This was a seminal review in psychiatry that I am fully in agreement with but there are a lot of easy to draw conclusions from this review that are false.
SRRI efficacy for one - The nature of SSRIs is that they are highly effective for some patients and useless/detrimental to others. This does not lend itself well to traditional measures of effect size. For those in the comments pointing out SSRIs low effect size, note that the effect size of morphine for pain is only 0.4 (SSRIs score 0.3). For instance, drugs that significantly improve 60-100% of patients are clinically insignificant under various guidelines. I can expound upon the various methodological reasons this is the case if there is interest.
This is not to say that SSRIs are good. There is no doubt they are overprescribed, have underdiscussed side effects, and are barely understood by their prescribers. I was severely depressed with suicidal ideation since I was 6 years old until I was young adult. I have pored over the psychiatric scientific literature for many years now, and I will say that understanding the sociological reasons for depression was much more effective at helping me than learning about the biological or pharmacological aspects. If you are in a similar position, I cannot recommend enough reading Crazy Like Us: The Globalization of the American Psyche by Ethan Watters as a starting point.
Another problem with measuring effectiveness that you are relying on patient (or caregiver) reported outcomes. There are no “objective” measurable criteria for depression, such as a biomarker on some lab test or survival at 5 years. Depression is assessed by asking people questions about how they feel, which is prone to all kinds of noise and bias.
A lot of the problem with studying psychiatric disorders is that you can’t just go around biopsying people’s brains; so we don’t have much of any idea what is going on at a molecular or cellular level. We just kind of know the behavioral tics that doctors can observe and what patients can tell us.
Thank you for ending with a further reading suggestion as a useful complement to your personal experience and research. Your write up is a strong positive in continuing toward advancing education, open mindedness, and patience with a delicate subject. I appreciate your notes in this context and, as small as one voice is in “anecdata” context, I’m glad to see the mention of sociological factors because it’s also in my journey of discovering more.
SRRI efficacy for one - The nature of SSRIs is that they are highly effective for some patients and useless/detrimental to others. This does not lend itself well to traditional measures of effect size. For those in the comments pointing out SSRIs low effect size, note that the effect size of morphine for pain is only 0.4 (SSRIs score 0.3). For instance, drugs that significantly improve 60-100% of patients are clinically insignificant under various guidelines. I can expound upon the various methodological reasons this is the case if there is interest.
This is not to say that SSRIs are good. There is no doubt they are overprescribed, have underdiscussed side effects, and are barely understood by their prescribers. I was severely depressed with suicidal ideation since I was 6 years old until I was young adult. I have pored over the psychiatric scientific literature for many years now, and I will say that understanding the sociological reasons for depression was much more effective at helping me than learning about the biological or pharmacological aspects. If you are in a similar position, I cannot recommend enough reading Crazy Like Us: The Globalization of the American Psyche by Ethan Watters as a starting point.