The antidepressant debate should move on

In her editorial Moncrieff (2002) ignored decades of work and focused on a few pieces of research, one of them from 1965. The editorial was followed by a letter criticising this view (Malt, 2002), which was, however, published under the title ‘The antidepressant debate continues’. This title might leave the impression that the effectiveness of antidepressants is still questionable.

Some of our colleagues might conclude that antidepressants have no proven effect and their patients should discontinue them. The consequences of such actions have been researched extensively: the relapse rates are approximately twice as high for patients who stop their medication in the first 2–6 months beyond the point of remission, compared with those who continue treatment (e.g. Anderson et al, 2000; Hirschfeld, 2001). Other patients might be denied an effective treatment. Going through all the evidence, which includes comparisons with other treatments and between different classes of antidepressants, animal work, and tryptophan and noradrenalin depletion experiments in people responsive to antidepressants, would be like reinventing the wheel, and is not the subject of this letter. As the rest of us continue to learn of advancements being made to refine and improve the pharmacotherapy of depression, is it possible that there is a group believing that antidepressants really do not have an effect? There is indeed an anti-depressant debate–but it is not whether they work but rather how they work that is the current focus of interest.