To the Editor: We appreciate the interest in our work and the thoughtful comments made by Dr. Kripke and his colleagues. We agree that in establishing a priori criteria for study inclusion we "set the bar" a bit higher than in their Cochrane review. We believe our study inclusion criteria, as described in the article, are reasonable and consistent with conventional standards for clinical trial study design (1). Also, in contrast to the Cochrane review, we focused on a more homogeneous diagnostic group (e.g., we did not include studies of subsyndromal depression, schizoaffective disorder, or bipolar disorder) and age range. In addition, we set parameters for a minimum therapeutic dose of active treatment, as well as a maximum amount for placebo conditions.

The Martiny report (your reference 3), published after the completion of our study, is an important new addition to the evidence base. We want to especially thank Dr. Kripke et al. for pointing out the two sets of reports that were referenced twice. We had detected (and corrected for) a third set but did not realize that there were two additional duplicate reports (perhaps because each article had different first and last authors). Still, our conclusions remain the same. There is a clear need for further study in this important area, including larger-scale multicenter trials, and an even greater need for all studies to conform to the principles of clinical trial research design and established standards for scientific reports in depression (2).

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