Dr. Faedda et al. base their interpretation on two points. First, the rate of switching to mania in our study seemed higher than that found by Akiskal et al. (1995). However, the number of subjects in our placebo group (N=15) was too small to estimate reliably a switching rate, and it is difficult to directly contrast findings from the 11-year, long-term study by Akiskal et al. with findings from our short-term study of acute and continuation treatment. Second, Dr. Faedda et al. feel that the increased risk of rapid recurrence, particular of mania, after lithium discontinuation played a role in our results. This is possible; nevertheless, what may be more important is that each subject was taking antidepressants—mostly tricyclics—throughout our study, including the period after lithium discontinuation. A switching rate of 13.3% in patients taking antidepressants does not seem unusually high. There have been numerous reports that, on average, tricyclic antidepressants induce switching in 9% of the patients treated for depression (1) and, in some studies, even up to 25% (2). With respect to the suggestion that unipolar patients who are unresponsive to antidepressants may represent a particular group with a disproportionately high risk of switching, we are not aware of any report in the literature to support this supposition.