Most people on antidepressants don’t need them

I have these friends. Husband and wife. Rich. Academic. Political. Both on antidepressants.

They get a dog. Beautiful white german shepherd.

Dog is a bit wild. So they consult a "dog psychiatrist".

Psychiatrist puts dog on antidepressants.

Why not a few weeks of Doggy Dicipline Academy? It's common to get german shepherds a bit of training.

"Nope" says the psychiatrist. "That would be cruel".

They worship that psychiatrist. Dingalings.

Without knowing the exact approval history in the US, I doubt that it is a lax approval process as much as it is an absence of better alternatives.

There are not really any known effective clinical interventions (be they in the form of medicine, therapy, or things like more exercise), and a 10% improvement is better than nothing (clinical therapy (notably Cognitive Behavioral Therapy) is generally believed to be more effective but not by that much and it is financially out of reach for many people who are able to afford medication).

Prescription of antidepressants really should be coupled with therapy (and often is), which if done right should prompt plenty of introspection. Also in those with severe depression, functioning is so low it can be difficult to even engage in therapy or make life changes without other treatment first.

I think you make an interesting broader point though. Clinically there is not enough consideration of life circumstances when evaluating depression, in my opinion. Obviously something like a death in the family is taken into account, but from what I've seen baseline quality of life is not a huge consideration in whether depressive symptoms are clinically meaningful. I suspect antidepressants would be more effective if this were better teased out.

In any event, there are certainly interesting philosophical and policy questions here, but for an individual that suspects depression, they should seek professional help regardless. A good clinician is not going to just prescribe meds and then tell the patient they're done.

More on this from Derek Lowe of Things I Won’t Work With fame:

https://www.science.org/content/blog-post/uselessness-phenyl...

> Why would a huge chunk of the population have a imbalance of brain chemicals?

That's what I think about from time to time as well. I have ADD and take meds for it. But I'm pretty sure that I only need these meds to be able to work in an open-space, corporate IT environment with dead-lines, responsibilities etc.

Without meds I get overwhelmed and panicky quickly, when taking them they turn me into kind of an office robot who's able to work without getting too stressed out or distracted by other things.

I suspect that I wouldn't need the meds if I had a different job. Which feels weird, because it sounds like I'm trying to fit into an environment, instead of being in an environment which fits me, if that makes sense. Then again, maybe everyone has to do that and it's just my biased perspective that I'm the one who's not made for it.

Which sucks, because I love IT, also as a hobby.

The easiest examples for that: Sometimes I do an IT project at home, maybe build a PC, configure a homelab, try out Stable Diffusion or edit videos from time to time. If I do these things at home I can easily sit in front of the computer for 5+ hours and loose track of time, but I don't seem to be able to be as focused for IT projects at work if I'm unmedicated. Unless they really interest me.