On HN, if you have a substantive point to make, make it thoughtfully; if you don't, please don't comment until you do.
A more accurate TL;DR might be something like: allowing off-label prescription is a two-edged sword. One the one hand, it has enabled innovation and the discovery of clinically effective treatments. On the other hand, the benefits are unevenly distributed because few doctors know about them, we know less about the side effects, and knowledge about effectiveness versus placebo is limited.
I would comment that many off-label treatments using anti-depressants do have significant double-blind studies behind them.
It’s slow and it costs, but there are good reasons for the trials required to demonstrate efficacy.