Mace and Jeff put Matt Walsh’s antidepressant episode under the clinical microscope — and it does not pass the functional impairment test. They break down the 2022 Molecular Psychiatry umbrella review that dismantled the low-serotonin narrative, explain why that finding doesn’t indict SSRIs as a category, and make the case that the “chemical imbalance” pitch was always more pharmaceutical advertising than clinical science. They also tackle what functional impairment actually means in diagnosis, the gender disparity in antidepressant prescribing, whether the SSRI-to-mass-violence argument is causal or just really committed to showing up in the same sentence, and what clinicians should actually be telling clients about medications they can’t fully explain. For anyone who has ever explained serotonin to a client and quietly wondered if they knew what they were talking about: this one’s for you. Music: “Machine Heart – Instrumental version” by Icarus. Licensed via Artlist Pro License #JeMO9k. Bielefeldt, A. Ø., Danborg, P. B., & Gøtzsche, P. C. (2016). Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers. Journal of the Royal Society of Medicine, 109(10), 381–392. https://doi.org/10.1177/0141076816666805 Brody, D. J., & Gu, Q. (2020). Antidepressant use among adults: United States, 2015–2018. NCHS Data Brief, No. 377. https://www.cdc.gov/nchs/products/databriefs/db377.htm Chua, K. P., Volerman, A., Zhang, J., Hua, J., & Conti, R. M. (2024). Antidepressant dispensing to US adolescents and young adults: 2016–2022. Pediatrics, 153(3), e2023064245. https://doi.org/10.1542/peds.2023-064245 Healy, D., & Mangin, D. (2024). Post-SSRI sexual dysfunction: barriers to quantifying incidence and prevalence. Epidemiology and Psychiatric Sciences, 33, e44. https://doi.org/10.1017/S2045796024000441 Kuehner, C. (2017). Why is depression more common among women than among men? The Lancet Psychiatry, 4(2), 146–158. https://doi.org/10.1016/S2215-0366(16)30263-2 Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2023). The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry, 28, 3243–3256. https://doi.org/10.1038/s41380-022-01661-0 Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143(8), 783–822. https://doi.org/10.1037/bul0000102 Stone, M., Laughren, T., Jones, M. L., Levenson, M., Holland, P. C., Hughes, A., Hammad, T. A., Temple, R., & Rochester, G. (2009). Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration. BMJ, 339, b2880. https://doi.org/10.1136/bmj.b2880
