The debate about whether psychological illness is best treated with medication or counselling is a long-standing one. Typically waxing and waning, the issue looks set to be rekindled by several recent books and articles.
A Limerick doctor, Terry Lynch, has written Beyond Prozac: Healing Mental Suffering Without Drugs, in which he questions the accepted wisdom of there being an identifiable biochemical explanation for depression. He focuses on counselling to help people with psychological and emotional problems.
The Noonday Demon: An Atlas of Depression is published this month by the established author Andrew Solomon. In it, he describes three episodes of major depressive illness and their devastating effects.
Solomon's thesis is that depression recurs, and he credits ongoing anti-depressant therapy for still being alive.
Whenever a debate arises about the merits or otherwise of a treatment, doctors look for "the evidence" in an attempt to advise their patients correctly.
The gold standard of clinical evidence is the randomi; a refinement of this process is the review of all published such trials in an effort to achieve scientific consensus.
So what does "the evidence" say about the treatment of depression? The latest edition of Clinical Evidence, a six-monthly compendium of the best available evidence for effective health care, sets out the effects of continuation and maintenance treatment with anti.
It cites strong evidence that continuing antidepressant drugs for six months after recovery reduces the risk of relapse, but it is less certain about maintenance treatment. "We found no adequate systematic review of maintenance treatment," say the authors, who promise to carry out such a review for the next edition, due out later this month.
What about the so-called talking therapies? Cognitive behavioural therapy is aimed at changing the dysfunctional beliefs and negative automatic thoughts that characterise depression.
"One systematic review has found that cognitive therapy is effective, and may be more effective than drug treatment in people with mild to moderate depression," according to Clinical Evidence.
At the other end of the spectrum of scientific evidence, New Scientist magazine recently reported on the work of Dr Andrew Newberg at the University of Pennsylvania.
Using modern brain-scanning techniques, he has demonstrated a reduction in physiological activity in the parietal lobes - a part of the brain that gives us our sense of personal identity - of subjects who reached a transcendent state of "oneness" during meditation.
Such findings support, at least indirectly, the thesis that talking therapies trigger biochemical modifications in the brain.
If it could be proven that cognitive behavioural therapy ( or other forms of counselling) triggers a reversal of the chemical changes that we know occur in major depressive illness that the two camps in the debate could begin to share some common ground.
As I see it, people need the fuel of antidepressants, at least in the short term, to gain the energy to deal with underlying negative thoughts and to participate fully in the counselling process.
This is merely a personal view, however, and it awaits proof of clinical evidence. In the meantime, it is important to emphasise the words of Dr. Lynch who warns people not suddenly to come off psychiatric drugs. " This should only be done with appropriate medical guidance and supervision" he says.