In my opinion, the key question is whether the placebo effect is mainly caused by spontaneous remission or a genuine therapeutic effect. If the former, we should perhaps adopt a policy of watchful waiting, only offering antidepressant treatment if there is no improvement within a specified period of time. If the latter, unless we have access to an effective alternative (such as CBT), we need to consider whether we can justify withholding such a highly effective treatment from our patients.