There is very little evidence that depression is caused by chemical imbalance in the brain, it's something that big pharma have sold you so they can sell their drugs.
Great book on the topic, check out lost connections.
I'm generally skeptical about SSRI's, but I think this goes too far into conspiracy territory.
The problem with SSRI's, especially in my experience and from my understanding, is that they aim for "mildly beneficial with minimal side effects" and hit somewhere closer to, "mildly beneficial with understated side effects that many patients will be too embarrassed to report". This doesn't mean SSRI's are total junk, but it does mean that they're kind of mediocre.
Ketamine is more of a high-risk high-reward drug, similar to the use of CNS stimulants to treat ADD. There's no question that amphetamines help people focus. There's also, understandably, far more concern about giving people amphetamines in the first place.
Also, it's easier to convince patients to take a boring prescription drug than to sell them on, "I think the real solution to your problem is this really scary-sounding drug that people take at raves; trust me, I'm a psychiatrist."
IIRC there have only been two studies on antidepressants that have gone on longer than 2 years and have been properly placebo controlled (active placebo, no washout group), so if a metastudy claims to include 21 studies then that's pretty good evidence that the metastudy is flawed.
> The results are reported after 8 weeks of treatment, so we don't know if they apply to long-term use of antidepressants.
I'm not sure why you would discount an improvement in symptoms over 8 weeks though. Many major depressive episodes will be resolved in that time ("The median duration of MDE was 3.0 months; 50% of participants recovered within 3 months"[1]), so even if they are not suitable, or less effective, for long term care, that can still be a improvement in quality of life.
(FWIW, it was 21 antidepressants, not 21 studies: "The researchers found 522 studies covering 116,477 patients in total. This included 101 previously unpublished studies.")
> I'm not sure why you would discount an improvement in symptoms over 8 weeks though.
I'm not, but I don't think anyone is arguing that SSRIs can't be effective for some people with severe depression when used in the short term. The issue is that that only represents a small percentage of patients.
Yes, while the "moar serotonin = moar happy" explanation of why antidepressants work is oversimplified and wrong in many cases, there is empirical evidence that some antidepressants are effective at treating the symptoms of depression and other illnesses.
I'm to depressed to look it up again, but there was a Psychologist Dr. Irving Kirsh whom used the Freedom of Information Act to study All the studies on antidepressants.
This is written about Kirsh's study, and it's confusing. Kirsh interpolation of the raw data showed that antidepressants don't work, and work less so for extremely depressed patients.
This doctor claims the opposite?
Pesonally, I find the research on the efficacy of antidepressants very confusing.
To those whom are depressed, I can offer this, it does get better with age.
You can also check out Peter Kramer's "Ordinarily Well: The Case for Antidepressants" for the exact opposite take. And "Against Depression", also by Peter Kramer, is a good take on recent findings about the biological roots of depression.
Dr. Kramer - he's a psychiatrist, who specializes in depression. I only point this out as the gentleman who wrote "Lost Connections" is a journalist, and thus holds no education to the discussion.
There is very little evidence that depression is caused by chemical imbalance in the brain, it's something that big pharma have sold you so they can sell their drugs.
Great book on the topic, check out lost connections.