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Dr. McClintock and Colleagues Reply

J Clin Psychiatry 2008;69:1662-1663 [letter]

Letter to the Editor

Sir: We appreciate the comments made by Dr. Swartz on our recent report of electroconvulsive therapy (ECT) in the treatment of atypical depression. We agree that our study was limited due to the lack of a placebo control group and to the use of the 24-item Hamilton Rating Scale for Depression (HAM-D- 24). Without a placebo control, we cannot be certain that ECT was beneficial in treating severely depressed patients with atypical features in the acute phase (i.e., spontaneous improvement could have occurred).