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> Many of these studies also rely on rating scales (typically HAMD or even PHQ9 for depression) that are a measure of depressive symptoms but don't in themselves have the power to make a diagnosis.

This is my point again if you read my original post, thank you. :)

I'd go further and say the DSM-V is pretty bad at narrowing down which medication to use for depression. I know so many people on damn SNRIs whose diet is complete trash.



Totally agree on your last point. There's little connection between DSM and treatment guidelines (which do exist, separately). And treatment is so fragmented between multiple care providers (with most people accessing a small subset) that many obvious things get lost.

(Caveat: my wife is a psychiatrist. We wrote a book on this: https://mhnav.com/book/)




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