Dr. McClintock and Colleagues Reply

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).