The authors outline the clinical management methods used in a long-term study of depressed elderly patients and comment on the positive aspects of such interventions on the successful recruitment and retention of subjects. Psychosocial or clinical management (CM) is the “glue” that holds a successful drug trial together. CM is recognized to be an essential element for success in drug trials for geriatric depression. The authors also discuss potentially negative aspects of comprehensive CM, such as those obscuring a psychotherapeutic effect in comparative studies.