Your patients seem to have a problem deeper than depression. They seem to be spending their lives doing things that they hate. Taking a pill to hate it less is probably a sub-optimal solution.
That might be true, but it is very hard for people to make reasoned changes when they are deeply depressed. Depression has real cognitive effects, which people frequently complain about. Depressive reasoning often looks like I SUCK I SUCK I SUCK I SUCK Everything is my fault and I screwed it all up, and I can’t fix it, and I can’t fix it because I SUCK I SUCK I SUCK. Ok—let me focus for a second—If I change this… I SUCK I SUCK … Ok, if I change this thing then… why can’t I think? Oh right I SUCK I SUCK I SUCK… etc, etc. Getting people out of that pattern is very helpful.
I think there’s a “different worlds” thing going on here that might be impeding communication. My experience of people suggesting that maybe I’m depressed is that they think I’m misguided in focusing on changing the underlying conditions of my life or trying to figure out what’s wrong. Maybe this is a deep depression vs moderate/mild depression thing.
It makes sense to me that someone in the condition you’re describing would benefit a lot from taking a pill to free up mental space. But, people I know very well have been prescribed pills to alter their mood without anyone checking whether their mental condition was anything like what you described.