21.   It all depends on how depression is defined and what kind of depressed patients are included in the clinical trials.

22.   Local newspapers have reported a rash of suicides, including the head of a leading tour company, and psychologists are seeing more depressed patients.

23.   Other studies show that perfectionists respond poorly to prevailing treatments, medication and psychotherapy that often work well for other depressed patients.

24.   Physicians are already starting to take advantage of some of these findings in treating depressed patients.

25.   Researchers have found several distinctive physiological changes in depressed patients.

26.   Seeking a biological explanation, the authors cite research showing that depressed patients have stickier platelets, the blood component that causes clotting.

27.   Severely depressed patients fared as well with either.

28.   Since most clinical trials enroll less severely depressed patients, the observed difference between the response to an antidepressant and a placebo can be misleadingly small.

29.   So two depressed patients who appear the same in terms of their symptoms may be biologically very different.

30.   SSRIs are also significantly less lethal than tricyclic antidepressants, making them safer for depressed patients, who can run a high risk of suicide.