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I have for many years 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.
The authors' notion that the serotonin hypothesis could be "a rationale for why people should take antidepressants" overlooks the practical fact that clinicians continue to prescribe them not because they block the 5HT reuptake pump, but because clinical experience repeatedly validates their clinical effectiveness.
This is not to suggest 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, ie to overcome each clinician's limited experience and faulty heuristics. Debunking the (never terribly convincing) serotonin hypothesis has nothing to do with whether or not we should prescribe SSRIs.
Competing interests:
No competing interests
10 October 2022
John Wynn
Psychiatrist
Clinical Professor, U. Washington School of Medicine
Re: Why it is important to discuss what antidepressants do
Dear Editor,
I have for many years 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.
The authors' notion that the serotonin hypothesis could be "a rationale for why people should take antidepressants" overlooks the practical fact that clinicians continue to prescribe them not because they block the 5HT reuptake pump, but because clinical experience repeatedly validates their clinical effectiveness.
This is not to suggest 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, ie to overcome each clinician's limited experience and faulty heuristics. Debunking the (never terribly convincing) serotonin hypothesis has nothing to do with whether or not we should prescribe SSRIs.
Competing interests: No competing interests