Although we concur that SSRIs possess more favorable dosing characteristics and may be more suitable for select groups of patients, such as those with ischemic heart disease(3), much more information is needed to determine the appropriate role of SSRIs and justify such dramatic shifts in prescribing practices. For example, recent evidence suggests that nortriptyline may be significantly more effective than fluoxetine in the treatment of poststroke depression (4). The Danish University Antidepressant Group found better remission rates with tricyclic antidepressants than with SSRIs, raising further questions about the true efficacy of SSRIs versus tricyclic antidepressants (5, 6). Similarly, emerging literature on the superiority of newer agents, such as venlafaxine, to SSRIs has invoked the "dual-mechanisms" explanation that is applicable to many of the tricyclic agents as well (7). With respect to adverse events, SSRI use may be associated with a substantially greater risk of major gastrointestinal bleeding, particularly in those taking nonsteroidal anti-inflammatory drugs (8). Although the frequency of adverse events associated with secondary amine tricyclic antidepressants and SSRIs is well documented, the burden of side effects and their longer-term, clinically relevant implications for patient well-being is poorly understood. Such issues, which may be even more relevant to an elderly population, warrant further consideration and more stringent analyses of the risks, benefits, and costs associated with treatment alternatives, rather than speculative conclusions and strong opinions.