The Work the Medicine Was Never Meant to Do

What the Research Actually Shows

Start with the fact that quiets the self-blame. When people picture antidepressants, they often imagine that the right pill simply lifts the depression, and that if it has not, either the medicine or the person must be broken. The largest real-world study of antidepressant treatment tells a different and more forgiving story. Thousands of people with depression were treated and measured carefully, and after the first antidepressant, only about a third reached full remission, meaning the depression had genuinely lifted (Trivedi et al., 2006). Many more improved, which matters and is real relief, but for most people the first medicine reduced the depression without fully resolving it. So if your antidepressant has helped and yet something is still not right, you are not the exception. You are describing the common experience, and it says nothing bad about you or about the medicine.

The next finding is the one that turns that fact into a reason to act, gently. When researchers followed people who had partly recovered, they found that leftover symptoms, the low mood that lingers, the flatness, the sleep that never fully righted itself, the sense that the color has not come back, are common: about a third of those who remitted still carried them. And these residual symptoms were not harmless background noise. They strongly predicted relapse. In that study, relapse struck roughly three quarters of the people who still had residual symptoms, against a quarter of those who did not (Paykel et al., 1995). Read plainly, that means the part the medicine has not reached is exactly the part most worth tending, not because the medicine is wrong, but because what is left unattended tends to grow back.

Here is where it is vital to be clear, because this is a subject where a wrong word can do harm. None of this is an argument against antidepressants. Depression has a real biology, medication addresses that biology, and for a great many women it is a floor that keeps them from falling through, the thing that makes it possible to get out of bed, to think, to begin. That is legitimate and it can be life-saving. The point is not that the medicine does too much. It is that a pill was designed to do one job, to ease the biology of the illness, and it was never designed to answer why the sadness came, to reconnect you to a body you have gone numb to, to give voice to years of swallowed feeling, or to rebuild a life that actually fits you. Those are simply different jobs. Which is why you should never adjust or stop your medication on your own; any change belongs in a conversation with your doctor. The question this article asks is not whether to take the pill. It is what to do alongside it.

And the research is encouraging about exactly that. When psychotherapy, the structured inner and relational work, is added to antidepressant medication, the combination outperforms medication alone for major depression, and, tellingly, the benefit of the medicine and the benefit of the added work appear to run through largely separate channels, each contributing about equally (Cuijpers et al., 2014). In other words, they are not doing the same thing twice; they are doing two different things that add up. A related line of research shows that a structured mind-and-body practice can meaningfully reduce the risk of depression returning and stands as a safe, empowering option to sit beside maintenance medication (Kuyken et al., 2016). The evidence, taken together, does not pit the pill against the inner work. It says the two belong together.

What Perukua Says About the Deeper Work

This is the ground Perukua has worked all her life, and it is worth saying at the outset what she is and is not. She is a vocalist and women's facilitator whose work has reached women in more than 63 countries. She is not a doctor, she does not treat depression, and she would never tell a woman what to do about her medication. What she carries is a body of practice for the exact territory the research points to: the part of healing that a prescription cannot reach. Her first principle is that relief that lasts has to include understanding, not only symptom control. Until we understand the causes, she teaches, all our actions stay superficial. She does not say this about medicine; she says it about any of us who tries to make a feeling go away without ever asking what it came to say.

She is unusually credible here, because she learned it on her own body the hard way. As a girl she was handed an ideal of how a woman should look, and she chased it with punishing restriction until her body broke down and her health with it. What finally turned it around was not another external fix or a stricter regime. It began when she stopped fighting her body and started listening to it and treating it with care, and she is careful to add that getting medical help is part of that, that you can and sometimes should turn to a doctor. The lesson she took is one she now teaches: the body is not the enemy to be corrected, it is the messenger to be heard. The body and the emotions, she says, are always sincere; they never lie.

From there comes the piece of her teaching that speaks most directly to a woman whose medicine has quieted the worst but left her strangely flat or absent. So much of what looks like a mood problem, she teaches, begins as a habit of suppression. We were taught to be good, sweet, quiet girls, she says, and we learned, methodically, in family and in society, to hold our feelings down; and when we suppress and subdue what is alive in us, everything becomes rigid, it withers, it loses its life force. She noticed, too, that when a woman is under long stress she loses the very sensitivity of the body: we are only thoughts, in her words, we feel nothing. That numbness is not something a medication was built to reverse. It lifts when a woman is helped to feel safely again, and that is a practice, not a prescription.

Her own turning point shows what the practice actually looks like. She describes going out into nature and letting sound move through her, letting it travel through her whole body until she felt relief, because, as she puts it, the energy had to move through her so it would not stay stuck somewhere in the body. That is the release a pill does not provide: not the silencing of a feeling, but its safe expression and passage out. And her method for getting there is not dramatic. The first step, she teaches, is always awareness of what is happening; the second is slowing down. Awareness, slowing, and giving held feeling a channel through the breath, the body and the voice: that is the shape of the work she offers, and it is designed to sit quietly alongside whatever care a woman is already in, never to replace it.

Why the Medicine Reaches One Layer and Not the Other

It helps to see why medicine reaches one layer and the inner work reaches another, because once the two are clearly different jobs, the guilt and the confusion both ease. Depression is not one single thing. It is at once a shift in brain chemistry and body physiology, a weight of feeling and meaning, and, very often, a life that has drifted out of shape: relationships gone quiet, a self long unexpressed, grief or anger held down for years. An antidepressant works on the first layer. It steadies the chemistry so the floor stops giving way, so a woman can sleep, think and function again. That is real and it is often the necessary first move, because you cannot do deep work while you are drowning. But steadying the chemistry does not, by itself, restore feeling to a numb body, or speak what has gone unspoken, or change a life that no longer fits. Those live on the other layers, and they answer to a different kind of tending.

