Well, there isn't really a cure for depression. Antidepressants work, in my opinion, by reducing the severity, or eliminating, some of the symptoms of depression, for example, anxiety, sleep disturbances, poor self esteem, without necessarily ever treating the depression itself. They lower your Hamilton score without necessarily curing the actual depression. In a clinical trial, the conclusion will be that the active compound lowered the Hamilton score of subjects on average significantly more than placebo, and the antidepressant will be hailed as effective. In reality, the antidepressant should be declared efficacious without necessarily being effective.
When you speak to many depression patients who are on antidepressant medication, they'll tell you the antidepressants work, in some sense, but that at the end of the day they still feel depressed.
Take caffeine for example. Caffeine actually raises your Hamilton score because it promotes insomnia, anxiety and irritability. Yet coffee drinkers usually report that coffee has a strong though short-lived antidepressant effect. I seem to recall that coffee drinking is associated with a lower suicide rate. Caffeine is a substance that, on paper, promotes depression, in the simplistic way that the severity of depression is measured, while in reality, it actually has an antidepressant effect.
I believe that prescription antidepressants work similarly. They lower your Hamilton score without ever really improving your mood. They may even work by reducing your ability to feel in its entirety, good or bad. Anhedonia is a documented side-effect of SSRI antidepressants. Long term use of SSRIs has an antidopaminergic effect as the dopamine transporter begins doubling as a serotonin transporter.
Some antidepressants barely outperform placebo. This is not necessarily as bad as it sounds because mental illness, by its very nature, has a strong psycho-somatic component. But I think one should be careful to adopt the attitude that antidepressants work, and alternative treatments don't, because there is plenty of evidence to the contrary.
An example of this is the infamous JAMA trial where St John's Wort was compared to placebo, with Zoloft as an active comparator. Both St John's Wort and Zoloft failed to outperform placebo. The press focused on the fact that St John's Wort, the alternative treatment, failed to outperform placebo, with little mention of the fact that Zoloft fared the same. This shows the bias against alternative treatments.
A meta-analysis has shown that the prescription antidepressant reboxetine does not outperform placebo.
Pharmaceutical companies also commit fraud. Here is a document, previously used in lawsuits used against Eli Lilly, showing how the company instructed researchers to alter trial data on fluoxetine:
It is a documented fact that young depression patients who use SSRI antidepressants are at higher risk of attempting suicide than young depression patients who do not use SSRI antidepressants.
SSRIs raise pre-synaptic serotonin levels within hours of taking the first tablet, yet an antidepressant effect takes weeks to manifest, coinciding with hippocampal growth, which may be, ironically, due to the release of brain-derived neurotrophic factor, a hormone that promotes neuron repair, released in your brain when the brain perceives itself as being under attack. How does this, the fact that increased levels of serotonin don't immediately yield and antidepressant effect, bode for the serotonin hypothesis of depression?
The antidepressant tianeptine is a serotonin reuptake accelerator. It does the opposite of SSRIs. How does this bode for the serotonin hypothesis of depression?
In my own depression journey, I have been treated by psychiatrists and GPs using medication, I have seen a psychologist, and I have experimented enthusiastically with supplements, diet, and lifestyle interventions. I believe, based on my experiences, that the best treatment is a comprehensive treatment. I do not believe, based on my experiences, that standard psychiatry on its own is all that effective, for depression at least, and I have, on many occasions, benefited greatly from the advice of the so-called quacks.