Does the paper really prove that problem solving treatment is helpful?

EDITOR—Please tell me if I am missing something, but I am not convinced that the paper by Mynors-Wallis et al shows that problem solving is an effective treatment for depression.1 As I read it, patients were allocated to one of four groups. Of the two groups treated with problem solving alone, up to a quarter (10 of 39 treated by the doctor and six of 41 treated by the nurse) withdrew from the trial because the treatment was not working. Those left in the trial—that is, those for whom the treatment was working—were compared with those given antidepressant treatment, and it was found that the treatment was working. I note that none of the antidepressant group withdrew because the treatment was not working.

It may well be that problem solving is helpful for depressed patients. It may well be that an hour's initial treatment followed by up to six sessions of half an hour is helpful for depressed patients. But I am not convinced that this paper proves it.

Study should have included placebo group

EDITOR—Mynors-Wallis et al conclude that problem solving is an effective treatment for depression.1 They base this statement on the effectiveness of selective serotonin …