In the 1980s, historian of pharmacology Mickey Smith wrote that new blockbuster medicines enter society by a three-step process. First, a wild popular embrace, driven by overestimation of the drug's potential, leads to overuse; next, the sudden discovery of “problems” with the drug leads to a backlash; and finally, a state of equilibrium is reached, in which the drug is used judiciously, its real benefits and limits seen clearly at last. Smith called these three stages the “law of the wonder drug.”

I remembered Smith's formula not long ago, while talking to an old friend on a summer ramble around New York City. The substance of our conversation was that antidepressants—a topic we'd bandied back and forth together for almost 20 years, in various states of using them ourselves and not—had begun to seem quaint. Maybe even a little retro, like lava lamps or tube socks.

This wasn't to say that antidepressants had become obsolete. We still knew plenty of people who took them, and as of 2011, antidepressants were hanging onto their status as the most-prescribed class of drugs in the USA. Instead, we realised, what we were picking up on was a change of attitude. From their first appearance in the late 1980s until recently, SSRIs were an A-list topic of debate in the culture wars, and the rhetoric, whether pro or con, was red hot. Antidepressants were going to heal, or destroy, the world as we knew it.

Those discussions now feel dated. While antidepressants themselves are here to stay, they just don't pulse with meaning the way they once did. Like the automobile or the telephone before them, SSRIs are a one-time miracle technology that have since become a familiar—even frumpy—part of the furniture of modern life. At some point recently, they've slid into the final act of Mickey Smith's wonder-drug drama. And in the aftermath of that change, many of the things that people used to say about them have come to sound completely absurd.

The early years of prozac conformed perfectly to the initial two steps of Smith's wonder drug paradigm. First, the breathless, love-at-first-sight embrace. In 1992, Time magazine ran a cover story announcing that “Freudian analysis” had become “irrelevant” to the treatment of serious mental disorder; for depression, prozac and medicines like it could achieve a “cure rate” of 90%. Although they were marketed as treatments for a mushrooming cluster of diseases, word got around that the new antidepressants could make some perfectly fine people even better, smoothing the rough edges of a personality in ways that could make for greater utility at home and at work.

The backlash, too, arrived right on schedule. Critics mused about the potential for side-effects—in her bestselling 1994 memoir Prozac Nation, Elizabeth Wurtzel worried that years of prozac use would leave her with “inoperable brain cancer.” Liberal-minded observers fretted that wide use of antidepressants might blot out all sadness from our demonstrably sad world, and enforce a kind of artificial, kitschy cheer. Often the critique of antidepressants fused with an existing tradition that accused American culture of being shallow, materialistic, and intolerant of difference. “If we're feeling just a little blue,” wrote English professor Eric G Wilson in his 2008 polemic Against Happiness, in a typical-enough knock against antidepressants of the time, “we can take paxil or prozac and in a few days enjoy an unreal gratification, the two-beer buzz of canned bliss.”

For some, the question was whether antidepressants could turn the individuals who took them into different people altogether. This possibility was introduced by Peter Kramer, psychiatrist and author of the 1997 super-bestseller Listening to Prozac. Kramer related how, while integrating prozac into his clinical practice in the early 1990s, he came to believe that the drug didn't just alleviate his patients' symptoms, as earlier medications had done, but rather changed their very personalities. His attitude toward prozac was both enthusiastic and fretful; he saw it as a sign of things to come. “When one pill at breakfast makes you a new person,” he wrote, we would soon inhabit a world where people would use choose prozac and drugs like it to change and optimise their inmost selves at will, for which he coined the term “cosmetic psychopharmacology.”

“Do you remember when people were worried that antidepressants would keep us from being our true selves?” my friend and I asked each other.

Oh, we remembered. In fact, that worry had consumed me when I was 18 years old and taking zoloft for the first time. Back then, I deeply resented “having” to take the drugs, largely out of fear that they might change things about myself that I valued. (In hindsight, I believe talk therapy would have helped more, but it was not offered at the time—it was the late 1990s, and Freud, after all, had been declared irrelevant in Time.) Would I have been less frightened if antidepressants had not been presented, thanks to Kramer, as ‘thymoleptics’, deep transformers of the self? I don't know. But what is clear is that no lofty philosophical warning about antidepressants of the last two decades has successfully held onto its gravitas.

