To the Editor Electroconvulsive therapy (ECT) is widely regarded as the most effective short-term treatment for major depressive episodes, including treatment-resistant depression (TRD). Deng et al¹ recently reported in JAMA Psychiatry the Clinical Outcomes of Magnetic Seizure Therapy (MST) vs ECT for Major Depressive Episode study, finding that the efficacy of ECT and MST were 鈥渋ndistinguishable.鈥� Expanding the interventions considered effective in TRD is welcome, given the dire need. However, the ECT remission rate after short-term treatment was exceptionally low, limiting confidence in the validity and/or generalizability of the findings.

In the Deng et al¹ study, the remission rate after ECT rate in the intention-to-treat group was 26.3%; this was assessed using the 24-item Hamilton Rating Scale for Depression. In contrast, large randomized clinical trials of ECT technical parameters and prospective naturalistic studies of ECT generally report remission rates between 50% and 85%.^2,3 A large effectiveness study in community settings had a remission rate of 46.7%.⁴ Ineffective forms of ECT, such as low-dosage right unilateral treatment, and sham ECT (administration of anesthesia alone) are associated with remission rates of approximately 20%, similar to the ECT outcomes in the Deng et al¹ study. Of interest, the recent Ketamine vs ECT for Nonpsychotic Treatment Resistant Major Depression study concluded that 鈥溾��ketamine was noninferior to ECT as therapy for treatment-resistant major depression without psychosis,鈥�^5(p2315) but the remission rates after ECT were 20.0% on the Quick Inventory of Depressive Symptoms self-report measure and 21.8% on the clinician-rated Montgomery-脜sberg Depression Rating Scale.