Drs. Sysko and Walsh Reply

Because this piece has no abstract, we have provided for your benefit the first 3 sentences of the full text.

Sir: We appreciate the points made by Drs. Vieta and Cruz intheir comment on our recent review of controlled trials of bipolarmania.¹ Our review noted a relative paucity of data availablefor analysis and important differences across study designsin the trials included in the analysis, limiting our confidence inthe indications that placebo response rates had changed overtime.¹ We therefore restricted our discussion of factors thatmight have contributed to an increase in response rates, as itwas not clear whether such changes had, in fact, occurred.’ ‹