"Not much better than placebo" is burying the lede.
The real problem is that placebo performs very well in depression studies. It's a well studied phenomenon.
Effective antidepressants are marginally better than placebo in the studies because the placebo group improves so much, not because the antidepressants don't do anything.
> and are shown to be about as effective as therapy — which is actually durable.
False dichotomy. The recommendation is for people on SSRIs to also do therapy.
You don't have to choose one or the other.
> There’s also rates of sexual side effects in excess of 70% [1]
If you read further in your [1] you'll see that the rate of side effects is not "in excess of 70%" but lower, and it depends on both the medication and the dose. Switching medications and changing doses is often sufficient to ameliorate some or all of these effects.
That paper also mentions newer alternatives such as Vilazodone (SSRI plus 5-HT1A action) which are shown to have lower incidence of these side effects.
> and they cause weight gain which is separately associated with depression.
SSRIs aren't really associated with weight gain once you exclude the older ones like Paroxetine which have anticholinergic effects. A lot of studies find statistically insignificant weight loss or slight gain.
Weight gain is really a negligible decision factor in modern SSRI treatment: https://www.ccjm.org/content/ccjom/70/7/314.full.pdf
There's a lot of misinformed fear mongering in your comment.