At the beginning of the year, the treatment of mood disorders made big news. 'Prozac does not work, say scientists', was the kind of headline we read.
The story that made such an impact was based on a paper in an obscure academic journal, PLoS Medicine, which published an analysis that had for the first time combined the results of 47 trials on some antidepressant drugs, including Prozac, and found only minimal benefits over placebo, except for the most depressed patients.
But the media missed vital points if the truth about treating mood disorders is to be communicated properly to the public, patients, therapists and doctors. Psychological problems usually require an approach that combines treatment modalities and tailors them to the specific patient. These include psychotherapeutic, behavioural, family, social and stress management approaches - not just pills.
We need studies that compare patients having psychological therapies combined with medication against patients having only psychological approaches, and patients having just medication. This kind of investigation is more difficult, so we don't have nearly enough such studies to come to a definitive conclusion about what works for mood disorders.
Prescribing a tablet requires expert supervision. What dose and how side-effects are monitored and dealt with, how the medication is selected and how it might be changed are all delicately handled issues that dramatically alter the impact of the pill.
This issue of physician expertise is not adequately examined in most randomised controlled trials, where a limited range of doses tends to be deployed. For this reason, antidepressants are not likely to fare well in the laboratory. The right drug in the right hands for the right patient is likely to be much more effective than the wrong drug, prescribed by someone who doesn't know what they are doing, to a patient whom it may not suit.
One paper in a relatively obscure journal cannot be the definitive pronouncement on whether anyone taking an antidepressant, or considering taking one, or any other treatments for mood problems, should be browbeaten into a hasty decision.
Psychological difficulties require a good therapeutic alliance between patient and doctor that allows both to openly consider a range of treatment options and to apply what we know from research to the specific patient.
The blanket and bald statement the media made that antidepressants do not work was so off-kilter that many of us in the field thought it just as dreadful as the usual low standard of mental health coverage.
Yet the real worry will now be whether this widespread media message that antidepressants do not work leads many to stop taking their medication, with consequent dramatically negative effects.