Science behind common anti-depressants appears to be backwards, researchers say

The problem is that we&#x27;ve never had an adequate theory of what depression is, and the evidence seems to be that it is far more complex and situational than any one-pill-fixes-all approach could ever attack. The author is correct, but hardly novel or prescient, in noting that there are serious issues with the long-term efficacy of SSRIs and SNRIs (and most other classes of psychoactive drugs). The problems of discontinuation of drug therapy, especially for long-term users, and that the drugs often appear to exacerbate the condition when withdrawn, were noted decades ago.<p>So, this &quot;study&quot; appears to rehash some old (and valid) critiques of the therapy. All it adds is the interesting hypothesis that depression is &quot;natural&quot; (so is senescence and death) and &quot;beneficial&quot;. Which I guess is the novel part.<p>We may not know what causes depression, but we do know that the constellation of symptoms that we call clinical depression are uniformly unpleasant and all-too-often fatal. So I&#x27;m really not convinced that labelling it natural and beneficial absent some pretty strong evidence is all that helpful.

From the sound of it, the important issue in question is depression itself, and not so much the efficacy of SSRIs. If the causes surrounding the physiological roots of depression are unknown or incorrect, no medicinal approach will be able to accurately address the issue, thus always leaving room for the placebo argument.

Unfortunately, without access to the full article, I can&#x27;t say for sure what the authors argue, but another possible explanation for the long delay between treatment onset and the reduction of depression is that SSRIs act as an active placebo.<p>If so, SSRIs are &quot;active&quot; because they do change <i>something</i> in the brain (unlike a corn starch placebo), but a placebo because the thing changing (serotonin levels) is unrelated to depression. However, since we know something is changing, we believe we&#x27;ll get better... and thus, we do.<p>(Think of an active placebo like menthol in dandruff shampoo. Menthol makes the scalp tingle and convinces us it&#x27;s working, but does nothing for the scalp itself.)<p>Regardless, there&#x27;s a lot of gaps and unexplained weirdness in how antidepressants work, so there&#x27;s still a lot of work to be done.

Given that the monoamine hypothesis was based on fraudulent research to begin with, has been contradicted by pretty much every study since, and has been discredited for years, this result is kind of moot at this point.

&gt;The best available evidence appears to show that there is more serotonin being released and used during depressive episodes, not less, the authors say.<p>During my brief stint on an SSRI I felt as numb as I ever had in the depths of depression, maybe even moreso - enough that I wasn&#x27;t worried about how numb I was. I stopped taking them because of that, it felt backwards to me as well.