How do we determine whether antidepressants are useful or not?

We read with interest the Article by Fredrick Hieronymus and colleagues in The Lancet Psychiatry.¹ The authors showed that SSRIs significantly improve scores in a subset of items in the 17-item Hamilton Depression Rating Scale (HDRS-17), over and above placebo, after a treatment period of 6 weeks, irrespective of baseline depression severity. However, we think that some uncertainties exist that should temper the authors’ conclusion that the “claim that antidepressants are useless for patients with non-severe depression has been premature and is misleading”.¹