How Psychiatric Drugs Really Work – And Don’t

Anders Sørensen is a clinical psychologist, Ph.D. in psychiatry, and internationally recognized expert and speaker on psychiatric drug withdrawal. For over a decade, he has worked at the intersection of psychotherapy, psychiatry, and neuroscience, helping individuals safely reduce or discontinue psychiatric medications through slow, hyperbolic, individualized tapering plans. He is the author of “Crossing Zero: The Art and Science of Coming Off- And Staying Off- Psychiatric Drugs”

Most people assume psychiatric drugs work like antibiotics: you have an infection, you take penicillin, the drug kills the bacteria, and you get better. It sounds reassuring to think depression, anxiety, ADHD, or psychosis work the same way; that there is a defect in brain chemistry and a drug to correct it. And no wonder this belief pervades our culture, when the drugs themselves are branded as “anti”-depressants, “anti”-psychotics, and “mood stabilizers.”

But that is not how psychiatric drugs work. The real story is simpler – and far less flattering – than the narrative psychiatry has built around them.

Psychiatric drugs are first and foremost psychoactive substances. The term psychoactive is broad, referring to “any substance that, when taken in or administered into one’s system, affects mental processes, such as perception, consciousness, cognition, or mood and emotions.” Put more simply, dictionaries define it as any substance that “affects the mind or behavior.”

In that sense, psychiatric drugs belong to the same broad family as alcohol, nicotine, and caffeine – substances that alter how we feel, think, and behave, without correcting any underlying defect.

Technically, they don’t remove anything. It’s not that they reach into the brain with surgical precision and extract the depression, the psychosis, the ADHD, or the anxiety. What they do is overlay another mental and emotional state on top of whatever we’re already experiencing. If that drug-induced state is strong enough, it’s the one we’ll feel – not the original distress underneath. This altered state may then be experienced as helpful, not so helpful, or worse than before. Often, it changes over time. But the original feelings and their causes don’t vanish; they are simply muted. Pushed down. Numbed. Distorted. Drowned out.

Think of how opioids work. When you take morphine for severe pain, the drug blocks the receptors in the nervous system that transmit pain signals. The injury is still there, but the brain doesn’t register the pain as much; your lived experience is simply one of being in less pain. Or consider caffeine. It doesn’t actually remove tiredness; instead, it blocks adenosine receptors, which are responsible for signaling the fatigue. You still need sleep, you’re still as drained as before – but under the influence of caffeine, you don’t feel as tired. Psychiatric drugs operate on the same principle: they alter how life feels.

From “Tranquilizers” to “Medicines”

When chlorpromazine – the first so-called antipsychotic – was discovered in the 1950s, it was described simply as a “major tranquilizer.” It calmed people, reduced agitation, and made them indifferent to disturbing thoughts and feelings. No one believed it cured an underlying illness – that much is clear from the academic articles of the 1950’s and 60’s. The logic was straightforward: a drug-induced state could sometimes be preferable to a distressed state.

But over time, language shifted. Drugs became “medicines.” Tranquilizers became “antipsychotics.” Sedatives became “antidepressants.” Pharmaceutical companies (yes, it came from them, not science) promoted the idea that these drugs corrected chemical imbalances in the brain. The “serotonin deficiency” theory of depression and the “dopamine excess” theory of schizophrenia quickly became household concepts.

The problem? These theories were built backwards – from how the drugs acted on the brain, not from evidence that some alleged imbalances caused the conditions. Decades of research have since failed to confirm the imbalance model, or, for that matter, any other model proposed within biological psychiatry’s narrow framework. Yet the paradigm stuck. It spread into everyday culture and became a discourse. So much so that anyone who questioned it risked being dismissed as misguided, anti-science, or even crazy.

What Psychiatric Drugs Do in the Brain

Psychiatric drugs do act on the brain. They are chemicals with biological effects – no one disagrees on that point. All are designed to cross the blood–brain barrier and, among other things, alter neurotransmitters, the chemical messengers brain cells use to communicate.

