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Some studies, not uniformly replicated, have showed greater antidepressant efficacy in severe depression than in milder depression, and some major guidelines have recommended against using antidepressants in mild depressions. In a clever analysis, researchers used patient-level data from 28 studies of selective serotonin reuptake inhibitors (SSRIs; N=8262) to examine symptom improvement on the Hamilton Rating Scale for Depression (HRSD).
No relationship was found between efficacy and symptom severity in analyses using the six core HRSD symptoms (mood, psychomotor retardation, guilt, interest, psychic anxiety, and general somatic symptoms). However, severity was associated with efficacy in analyses using the 11 noncore items (three insomnia i…