Like alcohol, which will produce inebriation in a person who has been diagnosed with schizophrenia, obsessive compulsive disorder, depression, or someone with no psychiatric diagnosis, SSRIs will also impact individuals in ways that are not specific to a diagnosis. Similarly, the class of drugs known as “neuroleptics” (misnamed “antipsychotics”) have also been advocated for the treatment of psychosis, depression, anxiety disorders, bipolar disorder, personality disorders, and so on — a list that contains considerable overlap with that found for SSRIs.
The therapeutics of these drugs rely on non-specific factors rather than disease-specific therapeutic effects. For example, with SSRIs, the evidence points to placebo effects being more important than any neuro-pharmacological ones. Much more. For example, having a good relationship with the prescribing doctor is a stronger predictor of a positive response to an “anti-depressant” than just taking the drug regardless of who prescribes it.
In fact, much evidence suggests that “antidepressants” are best thought of as enhanced placebos. The tiny (and not clinically significant) extra on-average improvement over placebos that SSRIs achieve in studies is most likely accounted for by “unblinding.”
What this refers to is that in studies when you compare a drug with a sugar pill placebo (a placebo is a pill that has no active chemical ingredient), you keep secret from the patients in the study and those who assess them, which patient is taking the SSRI or the placebo. Of course, patients would like to guess whether they are taking the active treatment or not, and so if you get side effects or feel different, you may realise you are on the SSRI side of the trial. When patients correctly guess they are taking the active pill and not the placebo, this is called “unblinding” (they are no longer ‘blind’ as to which arm of the study they’re in). It seems that unblinding is common in “antidepressant” studies.
This all means there is no such thing as an “antidepressant,” “antipsychotic,” “mood stabiliser,” and so on. These are dangerous concepts that, like “psychiatric diagnosis” have become established in our culture through marketing and institutional self-promotion. As far as the science is concerned, there are no chemical imbalances that these are correcting. Psychiatric medications, like alcohol or street drugs, make you feel different and then you have to interpret the significance of that for you.
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