Work in progress - why evidence-based guidelines do not mean the end of controversial discussions

Harter et al.'s (2010) statement points to differences in the interpretation of the German National Guidelines for the treatment of depression and adds some of the recommendations missing in the original paper. The response again stresses the general consensus and relates to controversies that did not find entry into the recommendations, although they are important for establishing a transparency in the discussion process. Not all clinically relevant questions can be answered based on evidence (e.g., differential indication as to treatment duration). Also, the issue of external validity has to be discussed again and again to ensure reception and implementation of clinical guidelines. Finally, the very cooperative process of the guideline development is pointed out.