To the Editor: Drs. Franco and Malhotra appropriately point out that additional treatment trials are needed before firm conclusions about the most effective treatments for poststroke depression can be drawn. Given the medical vulnerabilities of this population, studies such as ours must always confront a number of challenges in achieving optimal randomization and truly blind placebo control. Some of the criticisms from Drs. Franco and Malhotra may be due to a lack of understanding of the medical constraints that apply to the whole population, not just the depressed subgroup. For example, they state that only 61% of the depressed fluoxetine group and 50% of the depressed nortriptyline group were randomized. Actually, the patients who were not randomized because of contraindications for either nortriptyline or fluoxetine were not all depressed patients but, rather, were divided between depressed and nondepressed groups. In fact, 87% of the depressed fluoxetine patients and 81% of the depressed nortriptyline patients were randomly assigned. In addition, although some patients were not randomly assigned to fluoxetine or nortriptyline, they were all randomly assigned to active or placebo treatment by using double-blind methodology. With the exception of sex distribution, there were no significant differences between the fluoxetine, nortriptyline, and placebo groups.