ECT and Onset of Action

Although there is a long-standing clinical belief that electroconvulsive therapy (ECT) is the fastest available treatment for depression, ECT has not been compared directly with drug therapy. For this reason, it is impossible to say whether ECT treatment actually works faster than standard medications. Studies comparing various modalities of ECT have highlighted several factors that should be considered in any assessment of differential onset of antidepressant effect. First, patients are heterogeneous; that is, given any treatment or mode of treatment, some patients will respond, and some will not. Second, the choice of statistical method can significantly affect the interpretation of comparative onset data. Third, improved onset of action sometimes is achieved at the expense of tolerability. Thus, accelerating the onset of therapeutic response should not be an end in itself.