• Antidepressants (SSRIs, SNRIs, TCAs) mostly increase serotonin and/or noradrenaline by blocking their reuptake, often dulling both highs and lows.

• Antipsychotics mostly block dopamine, adrenaline, histamine, serotonin, and more, producing heavy sedation, cognitive slowing, and emotional flattening – often to the point where asking about a person’s goals, values, or needs in life becomes an unfair question.

• Stimulants like Ritalin or Adderall increase dopamine and noradrenaline, inducing a state of heightened but artificial concentration, energy, and drive.

• Benzodiazepines (like Valium, Xanax, Ativan) and Z-drugs activate the brain’s GABA system, the main “brake” in the nervous system. The effect is an immediate sense of calm, muscle relaxation, and relief from acute anxiety or agitation. But that quieting often comes at a cost: slowed thinking, reduced alertness, impaired memory, and emotional dulling. In higher doses, they can induce detachment or even sedation so strong it resembles chemical restraint. Much like alcohol, they take the edge off quickly – but tolerance can develop just as fast, often within weeks of use.

• Mood stabilizers such as lithium and lamotrigine dampen neural activity more broadly, creating states of sedation, inhibition, and emotional dampening.

So yes, these drugs change brain chemistry. The real disagreement is about what that then means. Mainstream biological psychiatry claims such alterations correct an underlying pathology. But a simpler – and far more accurate – explanation is that they are just drugs with drug effects. Drugs that create altered, psychoactive states which may or may not be helpful. Sometimes subtle, sometimes strong. Our subjective experience of “symptom relief” is just that: the feeling of being in a drug-altered psychological and emotional state. And as psychiatrist Joanna Moncrieff has argued for two decades, we should evaluate these drugs by the states they induce, not by unproven imbalance theories.

And here’s the uncomfortable truth psychiatry resists: the explanation is too simple.They’re just drugs.

Strip away the medical mystique, and what you’re left with are chemical emotion regulation strategies. Just look at how psychology defines emotion regulation:

• “Processes by which individuals influence which emotions they have, when they have them, and how they experience and express those emotions”

• “Actions taken by a person to change emotions or increase or decrease their intensity.”

That’s exactly what psychiatric drugs do. By that standard, psychiatric drugs fall squarely within psychologist’s domain – a way to regulate and manage emotions, thoughts, and behavior – not within some imagined realm of biochemical defect repair.

Of course, those effects are not universally positive. Far from it. Large meta-analyses consistently find that most people do not experience a meaningful benefit from today’s psychiatric drugs. For antidepressants, recent data showed that only about 15% of patients will experience an effect beyond placebo. Keep in mind that is only from the published literature (negative studies do not get published). The rest either get no response, worsen, or improve for other reasons – which are then misattributed to the drug, creating an illusion of effect. And that illusion is reinforced when withdrawal from a too-fast taper is misdiagnosed as relapse. 

The same pattern holds for so-called antipsychotics. A 2017 meta-analysis, Sixty Years of Placebo-Controlled Antipsychotic Drug Trials in Acute Schizophrenia, found that only a minority of patients achieved a “good response”: 23% on antipsychotics versus 14% on placebo. In other words: it’s statistically more normal not to respond than to respond.

Relief and its costs

For some, this altered state feels like relief. Racing thoughts slow down. Emotional turmoil flattens out. The nervous system slows. Muscles loosen. Sleepless nights give way to sedation.

But here’s the catch: the drug doesn’t only quiet the “bad stuff.” Psychiatric drugs are not specific drugs or magic bullets. They are blunt instruments. They also dull things we usually don’t want to dulled: motivation, energy, creativity, enthusiasm, joy, sexuality, spontaneity, memory – even the sense of being connected to one’s own feelings. One client told me it felt like living behind glass; another like walking in mud, and a third was so emotionally numbed that she temporarily couldn’t feel the love for her newborn. The very flattening that feels calming at first can, over time, begin to weigh a person down and disconnect them from what makes life meaningful.

