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Why don't SSRIs work in the medical subspecialty clinic?

During a recent supervision session with a resident, the question arose as to whether the diazepam being given to one of his clinic patients with chronic renal insufficiency should be replaced by a benzodiazepine that was either shorter‐acting or without active metabolites (the answer: probably unnecessary, since most of diazepam's metabolism is hepatic). Quite by coincidence, results of the Chronic Kidney Disease Antidepressant Sertraline Trial (CAST) had just been published by Hedayati et al., allowing our supervision discussion to meander onto a related, and probably more important, topic: What is the best way to treat depression in the medically compromised?