To the Editor.—
At the Chief Editor's request, I will comment on the recent publication of the results of the NIMH Treatment of Depression Collaborative Research Program by Elkin et al and on Dr Klein's letter.Dr Klein raised a number of criticisms about the appropriate statistical techniques and the interpretation of the results. These criticisms merit attention but the issues should be viewed in the larger context of the study and its achievements.
This is the largest psychotherapy research project ever undertaken in the United States, involving three collaborating field centers. It has the imprimatur of NIMH. Although multicenter trials are now common in clinical psychopharmacology, they have not been widely applied to evaluating psychotherapy. As such, the demonstration of the feasibility of designing and conducting this trial should be considered an achievement in itself.Moreover, the study pioneered a number of methods that have become the