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In Reply.—Ìý Several comments in response to Drs Rifkin and Quitkin's letter are in order. Their statement that "only one of the four (patients) whose conditions did not improve received drugs" is not an accurate representation of the clinical data we presented. We stated that the medication of one of the four patients whose condition demonstrated no change at follow-up was stopped as part of our study. In total, the conditions of none of the ten patients included in our study were treated with tricyclic antidepressants during the patients' baseline hospitalization; the remaining patient's condition was treated with lithium. As described in our report, the medication of four patients was stopped during the course of the protocol. We did not assign patients to "responder" and "nonresponder" groups, since we were not evaluating outcome of a specific treatment regimen.The MHPG excretion data for the baseline and follow-up periods in our study