Stephen J.LurieMD, PhD, Senior Editor
In Reply: In response to Drs Lespérance and Frasure-Smith, a power analysis suggested that a very large sample would be required to detect adverse cardiac events, and such a trial would have been unethical without preliminary safety and efficacy data. Lespérance and Frasure-Smith are also concerned about the validity of the depression outcome data because of potential unblinding due to adverse events. We disagree that independent raters, rather than treating physicians, are better to ensure blindness. Such concerns are unrealistic in this population. The average patient receiving placebo was receiving 11 other medications as well, and thus the physician was often unable to determine which medication was causing a patient's complaint.
Glassman AH, O'Connor CM. Sertraline for Treatment of Depression in Acute Coronary Syndromes—Reply. JAMA. 2002;288(19):2403. doi:10.1001/jama.288.19.2403-JLT1120-1-3