Dr Pundiak and Colleagues Reply
To the Editor: We agree with Dr Grey that careful characterization of residual depressive symptom severity after treatment response is important. In our study, Montgomery-Asberg Depression Rating Scale (MADRS) score after 5 years of relapse-free maintenance monotherapy with a selective serotonin reuptake inhibitor was a significant predictor of subsequent relapse risk. Subjects with a MADRS score of 1 to 4 (those Dr Grey describes as "well") had a relapse risk less than one quarter that of subjects with a score of 5 to 9 (hazard ratio = 4.3) and almost one sixth that of subjects with a score of 10 to 14 (hazard ratio = 5.7). These findings are presented in Table 3 of our article.
The "terminated well" group is defined in the article on page 1812 as those subjects who did not relapse prior to termination of the study and does not refer to discontinuation of medication. We apologize for any confusion about this terminology, especially since it was used in a slightly different fashion on page 1813 to distinguish between 2 groups of nonrelapsed patients: those who left treatment prior to study termination ("terminated well") and those still in successful treatment at study termination ("remained well").
Author affiliations: Freedom From Fear, Staten Island, New York (Drs Pundiak and Peselow and Ms Mulcare) and Department of Adolescent Psychiatry, New York University School of Medicine, New York; and the Statistics and Services Research Division, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Dr Case). Financial disclosure: None reported. Funding/support: None reported.
doi:10.4088/JCP.09lr05006ablu
© Copyright 2009 Physicians Postgraduate Press, Inc.
