Incorrect Impressions Concerning Industry-Sponsored Research.

example, are not represented in theDiagnostic and Statistical Manual of Mental Disorders (DSM) criteria.3 In evaluating the desirability of screening for depression in primary care, it is tempting, but in our view amistake, to reify theDSM criteria. This line of reasoning risks losing sight of a deeper reality: the criteria formajor depression arenot the thing itself, but rather an imperfect indexofanunderlyingcondition.3Abettermeans of assessing thedesirability of depression screening is to focus onevaluating thepractical clinical consequences of screening on patients who are screened. Dr Braillon raises concerns over antidepressant use duringpregnancyandcalls formore research in this area.Weagree that antidepressant use is common among pregnant women in the United States. Approximately 1 in 12womenwithin the Medicaidprogram, for example, receives an antidepressant at somepointduringherpregnancy.4Wealso agree that the risks of fetal exposure to antidepressants deserve more intensive study. The availability of large databaseswith information on maternalexposures linkedtochildhoodoutcomesprovidesopportunities to continue pursuit of this line of research. Dr Braillon further wonders why cognitive behavioral therapy is notmorewidely used amongwomen of child bearingage.Weagree thatevidence fromrandomizedclinical trials5 shows benefit for psychotherapeutic treatment of depression. Yet within the United States, increasing access to psychotherapy for depression faces several formidable obstacles. Thus, theproportionofdepressedadults in theUnited States receiving psychotherapy remains stubbornly low, due to factors related to the economics ofmental health care, low third-party reimbursement forpsychotherapy,demandsonpatient and clinician time, the ease of prescribing antidepressants, andthegeographicmaldistributionofmentalhealthprofessionals.Wemustbuilda largerandmorebroadlydistributed workforce trained to use evidence-based psychotherapeutic approaches for the treatment of depression.6