Oh! Well sure SSRIs are over-prescribed and shouldn't be a "front line" treatment. I agree with that. That, to me, is a very different question. What we call "

Oh! Well sure SSRIs are over-prescribed and shouldn't be a "front line" treatment. I agree with that. That, to me, is a very different question. What we call "depression" seems to be a complex bundle of brain mess. We group by symptom but unfortunately need to treat by cause and they are not 1:1. So SSRIs are a tool "we" have on a population level - but each individual depressed person is their own situation. Remember that "better than a placebo" is a population-level measure. Individual people will find a SSRI helpful or hindering as they go. I think you are mixing...policy ("we shouldn't assume this works for everyone") with drug efficacy ("SSRIs don't help more than a sugar pill"). How each persons' depression works is different and up-regulating serotonin is helpful to some subset of people. We don't know why and it's not the whole population, but talking about them in this way is not helpful in my mind.