To the Editor The article by Del Casale et al in JAMA Psychiatry compared esketamine plus selective serotonin reuptake inhibitors (SSRIs) vs esketamine plus serotonin-norepinephrine reuptake inhibitors (SNRIs) on 4 outcomes: all-cause mortality, hospitalization, suicide attempt, and relapse in depression. We are concerned that 3 outcomes are not reliably captured in the dataset used, rendering the entire report of uncertain validity. As a general rule, claims are often unreliable if not directly tied to reimbursement.