Subjects who responded to acute phase treatment, defined as 2 consecutive HAMD < 9 and greater than a 50% reduction in HAM-D score within 12 weeks, were offered entry into the continuation phase. Inter-rater reliability for the HAM-D was tested annually with site project coordinators and research assistants. Further training and evaluation were implemented until the inter-rater reliability was 0.8 or greater. Relapse during the continuation and recurrence during maintenance phases were determined according to the clinical judgement of the treating physician that the major depression had recurred or an intervention beyond what was permitted by the study protocol was required.