Mental illnesses are very complicated entities. Any single mental illness can have numerous simultaneous physiologic problems which all contribute to the development of the illness.

The reason this is so is that mental function is highly preserved by multiple redundant systems. Without intact mental function, human beings and other animals would not be able to survive in the wild. Rather, they would be easy prey. Even the brain has some capacity to regenerate and restructure itself to cope with injuries.

The problem of single treatments is that they may not cover enough of the physiologic problems to make a difference.

Also, current psychiatric medications are not developed or used by physicians with the intent to treat specific identified physiologic problems associated with a mental illness. Thus, they may not even solve the problem to begin with.

For these reasons, on the surface, a particular medication may appear to be a placebo.

However, if one identifies a physiologic problem associated with a mental illness and specifically targets it with treatment, then the treatment is much more likely to be successful.

For example, if suboptimal serotonin signaling is a prominent pathophysiology (physiologic problem) of an illness such as depression or anxiety, then using an SSRI is very appropriate and can make a significant difference.

However, if inflammatory signaling, dysfunctional adrenal function, nutritional deficiencies, and/or hormonal problems are the prominent
problems then an SSRI may not work significantly.

Unfortunately, again, physicians do not often consider pathophysiology first before treatment. They do trial and error work. This is why SSRIs can get a bad reputation.

Additionally, SSRIs may be given without considering a person’s dopamine signaling status, iron status, etc., to determine how the SSRI may influence other systems and cause adverse effects, which can negate the benefits.

From my point of view, SSRIs are being incorrectly used.

SSRIs when used well can be life saving. They can work well. They can work predictably. But only if the underlying pathophysiology and physiology are understood so that they may be correctly used.