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October 24/31, 2001

Antidepressant Medication for Chronic Tension Headache—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(16):1969-1970. doi:10.1001/jama.286.16.1969

In Reply: Drs Rifkin and Ward argue that patients with symptoms of depression should have been excluded from our trial to rule out the possibility that the mechanism of the TCAs' effect on CTH was their antidepressant activity. However, our goal was not to examine the mechanism of the effect of TCAs, but to address specific efficacy questions,1 including whether a TCA treatment effect even exists. Excluding all patients with symptoms of depression would have compromised the external validity of our trial; the efficacy of the 3 treatments would have been evaluated in a clinically unrepresentative patient sample (in which no patient exhibited symptoms of depression).

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