Key idea: SSRIs change the chemistry of the synapse. Whether that is enough to treat depression is the question HL essays weigh.
Antidepressant medication
What it does
SSRIs, such as fluoxetine, block the reuptake of serotonin, so more stays in the synapse.
How long
Mood usually starts to lift after two to six weeks, not at once.
Side effects
Nausea, poor sleep or lower sex drive for some people; stopping suddenly can cause problems.
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Cipriani and colleagues (2018) combined 522 trials with about 116,000 adults: all 21 antidepressants studied beat a placebo, though the average benefit was modest.
Go further: higher-level insight: Kirsch and colleagues (2008) combined drug company trials: for many patients, antidepressants did only a little better than a placebo, with a clear gain mainly in very severe depression.
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Key idea: Two large analyses agree that the drugs beat a placebo, and differ on whether the gain matters for most patients.
Cipriani and colleagues (2018)
- 522 published and unpublished trials
- All 21 drugs beat a placebo
- Benefit modest on average
Kirsch and colleagues (2008)
- Trials sent to the US regulator
- Small gain for many patients
- Clear gain mainly in very severe depression
So effectiveness depends on severity, and on time: relapse is more common after stopping medication than after cognitive therapy (Hollon, 3.1.9).
What HL adds: Paper 3 sources give effects as averages. Ask how big the difference is, not only whether there is one, and whether unpublished results were included.