Further studies comparing ECT to potential alternatives may reveal confounding by its non-seizure components

This commentary discusses the lack of rigorous placebo- or sham-controlled trials for electroconvulsive therapy (ECT). Further, it considers the scientific questions of whether the therapeutic effect of ECT is partly due to its non-seizure components, such as anesthesia and subthreshold electrical stimulation. Finally, further trials are suggested to compare ECT to treatments that highly resemble these non-ictal components. Such research could potentially answer these questions and explore the indications for these alternatives, which have less intense adverse effects.