Dr. Sallee Replies

TO THE EDITOR: The comments of Drs. Chabrol and Peresson about our assertion that “the rate of response to pulse clomipramine was robust” reconfirm the need for caution in overinterpreting studies with a small group size. It is true that when responders were defined by a decrease of 50% or more from baseline in Hamilton depression scale scores, differences by treatment did not reach statistical significance. It is not true, however, that treatment-resistant patients were disproportionately assigned to saline placebo. Random assignment of all subjects without regard to prior treatment led to a greater number of previously treated patients in the saline group (N=5) than in the pulse intravenous clomipramine group (N=1) for a total of six previously treated subjects. We did not, however, include in the text a full description of these failed trials. At least two patients in the saline group and the one previously treated patient assigned to the group could be described as treatment resistant (i.e., having failed to respond to two or more trials of adequate dose and duration). These patients accounted for many of the multiple treatments described. Two saline patients, however, were previously treated with a single course of SSRI, which could be characterized as either of inadequate dose or duration (6–8-week course). The low response rate (28%) of the saline cell to subsequent open-label SSRI treatment that we found in our study is not unusual within the adolescent population and cannot confirm a lack of therapeutic responsivity in the saline cell. As with all small studies, more hypotheses are generated than can be adequately addressed by the data. It is important to note that the study supports, but does not confirm, the ability of depression in adolescents to respond to antidepressant therapy.