Recent meta analysis of six well done studies has shown that antidepressant treatment effect may be minimal or nonexistent with mild or moderate depression whereas when utilized with severe depression showed clear improvement over placebo. Other factors which must be taken into account when treating depression are the presence of underlying medical disorders or other psychiatric conditions as well as whether the patient is grieving. Sometimes there is a dual diagnosis which must be recognized and the the presence of suicidal ideation always should be considered. Split treatment , when one professional treats the patient with psychotherapy and another treats the same patient with medication can present special issues. Antidepressant treatment can be extremely effective. However, the patient must be properly diagnosed and monitored.