There is also evidence that they might only work better than a typical placebo because the side effects make them an "active placebo", triggering a stronger placebo response. i.e. if you take a pill that doesn't make you feel any different, you may wonder if it's working, but if you feel weird and have unpleasant side effects then you know it's doing something.
This is particularly underappreciated in the research done on these drugs, because a double-blind study isn't actually double-blind if many of the participants can easily tell whether they're in the placebo group due to very noticeable side effects.
It's been mentioned in other comments, but I really recommend the work of Irving Kirsch on this; he's a brilliant scientist and his book The Emperor's New Drugs is a real eye-opener.
“They work fantastically” is a statement that requires many qualifiers.
They work fantastically for some subset of people. For other people, they do nothing. For other people, they have negative side effects that make them not worth whatever benefits they provide. For some people, they cause extreme negative effects when the medication is removed. For some other people, they increase the chance that they will commit suicide.
It does matter that we haven’t pinpointed why they work for some people, because if we did, we might be able to avoid those negative effects and wasted time for the people for which they don’t work.
If the effect is systematic, real, and measurable, it's just a matter of giving the medication to the people that benefit from it, and not giving it to the people that don't.
The real question is by what level is the effect is systematic, real, and measurable?
So the solution is prescribing something that has a lot of unpleasant side-effects for a lot of people? Medication that if you don't take will have SEVERE withdrawal symptoms?
I'm not trying to minimize the problems other people have had with withdrawal at all, just saying that it's possible to have a variety of different outcomes being on and off of them.
I wonder why you say 'SEVERE' so severely. It doesn't sound like you have any direct experience of this. I had to come off them and it wasn't a problem. My biggest fear, and it was huge, was that the depression would return. It didn't.
I had horrible withdrawal effects coming off lexapro/escitalopram, it was literally the worst experience of my life. I spent a month with maxed-out anxiety, feeling like I was going to die any moment, waking up at night with electric shocks running through my body, etc. I wouldn’t wish it on my worst enemy.
OK, that's an SSRI which is what I had to come off (prozac), with no major issues.
I'm not at all claiming it's a fun ride for everyone, just giving my one data point that it's not inevitably awful for absolutely everyone. Sorry you had to deal with it!
> It doesn't sound like you have any direct experience of this
It doesn't matter if I have personal experience with this although I do. A very bad personal experience with the mental health service that was provided as well as the side effects I was talking about.
> I had to come off them and it wasn't a problem.
This just comes off as ignorant, there is established literature on the withdrawal effects. I was not speculating or spreading FUD. They are real, documented and more common than your anecdotal lucky experience
They can however prescribe basically harmless pills that do more or less nothing. Low dose vitamin pills are sometimes used for this purpose.
Whether or not it's ethical for a doctor to tell a depression patient that the depression is caused by a treatable vitamin deficiency is another matter. Then again, maybe it really is caused by a lack of micronutients. After all we really don't understand depression very well.
This is particularly underappreciated in the research done on these drugs, because a double-blind study isn't actually double-blind if many of the participants can easily tell whether they're in the placebo group due to very noticeable side effects.
It's been mentioned in other comments, but I really recommend the work of Irving Kirsch on this; he's a brilliant scientist and his book The Emperor's New Drugs is a real eye-opener.