| Wow, where to start... 1. The whole 'chemical imbalance' thing is a gross over-simplification that might help as an introductory mental model but breaks down quickly. 2. The right thing to be measuring is symptoms, not the mythical chemical imbalance. Studies do measure changes in symptoms, typically using various rating scales, e.g. HAM-D. Measuring this way has its issues and challenges, but is being done. 3. Yes, there is an element of experimentation to find the right medication, which is hardly unique to psychiatric medications. 4. Yes, some medications are hard to quit without doing so slowly. Too many doctors don't help their patients with this. 5. Antidepressants are surprisingly effective, at least compared with many other medications. A good metric for effectiveness is the "number needed to treat" (NNT). It basically means how many people do you have to give a treatment to before you get a positive response that you otherwise wouldn't. With antidepressants, it's generally low single digits, for many around 4. Only helping 1 in 4 doesn't sound great. But check out theNNT.com for some comparisons. Aspirin to prevent heart attacks (NNT of 50-200 for people with previous heart disease, NNT 2000+ for those without previous heart disease). Antihypertensives (NNT ~100). See what's considered successful in other areas of medicine... |
The NNT for antihypertensives to lower blood pressure is essentially 1, after all.