Thank you for your excellent article. Being stuck in a bi modal competition, leaves us ignoring all the uncomfortable nuances that make diagnosis and treatment so challenging. We will never progress until we tackle issues in prospective studies that consider mulimodal types of depression in which skilled psychotherapists and psychopharmacologists become more curious about the array of factors that may increase vulnerability, or worsen the course of suffering

(eg. social factors such as isolation and poverty).

I become concerned, as one example, with non-psychiatric MDs "missing" the diagnosis of co-morbidity, with its complications and potentiall. for worsening a patient's condition. As a clinical psychologist and a severe sufferer, I continue to scratch my head when ECT is not included in the fray. Thanks very much.