To the Editor: We thank Dr. Wystanski and Dr. Fishbain for their thoughtful comments on our recent case report of an adolescent with complicated emotional and physical illness complaints. We wholeheartedly agree with Dr. Wystanski that it is not diagnoses we treat but the patient. He raises two additional important issues: 1) Was the diagnosis of depression accurate? 2) Would diagnosing Angela with either an anxiety or conversion disorder have changed the treatment algorithm used? Clearly, in all patients we identify target symptoms to guide our treatment approach. Angela had a symptom cluster most consistent with a depressive disorder. She did have additional symptoms in the realm of anxiety and even somatoform disorder. However, she only met full DSM-IV diagnostic criteria for depression, which provided us a framework around which to organize treatment. Having such a framework was important from two perspectives: 1) it allowed us to integrate empirically driven interventions for depression, such as paroxetine, cognitive behavior therapy, and family psychoeducation; and 2) it allowed us to organize the complex information for her family to help them develop a more cohesive illness narrative. Certainly, had Angela not shown progress in both physical and emotional symptom remission, we would have reformulated the case to consider other diagnostic possibilities and other treatment approaches. Using depression as the illness model allowed Angela’s family to recognize the early signs of a more clear-cut depressive episode 1 year after her hospital discharge and to reseek the appropriate treatment after they had self-terminated treatment. Although on the surface, similar medications and therapeutic approaches could be used to treat anxiety or somatoform symptoms, we argue that there would have been subtle differences in the interventions, such as the specific manual-based cognitive behavior therapy modality used, the psychoeducational approaches used with the family, and the target symptoms tracked to determine the medication algorithm used.