Take the idea that antidepressants might change our inner selves. That thought is less panicking than it once was because the very idea of an inner self, an essence, is less salient now than it was in the 1990s. Social media have finally manifested in our daily lives what postmodern critics have argued for decades—that the self is something “performed” or “created,” not an objective thing to be found or lost. In a world where a well-curated social media presence can be understood not just to reflect the reality of who I am, but in a very real sense to create it, the static idea of a “true self” that I can succeed or fail in being hardly computes. That doesn't mean that most people don't want to feel notionally authentic. But it does mean that a simplistic desire to be “who you really are” has come to sound ploddingly ‘90s, and the ‘90s might as well be the ‘50s; they represent a time when people were different, less intimate with irony or flux.

Copyright © 2015 Dr P Marazzi/Science Photo Library

Largely, though, antidepressants now appear neither so miraculous nor so threatening because we know them better—our sense of their power both to hurt and to help has diminished. In the USA, the landmark Government study known as STAR*D showed that after trying one medication, about a third of patients become symptom free. After four tries, the rate is 70%, though many patients drop out before getting there. When I ask around, I talk to people who say they feel that antidepressants saved them, but also those who couldn't stand the way the drugs killed their sex drive or caused their ears to ring or made them feel numb inside; I talk to people who say antidepressants helped, but then stopped helping, and long-time users who don't know if they're still doing anything at all.

Ironically, it's our acquired sense of their limitations that takes away antidepressants' existential threat. Something that works for only some people can't obliterate sadness from the palette of human emotions. People who feel turned into people they don't recognise by their antidepressants are as likely as not to seek a different drug. And people who feel that medication changes them don't claim to feel globally changed, as if they had become someone else. Instead they report a shift into a different register of their personality, a change the order of which is familiar to anyone who has used a recreational drug. The American novelist Lev Grossman, blogging about how the antidepressant he's been using for years, Wellbutrin, made him feel at first, writes: “If I could compare it to anything it would be—cover your ears, children—the high that comes with a little bump of cocaine.” That doesn't sound like being someone else so much as it sounds like being a slightly altered version of the self you already know too well.

Two representative works of fiction illustrate the distance between the popular perception of antidepressants in the 1990s and today. In 1994, Canadian novelist and angst-monger Douglas Coupland, whose novel Generation X helped popularise the term, published a short story called “1000 Years (Life Without God).” The main character is a man in his thirties named Scout, who takes pills that his doctor has prescribed for depression and anxiety. Scout tells us the pills make him “‘nicer,’” like “cosmetic surgery of the brain.” But they also prevent him from being himself. By taking them, Scout says, “I switched myself off,” and the reader is meant to root for him as he quits the pills and flees into the wilderness of British Columbia to regain his emotional and spiritual integrity, his “essence.”

Compare that to the handling antidepressants get in a recent novel, The Interestings, by Meg Wolitzer. In it, the protagonist's husband, Dennis, has depression in college and for decades thereafter; in the 1980s, he finds relief on MAOIs, until a near-fatal food interaction forces him to stop. Years later, he is admitted to a clinical trial of a fictitious SSRI-like drug called stabilivox. But stabilivox doesn't compromise Dennis' integrity or dull his feelings—quite the opposite. While taking it, Dennis recounts to his wife, “everything inside him seemed to unfold a little…only then did he realise how folded he'd been all these years.” If the drug has a flaw, it's not that it takes something away, but that it does not give powerfully or reliably enough. After the first blush fades, stabilivox keeps Dennis “in decent spirits,” and makes him “gain weight that he cannot take off,” faint praise that will likely ring familiar with millions of real-life SSRI users. Stabilivox puts Dennis back in the world, but it certainly doesn't make him “better than well”—it doesn't turn him rich or famous (as some of his friends are), or even uncommonly sanguine, and he and his wife continue their slide into ordinary middle age, complete with sagging bodies, middling careers, and an emptying nest.

This is antidepressants as most who know them know them now: helpful sometimes, imperfect certainly, often a pain, yet mercifully there if you need them. That's not to say there is nothing to worry about. In the USA, antidepressants have been both the cause and the excuse for a trend by which mental health care has increasingly come to mean medication and medication only; insurers will no longer pay for more labour-intensive talk therapies, even though they are effective and many patients prefer them. That is a real problem, one worth striving against.

But change us into other people? If only something could.