Paul Saladino· MD
these medications are number one over prescribed number two in the people that it does work it takes a while it takes four to six weeks suggesting that the mechanism has nothing to do with the amount of serotonin in the synapse it may have to do with other things having you know connected with that which we can talk about but in terms of the efficacy of these medications the trial is called star D and there have been multiple reappraisal xandrie analysis of star dekes but if you look at the star D trial with antidepressants what they generally find is that only about 30 to 40% of people respond well how many people responded to placebo about 25 to 30 percent responded to placebo so the actual statistically significant divergence of response to antidepressant medications there no statistically significant divergence until you had at least moderate or severe depression so when people with mild to moderate depression and start a trial there's basically the antidepressants look like placebo and this is the idea like very few people respond to these medications and once you get to severe depression there there is a statistically significant divergence in the response to these medications but at mild and moderate it's very weak