Do doctors know best? Comments on a failed trial

A randomised controlled trial was planned to compare two different treatmen t strategies-structured problem solving and selective serotonin reuptake in hibitor (SSRI) medication - for patients with mild to moderate major depres sion. The trial was to be conducted in the primary care setting with all tr eatment given by general practitioners. When no patients had been recruited into the study after six months, we performed an audit of all patients wit h depressive symptoms attending the doctors' practices over three weeks. Ex clusion criteria were changed to ease entry into the trial, but still no pa tients were recruited over the following six months. What went wrong?.