In Reply We appreciate the opportunity to respond to the letter by McCall et al and to clarify important aspects of our study¹ recently published in JAMA Psychiatry.

McCall et al called into question the efficacy of the electroconvulsive therapy (ECT) administered in our study. We administered 6 times seizure threshold right unilateral ultrabrief pulse ECT (6 × ST RUL UB ECT). The selection of 6 × ST RUL UB ECT was informed by the substantial body of controlled trial evidence supporting its efficacy. Notably, the Prolonging Remission in Depressed Elderly (PRIDE) study reported a remission rate of 61.7% among 172 completers who received 6 × ST RUL UB ECT.² However, as noted by McCall et al, it is important to consider the variability in efficacy rates across different studies and patient populations. Indeed, remission rates with 6 × ST RUL UB ECT have been reported to range from 13.3%³ to 73%.⁴ This wide range highlights the heterogeneity of depressive disorders and response to ECT. Our sample had several predictors of lower response to ECT, including a high degree of medication resistance, which may in part explain why our ECT condition had a remission rate on the lower end of the previously reported range.