Do antidepressants really cure depression, or just mask symptoms for a few weeks?

In this livestream podcast, Nassir Ghaemi breaks down what it means for a drug to “work.” He explains that antidepressants—better called monoamine agonists—can reduce depressive symptoms for a short period, especially in severe cases, but they do not eliminate the illness or prevent future episodes.

He reviews over 500 randomized trials and meta‑analyses (see https://www.thelancet.com/article/S0140-6736(17)32802-7/fulltext, https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050045, https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1399-5618.2008.00639.x, https://www.sciencedirect.com/science/article/pii/S0149291811007703). The data show a modest average benefit (Cohen’s d ≈ 0.3, about a two‑point drop on the MADRS), which is clinically meaningful only for severe depression. In mild to moderate cases the drug‑placebo difference disappears, and the placebo effect itself reflects natural recovery as well as therapeutic interaction.

The takeaway: these medications act like Tylenol for a fever—useful for short‑term symptom relief in severe depression but not a disease‑modifying solution. They lack evidence for long‑term prevention, especially in bipolar depression where they may even worsen outcomes. Consider them as one tool among psychotherapy, lifestyle changes, and, where appropriate, other pharmacologic options such as lithium for mood stabilization.

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