Podbit · Huberman Lab
SSRIs reduce OCD symptoms in some patients, yet there is almost no evidence that the serotonin system is causally disrupted in OCD. This is a broader problem in psychiatry: drugs that work don't necessarily tell us what's broken.
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At 28:20 · chapter starts 27:05
Having established CBT's superiority, Huberman pivots to a philosophically important point about SSRIs and psychiatric medicine more broadly. SSRIs do help some OCD patients — reducing symptoms measurably compared to placebo — but the scientific literature provides almost no evidence that OCD is caused by or rooted in serotonin system dysfunction. This is not a minor footnote; it's a fundamental challenge to how psychiatric pharmacology is often understood. Drugs are frequently assumed to reveal the biology of a disorder by the mechanism through which they help. Huberman argues this logic is flawed, and OCD is a clear example: the drug works (somewhat) but the implied causation is unjustified. He broadens this observation to depression, anxiety, and other psychiatric conditions — a recurring theme he believes clinicians and patients deserve to understand.
Combining SSRIs with cognitive behavioral therapy did not produce any further decrease in OCD symptoms compared to CBT alone, confirming CBT as the primary driver of improvement.
Despite SSRIs being partially effective for OCD, there is very little evidence that the serotonin system itself is causally disrupted in OCD — a recurring theme in psychiatry.
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