What does “work” mean in the case of antidepressants?

For many people who think that depression is caused by low serotonin, an antidepressant “working” means that it corrects their serotonin system.1 The honest message to such patients is that their serotonin system is likely to be more abnormal after treatment than before.2This might be a risk worth taking if there were evidence that the drugs saved lives or prevented suicide attempts. But more people died on active treatment than placebo in antidepressant trials submitted to the US Food and Drug Administration—even when the data from withdrawal and follow-up periods were excluded. Suicidal events with these treatments were double those with placebo, again after the suicidal events in the withdrawal period were excluded.3 Neither is there evidence that antidepressants help people return to work or improve quality of life.4The data underpinning the studies that Kendrick and Collinson mention just show that company assays worked at getting their drugs to the…
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