Psychiatry’s Necessary Shadow
Andrés Ruiz

You have selected articles to “prove” your point about antidepressants but such selection bias is the same tactic dishonest pharmaceutical companies use when they suppress certain studies and elevate others. Trying to interpret the multitudinous studies on antidepressants is much more daunting that the simplified approach taken by the author you champion. Actually, the scientific consensus is that while there is a large placebo effect present, antidepressants are not only of benefit but are lifesaving. Now you can go against the scientific consensus if you want, but your camo will include the anti-vaxers, climate change skeptics, etc.

The most compelling evidence of the efficacy of antidepressants comes from those afflicted with and relieved of severe depression. There are countless such people walking around living happy healthy lives who would otherwise be suicidal, thanks to antidepressant medication. That these patients more often than not relapse when they stop their medication does not support the thesis that their benefit is due to placebo effect which is well known to dissipate after a few weeks.

It is true that the molecular reasons antidepressants work are beyond the reach of science does not disprove their effectiveness. Fleming had no idea how his penicillin mold killed the bacteria, but that did not slow its deployment to treat infections, nor should it have. That the mechanism of antidepressant benefit is still unknown is not so surprising when one considers the incredible complexity of the brain.

As a psychiatrist, I look at the body (including the brain) and the individual (psyche). As one trained in the biopsychosocial model, I agree that today, to a distressing degree, there is a reductionistic approach which tries to shoehorn depression into a strictly medical phenomenon. In my experience, depression almost always has the dual aspects, the biological and the psychological, and its successful treatment requires the ministrations of both realms by qualified people.

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