Purely just my opinion on antidepressants:
It's not meant to make you happy but keep you from being non-functional with your daily routine. There are many reasons why these don't work and from my own experience at the clinics, most patients fall under these common conditions:
They expect results too soon
The meds are expected to work for like 4-6 weeks on average. It's not like paracetamol that reduces fever when taken after a few hours. This stuff takes commitment to follow through and when you're not in your best state of mind and no reliable support system, trying to get a quick fix on your mental state is an unreasonable expectation.
They lie about taking it
Some of the patients come in with the intention to fake their symptoms and get some medical certificate to rest from work. It happens far more common than you think and it they come in with a sad sob story just to move you. The dead giveaway is claiming they're perfectly fine just after 2 weeks on the meds (remember the therapeutic effects are appreciated around 4-6 weeks on average) during follow up. I'm not saying every patient that comes in fitting the profile is faking it but I've seen more of my fair share to be skeptical about every time someone claims they're suicidal.
These types just undermine the people that actually do suffer from major depression and that's just sad. Some would intentionally or unintentionally blow off their symptoms out of proportion just to get some prescription (adds proof to their employer they need the break). Note I said unintentionally as I do think some people really do want some attention and use the depression card to be manipulative to their significant other, see Borderline Personality.
Having fed the wrong advice
It ties up well with the first condition of having false expectations on the meds. Patient comes in with a preconceived notion after a friend or family's experience about the meds. Psychiatric disorders can have a strong familial factor that's why it's not new to hear an entire family does come in for consult. Some people just come in thinking that this X antidepressant worked on their kin so it might work on them.
I wish it was that simple but I have to weigh in whether the person that's going to take them has other medications that might interfere with the meds given, hepatic/renal impairments, comorbids like diabetes and etc.,
ChatGPT MDs and Google MDs
I'm not surprised that people can get information easily online. If they acquire the wisdom to use that information quicker, then that's more amazing. The fact that looking up your own symptoms and getting a bucket list of possible disorders on you is just fueling your anxiety, you may be a hypochondriac or delusional without the insight to know you have a problem. We acquire knowledge faster than the wisdom to actually use that knowledge. Let this sink in whenever you learn something as from my experience at the wards:
Patients don't usually present like textbook case examples, some would have their own unique ways to manifest the same problems and it can be quite tricky to tell until you get more experience facing several cases overtime. For a person that only focuses about "knowing themselves", I don't think people are wrong about assuming stuff about how they really know themselves but by Johari's Window, there are parts of the person that even they don't know about themselves but others do and these are the blind spots. I made a post about insight into one's own condition.
They're stuck with the trigger
Quite common with rape victims who developed PTSD. They still live in the same neighborhood or compound which forces the victims to relive the memory or trigger anxiety. This is why a change of environment isn't just a simple mental health support but a necessity. The meds are there to help people control the symptoms but if they continuously expose themselves to the triggers, that ruins the point. Unfortunately, not many can have the option to be move from their stressful environments. This also goes for work environments where BPO agents develop anxieties but are functional from a WFH setup.
Antidepressants aren't magic that makes the anxiety and depression go away. They do help you regulate your emotions making you capable of being functional. I ask patients about their feelings of like their minds just "floating", not in pain nor in happiness.
Which one mental state do they prefer? in a turbulent state that makes them want to commit suicide or just have this neutral state where they feel like a robot. Guess the answer.
I think it has partly to do with inner strength where patients can make the most about their condition while on meds and in turn sets them up to be happy. Meds are just tools and the healthy attitude towards their own condition influences their outcome more.
Thanks for your time.