The trials of ECT

Since its introduction in 1934, electroconvulsive therapy has been subjected to a large number of clinical trials of varying methodological sophistication. Although doubts continue to be expressed about the efficacy of ECT, there is a remarkable degree of unanimity in the findings of trials published over a period of 50 years: improvement rates in depression of 70-80 per cent, compared with 20-30 per cent in untreated controls. The principal caveat is that ECT is not a ubiquitous treatment, even in the field of depression, and only patients with endogenous illnesses, whether unipolar or bipolar, can be expected to respond. Even among these, ECT cannot be expected to prevent the relapses in an illness whose underlying course is episodic. The published studies leave little doubt that ECT is statistically more effective than any of the antidepressant drugs, although the relative difference in outcome between the 2 forms of therapy is small, and drugs are to be preferred in mild or moderate cases. However, ECT is an effective and rapidly acting treatment for severe depressive illness, and the rapidity of the response makes its early use desirable in patients at risk of suicide, and those showing marked retardation, agitation and weight loss.