Oral Lignocaine

SIR,-It is with interest one reads the paper by Dr. A. M. W. Porter on depressive illness in a general practice (28 March, p. 773). While Dr. Porter has put a lot of hard work into his paper, I feel it would have been valuable to enlarge on the parameters of the rating scales in order to bring out the important clinical assessment of depression such as external stress factors (reactive) and whether the depression is worse in the mornings. Is there sleep disturbance? Are there associated guilt feelings? Is there weight loss and poor appetite, and, most important, were there associated suicidal feelings? Stressing these clinical aspects would, I feel, have added more evidence to his conclusion. I think it would also have been helpful to know what part psychotherapy played in the treatment and assessment, as it is important not to dissociate medication from psychotherapy even in clinical trials. I feel it is a drawback that the duration of the trial was three weeks only. The conclusions arriv-d at might have been more significant if the duration of the trial was more than three weeks, since the Medical Research Council trial' showed that imipramine is a very worthwhile drug for treating depression. Dr. Porter indicated in his paper that in general practice quick results are expected. I think one would agree with him on this point so far as treatment of organic illness is concerned, but, with emotional illness, it takes certainly longer in view of the interactions of personalities and adaptation to stress factors, psychotherapy, etc.-I am, etc.,