Paradoxically, it can also make it harder to understand the root cause of our distress and sometimes-destructive behaviors we use to cope with it. If the signal is muted, how do you know what you’re actually depressed, anxious, stressed, or psychotic about?

This isn’t really a “side effect.” It is the effect. And that effect may be helpful in some ways, neutral in others, and harmful or even devastating in others. Whether it feels helpful or harmful depends on the person, the context, and how long they remain in that drug-induced state.

Sometimes these effects are helpful in an acute crisis. But what soothes in the short term can, over time, flip into being part of the problem. Take so-called antipsychotics, for example. They can certainly hammer down an acute psychosis. But kept on for months or years, they can leave a person stripped of energy, purpose, and emotional depth.

And here’s something psychiatry rarely acknowledges: Benzodiazepines, though they work on a completely different receptor system, can calm acute psychosis just as well as so-called antipsychotics. That fact alone should make us pause and rethink what “antipsychotic” really means. It should be obvious that this is no anti-psychotic effect. It’s just a drug effect.

Drugs don’t target illnesses. They target people.

At the end of the day, the only real question to ask – and it’s a question for the person taking the drug, not the “professional” – is this: Is the drug effect helpful to you?

And if the answer is yes, that’s where the deeper reflection begins. If you find your medication helpful, don’t stop there; get curious about what exactly it’s doing for you. Here are some questions I often invite my clients to sit with:

• How does the medication affect you right now? In your body, in your mind, in your energy, in your emotions? 

• Do these effects help you in your daily life, or do they hold you back? If it’s both, how do the helpful and unhelpful effects balance against each other?

• In what specific ways has the medication been useful to you? Can you describe exactly how? Which effects do you value, and why?

• Which feelings inside you are the hardest to bear? What feels so relieving not to have to face?

• Are there thoughts, emotions, urges, voices, or memories that feel unbearable – things so painful you’re trying to escape from them?

• And finally: what might be the cost of not feeling what is difficult to feel?

And when the noise of drug effects is stripped away, what often emerges is not a broken brain, but the true drivers of distress: trauma, overthinking, attachment to thoughts, disconnection, relationship struggles, lack of meaning – and even poor metabolism and diet. The expanding field of metabolic psychiatry is showing just how profoundly food and energy regulation shape mood and cognition.

Toward a more (Radically) Genuine conversation

It’s deeply human to want to alter our state of mind. From alcohol and cannabis to coffee and opium, people have sought ways to change consciousness, awareness, and mood for as long as history has been recorded. In that sense, psychiatry is not unique. It is simply another cultural system for delivering psychoactive substances – only it rarely admits that’s what it’s doing.

Psychiatric drugs don’t fix chemical imbalances. They don’t cure “mental illness.” What they do is overlay another state on top of our existing one, almost like a brain hack or cheat code. Sometimes that alteration feels helpful. Sometimes it doesn’t. And often, the balance shifts over time and what begins as relief slowly shifts into burden.

The decision to start, stay on, or come off psychiatric drugs should not rest on myths about broken brains or chemical deficiencies. It should rest on an honest weighing of one simple question: Is the drug-induced state more bearable than the alternative? And if it is, why?

Understanding psychiatric drugs this way doesn’t mean dismissing them outright. These are powerful psychoactive substances. They can relieve suffering, but they can also create it. They can help us endure, yes. If that’s our goal.

And if we mistake numbing for healing – or withdrawal for relapse when a drug is stopped rather than tapered hyperbolically – we risk trapping people in a lifelong cycle of medication.

Perhaps the most radically genuine step is simply this: to tell the truth about what these drugs do and don’t do. Only then can people make informed, genuine choices about their mental health and how they choose to regulate it. 

Maybe this is why biological psychiatry resists the drug-centered model: it strips away the aura of medical expertise. If psychiatric drugs are just another form of emotion regulation, then the conversation doesn’t belong only to psychiatry. Psychologists, therapists, and most importantly patients themselves suddenly have a legitimate seat at the table.

And maybe the real expertise isn’t in writing prescriptions, but in helping people live without needing to numb or chemically alter their life experience.

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