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Frais's insightful perspective on seeking an effective treatment for his medication-resistant depressive illness highlights the important place of electroconvulsive therapy (ECT) in management of the condition (1). Not only is ECT the most efficacious treatment for this disorder (2), it retains good effectiveness following pharmacotherapy failure (3). Despite this, Frais's experience of starting the treatment late in the course of his illness only after he had requested it himself (1) is all too common. Many outpatients and families lack his resourcefulness and are never offered ECT despite its potential benefits.
It is vitally important for community and inpatient psychiatrists to offer ECT early, alongside other options, to patients with resistant moderate or severe illness. ECT is not a treatment of last resort.
Yours faithfully
Dr Richard Braithwaite MRCPsych
Consultant Psychiatrist, Sussex Partnership NHS Foundation Trust
Chair, Committee on Electroconvulsive Therapy & Related Treatments, Royal College of Psychiatrists
Mr Neil Kinlay
Expert by Experience, Committee on Electroconvulsive Therapy & Related Treatments, Royal College of Psychiatrists
Prof Julie Langan Martin
Professor of Psychiatry and Honorary Consultant Psychiatrist, University of Glasgow
Chair, Scottish Electroconvulsive Therapy Audit Network
Prof Declan M McLoughlin PhD MRCPsych
Head of Discipline, Dept of Psychiatry, Trinity College Dublin
Member, Committee on Electroconvulsive Therapy & Related Treatments, Royal College of Psychiatrists
Prof George Kirov
Clinical Professor, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University
Member, Committee on Electroconvulsive Therapy & Related Treatments, Royal College of Psychiatrists
References
1. Frais A. Finding the right treatment for severe depression. BMJ 2025;389:r478.
2. UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003 Mar 8;361(9360):799-808.
3. Heijnen WT, Birkenhäger TK, Wierdsma AI, van den Broek WW. Antidepressant pharmacotherapy failure and response to subsequent electroconvulsive therapy: a meta-analysis. J Clin Psychopharmacol. 2010 Oct;30(5):616-9.
Competing interests:
RB, NK and JLM have no competing interests. DMM has received speaker’s honoraria from MECTA, Otsuka, and Janssen and an honorarium from Janssen for participating in an esketamine advisory board meeting. GK receives royalties from a book about ECT.
10 April 2025
Richard Braithwaite
Consultant Psychiatrist
Neil Kinlay, Julie Langan Martin, Declan M McLoughlin, George Kirov
Sussex Partnership NHS Foundation Trust
Meadowfield Hospital, Arundel Rd, Worthing, West Sussex BN13 3EP, United Kingdom
Electroconvulsive therapy should be offered early in medication-resistant depressive illness
Dear Editor
Frais's insightful perspective on seeking an effective treatment for his medication-resistant depressive illness highlights the important place of electroconvulsive therapy (ECT) in management of the condition (1). Not only is ECT the most efficacious treatment for this disorder (2), it retains good effectiveness following pharmacotherapy failure (3). Despite this, Frais's experience of starting the treatment late in the course of his illness only after he had requested it himself (1) is all too common. Many outpatients and families lack his resourcefulness and are never offered ECT despite its potential benefits.
It is vitally important for community and inpatient psychiatrists to offer ECT early, alongside other options, to patients with resistant moderate or severe illness. ECT is not a treatment of last resort.
Yours faithfully
Dr Richard Braithwaite MRCPsych
Consultant Psychiatrist, Sussex Partnership NHS Foundation Trust
Chair, Committee on Electroconvulsive Therapy & Related Treatments, Royal College of Psychiatrists
Mr Neil Kinlay
Expert by Experience, Committee on Electroconvulsive Therapy & Related Treatments, Royal College of Psychiatrists
Prof Julie Langan Martin
Professor of Psychiatry and Honorary Consultant Psychiatrist, University of Glasgow
Chair, Scottish Electroconvulsive Therapy Audit Network
Prof Declan M McLoughlin PhD MRCPsych
Head of Discipline, Dept of Psychiatry, Trinity College Dublin
Member, Committee on Electroconvulsive Therapy & Related Treatments, Royal College of Psychiatrists
Prof George Kirov
Clinical Professor, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University
Member, Committee on Electroconvulsive Therapy & Related Treatments, Royal College of Psychiatrists
References
1. Frais A. Finding the right treatment for severe depression. BMJ 2025;389:r478.
2. UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet. 2003 Mar 8;361(9360):799-808.
3. Heijnen WT, Birkenhäger TK, Wierdsma AI, van den Broek WW. Antidepressant pharmacotherapy failure and response to subsequent electroconvulsive therapy: a meta-analysis. J Clin Psychopharmacol. 2010 Oct;30(5):616-9.
Competing interests: RB, NK and JLM have no competing interests. DMM has received speaker’s honoraria from MECTA, Otsuka, and Janssen and an honorarium from Janssen for participating in an esketamine advisory board meeting. GK receives royalties from a book about ECT.