Similar results were found by Lerner et a 1. ( The authors indicate that antidepressants might not be required for all employees with milder depression, but when prescribed, medication should start as soon as possible. However, it remains a fact that the positive employment effects are lower than the clinical effects (Frank and Koss, 2005), i.e. clinical improvement does not automatically nor fully translate into better work functioning (measured with functioning scales) and increased paid employment with substantial earnings, or in getting off disability benefit rolls. First, symptom improvements do not always go hand-in-hand with productivity improvement.