Antidepressant drugs do work, but we don't really know why. Selective serotonin reuptake inhibitors appear to work. So do monoamine oxidase inhibitors. So do selective norepinephrine and dopamine reuptake inhibitors. We used to think that tianeptine was a serotonin reuptake enhancer, but we now think it's a mu-opioid agonist; either way, it seems to work as an antidepressant. Opipramol is a stone cold whodunnit of a drug.
Nobody really knows what causes depression. We know that there are certain risk factors, we know that there are useful treatments, but we don't really have a clue what's going on inside the brain.
The chemical imbalance hypothesis isn't particularly accurate or particularly helpful. Psychiatrists see some patients who are severely depressed for no apparent reason, but most see far more patients who just have lives that would make anyone miserable. Depression is emphatically not randomly distributed - prevalence rates are vastly higher in certain groups, for reasons that can only plausibly be psychosocial. The chemical imbalance hypothesis lets society abrogate responsibility for the fact that a lot of people are justifiably downtrodden, despondent and hopeless.
We need to recognise depression as a complex, multifaceted disorder with neurological, cognitive and social components. Antidepressant drugs have life-changing effects for some patients, but psychotherapy and lifestyle interventions are also enormously valuable. Some patients achieve complete remission within weeks of starting antidepressant drug treatment; others have tried four or five drugs with no noticeable benefit. If you're suffering from depression, you'd be foolish not to try drug treatments, but you'd be equally foolish to only try drugs.
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