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April 8, 1983

Treatment of Depression-Reply

Author Affiliations

University of Chicago

JAMA. 1983;249(14):1825-1826. doi:10.1001/jama.1983.03330380022009

In Reply.—  These letters suggest the need for explicit clarification of certain issues implicit in my editorial entitled "Depressives, Doctors, and Antidepressants."Doubtless there would be general agreement that "chlordiazepoxide is [not] preferentially indicated compared with imipramine in patients who have been depressed for at least three months, with a Hamilton test score of 25 or higher, probable or definite endogenous syndrome, and required admission as inpatients." The question is how faithfully this description, the sample studied by Keller et al, and the patients seen by investigators in tertiary-care centers generally represent depressed persons in the community who do not contact the medical care system or who are seen by primary care physicians.Systematic information about this point apparently is not yet available. Conversations with research psychiatrists who have long experience in working with family physicians suggest that depressed persons seen in primary care settings tend to be less severely