Seriously depressed patients who have failed to respond to one or more antidepressant medication trials should be referred for ECT consultation, sooner rather than later, to ensure optimal outcomes. Suicide risk in this population is elevated, as is the potential for ongoing medical morbidity, not to mention the continued suffering from the depressive episode itself. A recent study (2) comparing three ketamine infusions with three ECT treatments in 1 week touted ketamine as a superior treatment and received considerable media attention (3). A reasonable interpretation of that research is that it replicated the finding of a signal of early antidepressant response with ketamine. However, ketamine remains completely unproven as a definitive treatment for a major depressive episode. Seriously ill psychiatric patients are often desperate for dramatic cures; their health care providers, acknowledging that our current treatments are often lacking, are also eager for the newest breakthroughs. Such desperation and enthusiasm should not cloud our clinical judgment; proven, evidence-based treatments, including ECT for seriously depressed patients, should be offered before unproven, experimental approaches, no matter how “in vogue” those approaches may be.