Efficacy of Imipramine and Chlordiazepoxide in Depressive and Anxiety Disorders Questioned

To the Editor.—  I would like to comment on two articles in the Archives.^1,2 These two articles from some of the world's most famous and reputable universities must be received by European psychiatrists with the utmost attention.The article by Lipman et al¹ deals with a sample of primarily depressed outpatients (recruited by advertisement), who are not very ill but considered to be at least moderately depressed. The mean score on the Hamilton Depression Scale (on 21-item modification) was 22.1±6, telling us that a part of the sample hardly meets Hamilton's criteria for clinical depression (>15 on a 17-item scale). This is unjust to the outcome of treatment, probably more so to treatment with imipramine hydrochloride than to the other treatments, and might explain why patients at week 8 did not rate appreciable improvement very often; only 31% rated "very much better" or "quite a bit better." That