GPs need to be sure that patients in treatment who have, or who have contact with, children are properly counselled about the safe storage of take-home doses of buprenorphine. Given the absence of any fatality in the study, I would welcome debate about the relative safety of inadvertent methadone and buprenorphine overdoses in children.

Children of mothers with persistent antenatal depression were 34% more likely to have developmental delay

The findings of this study are consistent with the evidence from randomised controlled trials that exercise may be effective in the short term as a treatment for mild to moderate depression. However, this is a cross-sectional study and cannot therefore indicate the direction of causation. The results may simply reflect the fact that depressed patients are less motivated and exercise less.

The authors conclude that there is a favourable risk/benefit profile, justifying the cautious use of antidepressants as a first-line treatment option. It is likely, however, that they have underestimated the risk of suicidal behaviour. Youths at risk were excluded from the trials and data were only collected retrospectively as part of adverse event reporting.

One of the fundamental principles of cognitive therapy is that it requires a sound therapeutic alliance. It has even been suggested that the quality of the therapeutic relationship is more important than the specific type of psychotherapy used in determining the clinical outcome. Computers may complement the role of physicians and therapists, but they are no substitute.