinuing the use of SSRIs.
34These findings reveal the relational and transformative nature of SSRIs, challenging biomedical frameworks that prioritize static measures of efficacy. By examining SSRIs as “pharmakon,” entangled with the lives of their users, this research emphasizes the need for nuanced, interdisciplinary approaches to understanding mental health interventions. The lived experiences and becomings of SSRI users call for a rethinking of antidepressants not as isolated tools but as active participants in shaping bodies, identities, and social worlds.
35This paper situates SSRIs within a relational framework of care, exploring their intimate ambivalence as both sustaining well-being and enacting harm. Rather than only a matter of concern (Latour 2004) or a means of knowing materials (Ingold 2012; Hardon, Sanabria 2017), SSRIs also emerge as a matter of care (de la Bellacasa 2017), deeply entangled with the lived realities of their users. These entanglements provoke constant questioning: Are SSRIs a technology of care, or do they ultimately enact harm? When harm is perceived, participants often engage in a “care as tinkering” process (Mol 2010), adjusting dosages, exploring alternative antidepressants, or discontinuing use entirely—sometimes with the guidance of medical professionals and sometimes independently. As seen in participants’ “antidepressant journeys,” this tinkering reflects the inherently experimental and iterative nature of living with SSRIs.
36The process of living with SSRIs can be understood as a form of becoming, characterized by dynamic entanglements between bodies, medications, and socio-technical systems. In this framework, SSRIs do not merely act upon the body; they co-constitute new configurations of identity, agency, and health. For example, participants described how SSRIs enabled them to manage work and social obligations while simultaneously introducing emotional blunting and relational tensions. These transformations disrupt binary frameworks that separate mind and body, self and other, or efficacy and side effects. Instead, SSRIs foreground multiplicity—their effects are contingent, relational, and deeply situated within individual and systemic contexts. As a “pharmakon” (Derrida 2004), SSRIs embody ambivalence, functioning as both remedy and poison. This duality is evident in participants’ narratives of paradox: SSRIs provided stability yet alienated them from their emotions; they alleviated symptoms but introduced side effects that challenged their sense of self. These contradictions reveal the ethical dimensions of antidepressant use, as individuals constantly weigh the benefits of care against the potential harms.
37While this paper does not engage in direct comparisons between SSRIs and other drug classes, the ethnographic insights propose distinctive features of antidepressant entanglements. Unlike many pharmaceuticals that target acute or physically localized conditions (e.g., antibiotics or analgesics), SSRIs intervene in the nebulous terrain of mood and cognition, blurring boundaries between “treatment” and “selfhood.” Their effects are not merely physiological but ontological—reconfiguring dimensions ranging from emotional capacities, temporalities of experience, and even moral evaluations of productivity or “normalcy.” This transformative potential is compounded by their long-term use, which fosters protracted, iterative negotiations between users and the drug, as seen in participants’ “antidepressant journeys.” Moreover, the pharmakon duality of SSRIs, their simultaneous framing as lifesaving and identity-altering, sets them apart from drugs with more circumscribed cultural narratives (e.g., insulin or antihypertensives). Where other medications might be tools for managing discrete pathologies, SSRIs become co-constitutive of the self, entangled in debates about authenticity, agency, and what it means to “feel better.” By engaging with SSRIs, individuals become part of broader networks of practices, inscriptions, and negotiations. These entanglements demand a rethinking of mental health interventions, moving beyond static models of efficacy to account for the relational and situated nature of antidepressant use. The process of becoming with SSRIs underscores the need for interdisciplinary approaches that bridge biomedical, social, and ethical dimensions of care.
38This paper has explored the complex and relational dynamics of living with SSRIs, emphasizing the ontological shifts they produce and the inscriptions that shape understandings of antidepressant use. By integrating autoethnographic insights with digital ethnography, it reveals the deeply entangled nature of SSRIs as both material objects and socio-cultural entities. These findings challenge static biomedical models by foregrounding the fluid and negotiated realities of antidepressant use, where SSRIs emerge as a “pharmakon” with the dual potential to sustain care and enact harm. The interdisciplinary approach taken in this study bridges biomedical, sociocultural, and experiential dimensions of mental health, offering a more holistic understanding of antidepressant use. It contributes to anthropological scholarship by advancing debates on pharmaceutical entanglements and highlighting the importance of relational and situated perspectives in mental health research. Future research should expand on the global and cultural variability of antidepressant experiences, particularly in non-Western contexts, and explore the implications of digital mental health communities for reshaping mental health discourses. These findings also call for more nuanced clinical and policy frameworks that account for the lived complexities of antidepressant use, moving beyond efficacy metrics to address the relational and ethical dimensions of care.
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