Electroconvulsive therapy (ECT) versus sham ECT for depression: do study limitations invalidate the evidence (and mean we should stop using ECT)?

SUMMARY Electroconvulsive therapy (ECT) for depression is a controversial treatment with highly polarised views about the balance between therapeutic benefits and adverse effects. Studies investigating whether ECT more effective than placebo started in 1950s, most important randomised controlled trials carried out four decades ago which was compared sham (SECT) involving anaesthesia but no electrically induced seizure. Subsequently data have been pooled number of meta-analyses found that an treatment. However, recent review quality SECT-controlled studies, based on them, concludes their too poor to allow assessment efficacy that, given its risks (permanent memory loss death), use should be suspended. This commentary critically discusses methodology this conclusions.