BMJ 1995;310:1267 (13 May)

Letters

Definition of depression is questionable

EDITOR,--Mynors-Wallis and colleagues claim that problem solving treatment and amitriptyline are equally effective in major depressive disorder.1 Even though they required their patients to meet the research diagnostic criteria for depression, just how severely depressed they were comes into question. To be eligible to take part in the study patients had to score just 13 on the Hamilton depression rating scale. Drug licensing authorities, such as the Committee on Safety of Medicines and the Food and Drug Administration, and most investigators would regard a score of 18 as being the minimum required for entry into any trial.

Older tricyclic antidepressants such as amitriptyline are associated with a plethora of adverse effects and may not have been the most appropriate choice of agent. Newer tricyclic drugs such as lofepramine, selective serotonin reuptake inhibitors, or even the recently introduced selective noradrenaline reuptake inhibitors might have been a better choice as they have . . . [Full text of this article]


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Relevant Article

Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care
L M Mynors-Wallis, D H Gath, A R Lloyd-Thomas, and D Tomlinson
BMJ 1995 310: 441-445. [Abstract] [Full Text]

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