ECT and onset of action

Although there is a long-standing clinical belief that electroconvulsive th erapy (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 medicatio ns. Studies comparing various modalities of ECT have highlighted several fa ctors that should be considered in any assessment of differential onset of antidepressant effect. First, patients are heterogeneous: that is, given an y 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 th e onset of therapeutic response should not be an end in itself.