The molecular action of antidepressants is irrelevant

For many years I have explained to patients that the molecular action of antidepressants is ultimately irrelevant to their clinical application. When patients ask me, “Does this mean I have a serotonin deficit?” I tell them that our success gluing up a broken chair leg does not mean the chair had a “glue deficit.” We prescribe these drugs—we try them—because they are often helpful.Moncrieff and Horowitz’s notion that the serotonin hypothesis could be “a rationale for why people should take antidepressants”1 overlooks the practical fact that clinicians continue to prescribe them not because they block the serotonin reuptake pump but because clinical experience repeatedly validates their clinical effectiveness.This is not to say that clinical experience is a very reliable guide to what works; it is the business of “drug companies and academics” to provide reliable evidence for what works—that is, to overcome each clinician’s limited experience and faulty heuristics. Debunking…
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