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To the Editor: In his astute editorial, Carl Salzman, M.D. (1), calls attention to the continuing ambivalence of the field toward ECT and the resulting lag in understanding of its mechanisms of action and relative efficacy and effectiveness in the treatment of depression (2). Steps to address these problems are now under way as a result of the recent programmatic reorganization of the National Institute of Mental Health (NIMH) (3, 4).
Intervention research supported by NIMH includes efficacy and effectiveness studies of all therapeutic modalities, including ECT. The benefit-risk ratio of different electrode placements and stimulus dosing (5) and predictors of response (6) are among the clinical reports published this decade from NIMH-funded studies of ECT. Readers of the Journal will recall that the last article (6) 3 years ago described the initial stage of an ongoing, three-site clinical trial comparing two medication regimens and placebo as maintenance treatment after a successful course of ECT, which without effective follow-up treatment has a distressingly high early relapse rate (2). Another clinical trial in four centers will examine the decades-old empirical practice of continuation ECT to prevent relapse, particularly when other strategies have failed to sustain ECT-induced remission (2, 4).
As Dr. Salzman suggests, perhaps the most important challenge facing the field is to convey to the next generation of clinical and basic investigators the necessity of enhancing research on the actions and role of ECT. To this end, NIMH grants directed at early-career investigators are enabling the entry of junior faculty into patient-centered and preclinical research with ECT.
ECT remains an essential component of the therapeutic armamentarium. Furthering our understanding of its optimal application and its mechanisms of action remains an important goal for the field, even as newer generations of pharmacological and psychosocial interventions narrow, but do not eliminate, the niche for convulsive therapy. We welcome the opportunity provided in the reorganized NIMH to contribute to the growing research base for ECT as part of our overall program development efforts.
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