This is exactly why the leftover symptoms in the research are so common and so stubborn. When the medicine has done its job on the chemistry and something still feels off, that something is usually sitting on one of the other layers: the body still braced and unfelt, the feeling still held down, the life still misaligned. A higher dose or a different pill can be the right medical answer for some people, and that is a doctor's call, never a self-experiment. But often the missing piece is not more medicine at all; it is the layer medicine was never aimed at. This is why adding the inner and relational work to the pill beats the pill alone, and why the two benefits run on separate tracks (Cuijpers et al., 2014). They are treating different parts of the same condition.

One honest boundary belongs here before any practice, and it is the most important paragraph in this piece. Everything below is a gentle companion to treatment, not a treatment and not a reason to touch your medication. Do not change, reduce or stop an antidepressant on your own; that decision is your doctor's, made with you, because stopping suddenly can be genuinely dangerous. And some things are beyond the reach of any self-practice: if your mood is flat and heavy most of the day for two weeks or more, if you have lost interest in nearly everything, if you cannot function, or if you have any thought that you do not want to be alive, that is not a moment for a breathing exercise. That is a moment to contact your doctor now, or a crisis line such as 988 in the United States. Perukua is an artist and facilitator, not a doctor and not a therapist, and the practice below is offered in that spirit: as something to do alongside real care, to reach the layers the medicine was never meant to reach.

A Practice: Tend What the Medicine Cannot Reach

If your medicine is doing its part and you want to tend the part it cannot, the aim is not to fix yourself faster; it is to come back, slowly and safely, into your own body and feeling, so the layers the pill does not touch begin to soften and move. These are five gentle ways to do that, drawn from what the research rewards and what Perukua teaches, all of them meant to run alongside your care.

First, rename what you are feeling. Before anything else, change the story. A medicine that helps but does not make you feel whole is not proof that it failed or that you are beyond help; it is the ordinary shape of recovery, and it points to work on a different layer, not to a verdict about you. Perukua would have you go one step further and treat the leftover flatness or ache not as an enemy to silence but as a messenger to hear, because in her words the body and the emotions never lie. The practices below all work better once you are no longer at war with what you feel.

Second, come back into the body, a minute at a time. Numbness is often what remains when the chemistry is steadier but the body is still braced, and it lifts through gentle, repeated contact, not analysis. Once a day, rest one palm on your chest and one on your belly, let the breath drop low so the lower hand rises, and simply notice one real sensation: warmth, weight, the pulse, the air. Perukua teaches that under long stress we become only thoughts and feel nothing, and that slow belly breathing begins to reverse it; it also, in her teaching, gently massages the body's stress glands and lets them ease. This is the plainest form of the body-first work, and her free daily practice, From Stress and Anxiety to Inner Harmony in 15 Minutes, is built precisely to guide it.

Third, give the held feeling a channel. Suppressed feeling does not vanish; in Perukua's teaching it stays stuck in the body and quietly drains the life out of us. So let a little of it move, safely and privately. Let a long exhale carry sound, a low hum or an open sigh; let it become a fuller tone if it wants to; if tears come, let them come. She describes her own healing as letting sound pass through her whole body until she felt relief, so the energy would not stay stuck. You are not performing and you are not forcing a breakdown; you are opening a small, regular outlet for what has been held, which is the release a pill was never designed to give.

Fourth, look, without rushing, at what the sadness is pointing to. This is the understanding the research keeps returning to, and Perukua's principle that until we understand the causes our actions stay superficial. Not as harsh self-analysis, but as honest noticing: where in my life have I gone quiet, or gone along, or gone unexpressed? What have I been grieving, or swallowing, or postponing? You do not have to solve it. Naming it is the start. This is also the layer where a good therapist is invaluable, and where the evidence is strongest that adding that work to your medicine helps more than the medicine alone.

Fifth, keep the medicine in your doctor's hands, and build the rest slowly. As the inner work begins to reach you, you may feel more, which is usually a sign of thawing, not of getting worse. Let it be gradual, and keep every medical decision where it belongs. If you ever wonder about your dose, whether it is working, or whether you might one day come off it, take that to your doctor, not to your own judgment on a hard evening. Caring for the layers medicine cannot reach and letting your doctor steward the medicine are not in tension. Done together, they are the whole of the care.

In Closing

If your antidepressant helps but you still do not feel whole, hear this clearly: the medicine has not failed and neither have you. A pill was built to steady the biology, and that is a real and often necessary gift, the floor that lets you stand. But it was never meant to feel your feelings for you, to speak what you have swallowed, or to live the life that is still waiting. That is the work the medicine was never meant to do, and it is yours to do, slowly and safely, alongside your care. Come back into your body a minute at a time. Let held feeling move. Look, without cruelty, at what the sadness has been pointing to. Keep the medicine in your doctor's hands. The part that is not yet healed is not proof that you are broken. It is the part of you still asking, patiently, to be lived.

This piece is general information about wellbeing, not medical advice, and Perukua is an artist and facilitator, not a doctor or therapist. Antidepressants treat a real illness; never start, change, reduce or stop a medication on your own, as stopping suddenly can be dangerous. Any decision about medication belongs with your doctor. These practices are a companion to medical care, never a replacement for it. If your mood is flat and heavy most of the day for two weeks or more, if you have lost interest in almost everything, or if you have any thought of not wanting to be alive, please reach out to your doctor now, or contact a crisis line such as 988 in the United States.

References & Quote Sources

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