First, the analyses confound different types of misuse. Thus, misuse was defined as either using a sedative without a prescription or using more than the amount prescribed by a physician. The prevalence of each type of misuse is not stated, but we would argue that these represent two different phenomena. Nonprescribed use of sedatives by some individuals bears little relevance to the risk of sedatives prescribed to another group of individuals. Second, the analyses do not consider the indication or diagnosis of individuals taking hypnotics. This is important because most patients with insomnia may have different risks than patients with anxiety or depressive disorders. Likewise, taking a benzodiazepine receptor agonist once per day (for insomnia) may carry different risks than taking such a drug multiple times per day (for anxiety or depression). Third, the definition of dependence (even in DSM) can confound truly maladaptive drug use with other phenomena, such as tolerance, rebound symptoms, withdrawal symptoms, and even recurrence of the original disorder. Physiological dependence can be observed with many types of drugs, including benzodiazepine receptor agonists and antidepressants, but is not necessarily an indicator of the real concern, which is maladaptive drug use. Fourth, the epidemiological data do not distinguish among different agents. In fact, there is some uncertainty regarding which drugs may be described as "sedative/hypnotics," given the widespread use of sedating antidepressants and antihistamines for insomnia. Within the class of benzodiazepine receptor agonists, there may be important differences among specific agents based on pharmacokinetics or receptor selectivity. Finally, as the authors point out, cross-sectional associations between sedative drugs and depression or suicidal ideation should not be taken as causal effects. Patients who are given prescriptions for psychotropic drugs are, by definition, at increased risk for these problems.