This patient commentary addresses the absence of rigorous placebo- or sham-controlled trials for electroconvulsive therapy (ECT) and discusses whether its therapeutic effects are partly attributable to non-seizure components like anesthesia and subthreshold electrical stimulation. It proposes noninferiority trials comparing ECT and non-ictal treatments such as subconvulsive electrotherapies and psychotherapeutic anesthesia to investigate these components and evaluate potential alternatives with lesser adverse effects.
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