I cannot accept the notion that the need for these drugs soared 400% since the 80s. Sure they are being prescribed but how many of the people they are prescribed to actually NEED them? I've talked to people who were given them after telling their dr they were feeling a bit down, were suffering grief (a normal and natural process), IBS and a host of other things. As for the placebo effect, I don't know. It's possible. But for me, a tricyclic - if it did anything at all - took over a month to take effect while Paxil took only 2 weeks to lift my depression. Of course that's only me... but then I've had 5 episodes of depression so I feel I am well qualified to comment.
