Why it is important to discuss what antidepressants do

Kendrick and Collinson suggest that we overstepped the data in discussion of the relevance of our serotonin paper to antidepressant use.12 The serotonin hypothesis was propagated by drug companies and academics as a rationale for why people should take antidepressants. It is still widely disseminated,3 but the evidence is unconvincing. No other biological hypotheses for depression are proved or accepted.4If there is no conclusive evidence that antidepressants work by reversing an underlying abnormality, we must consider other plausible explanations for how they might work. We know antidepressants, like other psychoactive drugs, produce subtle mental changes,5 including emotional numbing.6 These are likely to affect depressive symptoms and might, along with physical effects, produce amplified placebo effects (which are not refuted by the paper cited, as there is good evidence of unblinding7 and expectation effects in antidepressant studies).8 We suspect that few patients are currently given this information.The antidepressant trials mentioned routinely…
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