The reaction from psychiatrists is interesting, and says a lot about how things are so dysfunctional, how the involvement of psychiatry in chronic illness is toxic at any level, there is simply no safe level because it's too arbitrary. It mostly seems to boil down to: we already knew this, privately, so saying it publicly is not useful. Very similar to how deconditioning has been debunked, but even though it's the basis for GET, GET should still work.
So with the hypothesis debunked publicly, it seems that holding on to trials showing effectiveness is all that's left. Except their evidence is also poor, unreliable, biased and usually restricted to short-term, which is not how it's used in real life. It's also been known that the effectiveness of SSRIs has diminished over time. Not coincidentally: exactly like CBT. And placebo. Because at first you can show big effects, then as you have to do slightly more rigorous studies, bias reduces a bit and that "effectiveness" disappears.
It really seems to boil down to the idea that true or false, the most important thing in medicine is to appear in control, being confidently incorrect is OK, as long as no one is embarrassed. Very political, in a nutshell. There's even the same name-calling and "this person is biased because they disagree with 'common wisdom'" and anti-psychiatry.
This is one opinion but it has all the hits:
The serotonin hypothesis of depression: A meaningless debunking.
The serotonin hypothesis of depression, which became popular from the 1990s until now, is false, and has been known to be false for a long time, and never was proven to begin with.
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The review paper merely documents the absence of much if any scientific evidence for these oversimplified false hypotheses. So it’s not new scientifically at all.
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The use of SRIs should be based solely on the efficacy data shown for those agents in randomized clinical trials. Those data are indeed weak, and thus, I hold the view that SRIs should be used much less than they are, and for shorter durations, but this view has nothing to do with the already known false concepts of a serotonin theory of depression.
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“‘Depression’, as commonly conceived, is not a disease; it is a set of symptoms, like fever, chills and night sweats.
The irony of most physicians believing that CFS is actually depression because CFS is just a set of symptoms, therefore not a real condition, but are OK with the most completely vague definitions of depression and anxiety. Anyway this is one psychiatrist's opinion, there are many different opinions, because basically this is all a set of opinions, rooted in 19th century bigotry and attributing superficial behavior to preferred causes just because.
It's weird to use those symptoms, fever, chills and night sweats. I don't think they have much to do with depression. Chills and night sweats are definitely common side-effects of SSRIs, though. So this is like a vision of cancer that focuses on the side-effects of chemotherapy. So much wrong here.
I do agree that depression is more likely a symptom, not a unique condition, but the idea that it itself has sub-symptoms is the same silliness that made ME into fatigue and subsumed all symptoms as sub-symptoms of fatigue. Symptoms do not have sub-symptoms, this is nonsense. They are simply co-morbid, similar to how flu-like symptoms is a set of symptoms.
It's easy to see how similar this is to arguments being made about why GET is still good even if the lack of evidence for deconditioning were accepted. The problem is not about specific claims or treatments, it's a discipline in crisis, having made empty promises and mislead everyone for too long, just because secrecy can be abused to hide the truth.