There’s a fundamental issue about SSRIs that most people are unaware of and it explains a large part of their perceived effectiveness.
It is well-known that placebo is one of the most powerful interventions in depression, often accounting for the majority of clinical improvement in trials.
But something even more problematic happens in antidepressant trials.
The gold standard of evidence-based medicine is the double-blind, randomized controlled trial (RCT).
Neither the patient nor the clinician should know who is receiving the active agent and who is receiving the inert placebo.
However, SSRIs possess a distinct side effect:
dry mouth, nausea, sexual dysfunction, and sedation.
Inert placebos do not.
This discrepancy leads to unblinding. In clinical trials, patients who experience side effects correctly guess they are in the active arm.
Side effects act as a cognitive confirmation that the patient is receiving a "potent" treatment. This confirmation amplifies the expectancy effect, creating a placebo response.
Essentially, the more toxic the drug feels, the more the patient believes it is working, inflating the subjective reporting of mood improvement.
If you are interested about this subject I couldn't recommend more:
Chris Masterjohn articles about SSRI
https://t.co/ioXvADVosY
"Antidepressants and the Placebo Effect" and "The Emperor's New Drugs" - Irving Kirsch
The serotonin theory of depression: a systematic umbrella review of the evidence - Joanna Moncrieff
Bonjour à la #TeamParieur ! 💸
Je suis un étudiant parieur et j’ai enfin décidé de commencer mon propre compte sur Twitter.
Après des années de pratique, ces derniers mois et surtout cette coupe du monde m’ont convaincu de me lancer. 🏆