The Lancet article is very helpful. Right off the top, many of the drug-drug interactions reported with MAOIs are certainly not medically superficial. Such adverse interactions, listed in practically every drug's Product Monograph, appropriately limit the reasonable use of that class of drug, unless there are absolutely no other choices. Anyway, in order to get a better handle on the 'state of the art' of pharmcological treatment in depression, the blending of all severities of disease should be avoided. For example, severe depression (Major Depressive Disorder) and mild to moderate depression are somewhat different kettles of fish. An MDD patient in one of their cyclic episodes can be quite unreachable to CBT as a result of deep and troubling cognitive dissociation. SSRIs have been shown to be very helpful in some, if not in many, MDD cases, but possibly less so in mild to moderate disease. Its encouraging that diabetes disease nomenclature is currently undergoing much needed changes to reflect what we now recognize as the key functional elements of that disease. The definitions of various forms of depression are in much need of some similar tweaking, for now based on symptomatology, but hopefully sooner than later, based on underlying organic causes. I think then the evidence-based best treatment practices and therapeutic options, likely to be somewhat different between functional sub-groups, may become more clear.

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