Are we as depressed as we think we are?

MEDICAL attitudes to psychotropic drugs in general and antidepressants in particular tend to be casual, and their effects seen as innocuous. Indeed if used as recommended by their manufacturers tricyclic antidepressants are not very effective drugs, although some of their side effects and interactions can be very serious. It has been stated that tricyclics generally have a margin of superiority over placebos of 2030 per cent, and given an average placebo response of 40 per cent in most psychiatric patients, they thus fail in 30 40 per cent of cases (Lehman, 1966). There are a number of factors contributing to this including a wide individual variation in pharmacokinetics (Alexanderson et al, 1969; Asberg et al, 1971) and poor patient compliance (Willcox et al, 1965), but perhaps the most important, although controversial, is the failure to distinguish depression as an illness from depression as a symptom.