Depressive symptoms are common and often lead the patient to seek medical advice. Forty proprietary antidepressive drugs are available in Britain. Although it is generally agreed that antidepressives can be helpful, it is not yet clear whom they may help, or how much. This is because of disagreement on the classification of depressive illness,1 and difficulty in predicting its natural course. Many patients get better without drug treatment. Although double-blind comparisons with placebo over the past 20 years have shown that these drugs reduce depressive symptoms in most patients, this is less convincing in clinical practice.2 3 Several factors influence the response to drug treatment and understanding them should improve the management of depression.
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