So a few days back I was tweeting about SSRIs. The big question with these drugs is: why do controlled trials routinely show such small effects when practitioners and patients report life-changingly-large effects?

So first off, at this point the evidence is pretty clear that SSRIs and other anti-anxiety/anti-depression drugs truly don't do very much. Their average effects are beneath clinical significance, as I tweeted about here:

Basically, the problem these drugs face is that while they actually see relatively LARGE effects.... but that placebos in those trials ALSO see large effects (and most untreated depression improves within a year anyways).

So basically you have this problem where:
1. The condition tends to improve on its own in a majority of cases
2. Placebo effects for the condition are unusually large

Which means the large crude effects of SSRIs get swamped.

So that raises two new questions.
1. (Not my focus here) Are we treating these conditions appropriately given their untreated prognosis is usually (though certainly not always!!) "goes away in a few months"?

2. Why are placebo effects so unusually large?