Modified versus Unmodified Ect : Is There a Paradigm Shift?

REPLY Sir, It is a matter of satisfaction that our article has generated interest. We would like to respond to each of the observations by Agarwal (2000) one by one. (1) We are in complete agreement with the author of this ' letter to editor' that the usage of term non-parametric and parametric variables is not technically sound. However, the conventional usage of these terms is seen in many scientific communications. Certainly, the term 'inappropriate distribution' should best be avoided. (2) We agree that variables with large standard deviation (S.D.) should preferably be analyzed by non-parametric tests. The variables with large S.D. were subjected to re-analysis by Mann Whitney U Test and results obtained were identical to that obtained by t-test. However, it should be mentioned here that, in the original analysis, modified t-test was applied so as to take care of the large S.D. (3) Regression analysis was, indeed, not carried out due to small sample size. In statistical terms, the term predictor' is not in keeping with the analysis so carried out. However, in keeping with previous literature and for want of a better term, 'predictor 1 was used in the research report. (4) Randomized controlled trials on large sample size and with a sound methodology should be an 'idea" method of determining predictors of response to ECT. However, numerous ECT-related and clinical parameters, along with associated ethical issues, need to be taken into consideration at the same time. This study, being one of the few studies on ECT in depression in India, provides a base on which future research (related to predictors of response to ECT in depression) can be executed. Sir, There has been a resurgence of interest in the ongoing debate between the use of modified versus unmodified ECT with respect to Indian population. The earlier recommendation of mandatory use of modified ECT as expressed in the aftermath of the National Conference on ECT in 1990 has now been questioned (Shah and Rassiwala,2000). In a similar vein, unmodified ECT has recently been shown to have considerably less musculoskeletal morbidity then earlier believed (Andrade et al.,2000). Thus, there appears an emerging consensus that while modified ECT is desirable where adequate facilities are available, < unmodified ECT cannot be looked down with abhorrence and totally discarded. Similar views have been expressed by many authors in a recent issue of Archives of Indian Psychiatry a paradigm shift from …