As the Scottish division of the Royal College of Psychiatrists, we have been interested in the media's reporting of Kirsch and Moncrieff's article suggesting that "antidepressants are no better than sugar pills".

For years, popular culture over-hyped the effectiveness of antidepressant drugs such as Prozac. Excitable coverage about a "Prozac nation" taking "happy pills" to be "better than well" had little relation to the research base suggesting that they were beneficial to people with depression. It now looks as if the media pendulum is swinging in the opposite direction. But we should take care not to disparage antidepressants inappropriately.

It is unacceptable that drug companies should conceal negative findings from clinical trials, and we welcome new research published in the Public Library of Science that reveals this hitherto hidden information.

But the "new" findings that hit the headlines this week aren't much different from what has been known for years, and published by the National Institute for Clinical Excellence (Nice) in 2004: antidepressants are generally ineffective in mild depression, but often therapeutic in more severe illness. Psychological therapies will complement, rather than replace, drug treatment for many people. Although most people recover from depression, significant numbers have quite devastating illnesses where appropriate treatments, including drugs, could prevent depression from becoming chronic. There is the real risk, therefore, that imbalanced reporting could encourage those with serious illness to jettison treatments that work for them, or could discourage those with serious depression from seeking and accepting appropriate treatment.

Dr Tom Brown, Dr Premal Shah, Dr Michael Smith, Royal College of Psychiatrists, Scottish Division.

I was concerned by the front-page headline in The Herald which repeats an opinion that Prozac (fluoxetine, a new generation anti-depressant) may be a "waste of time for most" (February 26). Your dramatic headline runs the risk, at best, of causing confusion among the many patients in Scotland and elsewhere who feel benefit from such licensed medicines and, at worst, may prompt some to discontinue their medication, at considerable personal risk. So I would urge due caution over the interpretation of this recent review, at least until a proper critique has been sought from those in the UK who are best equipped to provide it, in this case the Medicines and Healthcare Products Regulatory Agency.

Professor A V P Mackay

I agree with Dr Colin Guthrie that the placebo effect has an honourable place in a general practitioner's therapeutic cupboard. I also hope that cognitive techniques that GPs use in short consultations and our relationship with patients have a therapeutic effect in depressive illness and anxiety disorders.

In fact, Dr Guthrie's high-cost comment is not now the case. When Prozac and other SSRI compounds were first prescribed more than 20 years ago, they cost the NHS £22 per month at standard dose. Now, off-patent, the two most commonly prescribed modern antidepressant drugs cost between £15 and £25 in total for a nine-month course of treatment. As such, I suggest they are cost-effective placebos but should be prescribed with care and the response monitored.

Locally, here in Forth Valley, NHS patients can be offered an interactive computer-delivered treatment involving nine hour-long weekly sessions. This "Beating the Blues" cognitive behaviour therapy programme has been shown to be effective for moderate anxiety and depression.

With a delay from referral to commencing treatment of just two to three weeks, this a good option to be able to offer.

Dr Philip Gaskell, Allan Park Medical Practice

I feel the headline regarding ssri antidepressants was, at best, scare-mongering and, at worst, potentially detrimental to millions of patients in this country. Selective Serotonin Reuptake Inhibitors (SSRIs) are prescribed to depressed patients based on gathered clinical evidence. There is no doubt in my mind that they work well in appropiate patients. I agree completely with non-pharmacological treatment also, but the two modalities are synergistic in a genuinely depressed patient.

May I also clarify that Efexor is not an SSRI but a Serotonin and Noradrenaline Reuptake Inhibitor (serotonin and noradrenaline are the chemicals thought to be most involved in depression). Many patients might, as a result of your coverage, stop complying with their medication and perhaps suffer worsening depressive symptoms or a physical withdrawal reaction. In my opinion, your coverage did not give a balanced view.

Dr Robert McGonigle

I fear Dr Guthrie's comments have not been helpful. The placebo effect is ill-understood except by those who study it in detail, and doctors are as guilty as anyone of using it in dismissive terms - "only a placebo" - ironic, since doctors are as likely to experience the placebo effect as the general public. Placebo effects are associated with the body's self-healing, the triggering of which is frequently our most potent weapon, but something we seem intrinsically sceptical of, preferring to rely on drug treatment. Dr Guthrie's comments on homeopathy seem in keeping with the "can't work, so doesn't work, so must be kiddology" school of thought.

With regard to Prozac, it is, in fact, very cheap, particularly since it came off patent, some time ago, and in my experience has well-tolerated side-effects. A little commented on phenomenom is the "nocebo effect", the dark twin of the placebo. There is an increased risk of problems if you believe something is bad to take or will do you harm. Given that depression and antidepressants are such emotionally loaded subjects, and the "just pick yourself up and get on with it" attitude prevails, it would not be rocket science to suggest this might have an impact As for green tonics, masquerading as medicines, it is partly this attitude that makes people distrustful of placebos, since they see themselves as being palmed off and patronised. Perhaps more honesty would be appropriate.

Trials rarely take into account the thoughts and feelings of patients, yet this is relevant to their behaviour and responses. We should, therefore, be careful with our interpretation of results.

Dr Martin R Innes, Ravenswood Surgery.

In the article about the concerns over the efficacy of the newer antidepressants, it was noted that GP prescriptions for antidepressants have risen over the years.

One area that could contribute to this is the increased recognition of depression by general practitioners. Concern has been expressed over the years that GPs were not picking up the signs and symptoms of depression in their patients.

Recognition and effective treatment of depression not only benefits individual patients but also improves the health of the nation.

Dr Gregor Purdie, Gardenhill Primary Care Centre, Castle-Douglas