November 1989

Editorial Note (Especially for the Media)

Arch Gen Psychiatry. 1989;46(11):983. doi:10.1001/archpsyc.1989.01810110025003

The preceding report is the initial overview of findings of a truly unique and complex pilot study conceived over a decade ago. The results will evoke heated technical arguments as methodological details receive thorough scrutiny. Unfortunately the study has been widely bruited and ineptly epitomized in the media over the past 2 years. Both popular interest and methodological debate (or turf wars on who should treat) can, however, distract from some abiding and essential facts that deserve emphasis. Thus, the high prevalence of untreated depressive disorders that are socially disruptive and medically costly has been firmly established as a major public health problem.1 Effective, efficient, and accessible interventions are therefore a worthy goal.

In this respect an unanticipated finding deserves note. It derives from the study's design in which a pill placebo is coupled with "clinical management" rather than the traditional "no treatment" control. The control group received more

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