The Epidemic of Mental Illness: Why?

It's actually even worse than that because they do something called washing out placebo responders. Essentially before the study begins they give everyone a placebo, and then eliminate those who respond best to the placebo from the study. So that 82% figure is only compared with the people who didn't receive the most benefits from the placebo. The most ridiculous part is that the FDA has let the pharma companies get away with this for so long they now argue that it's not unethical because everyone else is doing it, it's just the standard practice.

Robert Whitaker has a great explanation of the implications of this in his book Anatomy of an Epidemic, which is one of the three books this article is reviewing.

Even more striking: “When administered as antidepressants, drugs that increase, decrease or have no effect on serotonin all relieve depression to about the same degree.”

Any drug that has palpable side-effects works about as well as current antidepressants. The most astonishing example is tianeptine, a Selective Serotonin Reuptake Enhancer. An antidepressant that has a main mechanism of action that is the exact opposite of SSRIs, but is just as effective. However you slice it, that's utterly fascinating.

Either tianeptine has a yet-unknown mechanism of action, in which case there's the potential for a whole new class of drugs, or it doesn't, in which case the serotonin hypothesis has to be fundamentally rethought. If there was any amount of intellectual honesty in psychopharmacology, there would be a huge research effort to decode exactly why tianeptine works. As it is, nobody is prepared to even fund FDA approval. A cynical man might wonder whether more attention might be paid to the drug if it were still under patent.

IMO this is the smoking gun of modern psychiatry. Nobody wants to talk about tianeptine; Nobody wants to talk about why nobody wants to talk about tianeptine. I cannot imagine any possible explanation that isn't absolutely damning.