Since limitations of many early trials for both products are well-documented, a fair amount of skepticism exists as to efficacy In brief, major weaknesses included small sample sizes, insufficient study durations, lack of experience among investigators, lack of a placebo-control, lack of a strict definition of MDD, diagnostic heterogeneity of the participants, inclusion of subjects with only mild illness, failure to use standard rating instruments (such as the Hamilton Depression Rating Scale [HAM-D] or Montgomery-Asberg Depression Rating Scale [MADRS]), and questionable analytic approaches (i.e., not limited to “intention to treat”).