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Most SSRI’s are prescribed by general practitioners and often with fairly low thresholds. I’ve seen interactions like this: Patient comes in to follow up high blood pressure. Doctor: Have you been feeling depressed lately? Patient: Well, yeah I have actually. Doctor: Do you want to start a medication for that? Patient: Uh, ok.

Most psychiatrists would not do that. And I think psychiatrists at academic centers would not pretend to know exactly how SSRIs work at this point.

Nonetheless, SSRIs have a modest effect on average but for some patients they’re life changing. Recently met someone who was so depressed she could barely get out of bed in the morning. Started on the right Med (after a first failed trial) and she’s been happy ever since (more than a decade).

Soon enough we’ll be able to specifically identify which patients are likely to be good responders and who won’t.