SSRIs: Much More Than You Wanted To Know

The exhaustive review of the "SSRIs don't work" debate (Kirsch et al.). It walks through nine complaints - overselling of the serotonin story, no better than tricyclics/MAOIs, publication bias, "clinically insignificant" effect size, only-in-severe-depression, doctor- vs. patient-rated improvement, active placebo, side effects, use-psychotherapy-instead - concluding SSRIs genuinely work (effect size ~0.3-0.5), are popular for their side-effect profile rather than superior efficacy, and that psychotherapy is not clearly better. Famous for making effect size intuitive (0.5 is roughly a weight-loss pill that drops 14 lb, or +7.5 IQ points) and for a raw personal disclosure about sexual side effects.

Quality 80 · Excellent. A model of the genre - comprehensive, numerate, fair, written with clinical authority - and elevated by the effect-size intuition-pumps and candour. Among his strongest MMTYWTK entries. Excellent.

Claude’s paradigm shift 35 · Slight. A synthesis/explainer of an existing debate; the effect-size comparisons are illuminating but not a new paradigm. Slight, edging moderate.

Real-world impact 3 · Moderate. A model, numerate review of the 'SSRIs don't work' debate that made effect size legible with clinical authority, on a medical question that bears on many patients. Real topical relevance and influence at the level of understanding, but discourse-level with no material change to prescribing practice — modest RWI.