We thank Battle and colleagues for their interest in our review. The decision whether a woman needs an antidepressant should be typically made by a psychiatrist who would consider all therapeutic options, including psychotherapeutic methods. We concur with Battle and colleagues that the decision should consider the pregnant woman’s preferences, values, and concerns about engaging in various treatments. In fact, many times psychotherapy and medications go hand in hand, complementing each other. Also, medications may sometimes make the patient more available for psychotherapeutic methods. In fact, we believe that psychotherapy should be made available to many more patients, and that depressed pregnant women should be prioritized in waiting lines for receiving these treatments. Although of great importance, these aspects were outside the scope of our medication safety review. In that context, it would have been only fair for Battle and colleagues to remind the reader that psychotherapy is by far more expensive, and unfortunately still out of reach for millions of women in the United States and elsewhere.

Last, Battle and colleagues perpetuate the term “efficacious” (“cognitive-behavioral therapy and interpersonal psychotherapy are clearly efficacious ” ) referring to a metaanalysis in a nonpregnant adult population . In fact, the studies they quote have shown these methods to be effective , and not efficacious (which means showing effect under ideal conditions, rather than under real-life situation). We need more research and documentation that these therapies are efficacious in populations of pregnant women in a real-life setting, and encourage Battle and colleagues to continue their important work.