[tumba]

That’s a bit reductive. For example, many anti-depressants affect serotonin reputake, which is now known to be integral to gut function. Further, often these off-label uses are at doses far below the levels required for anti-depressant effects.

A more accurate TL;DR might be something like: allowing off-label prescription is a two-edged sword. One the one hand, it has enabled innovation and the discovery of clinically effective treatments. On the other hand, the benefits are unevenly distributed because few doctors know about them, we know less about the side effects, and knowledge about effectiveness versus placebo is limited.

I would comment that many off-label treatments using anti-depressants do have significant double-blind studies behind them.

[QAPereo]

The first principle is that you must not fool yourself and you are the easiest person to fool.

It’s slow and it costs, but there are good reasons for the trials required to demonstrate efficacy.

[ogdoad]

It was intentionally reductive :)