I would like to point out a couple of facts about the decline in electroconvulsive therapy (ECT) use not mentioned by Eranti & McLoughlin (Reference Eranti and McLoughlin2003) in their recent editorial.

The use of ECT without consent has not declined at all since 1985. There were 3362 people given ECT without their consent under section 58 of the Mental Health Act 1983 in England and Wales in the 2-year period 1985–87, 4454 in 1987–89 and 4463 in 1999–2001, with little change in the years between (Mental Health Act Commission, 1988–2002).

It was the 1970s that saw the greatest decline in ECT use, from an estimated 60 000 courses in Great Britain in 1972 to 30 000 in 1979 (Reference Pippard and EllamPippard & Ellam, 1981).

The decline in ECT use over the past 20 years or so has been marked by regional variations. While in England ECT use fell fairly steadily during the 1980s, in Scotland it remained fairly constant during the 1980s and early 1990s and then fell by about a half in the mid-1990s (Reference Freeman, Hendry and FergussonFreeman et al, 2000). In the East Anglian region ECT use actually increased during the 1980s (Reference PippardPippard, 1992).

I think it is hard to reconcile these facts with the authors' suggestion that new drugs, improvements in patient care and better appreciation of the indications for ECT are responsible for the decline in ECT; although this would be the most respectable explanation for the decline in use of a treatment which is still described as safe, effective and life-saving — especially since the textbook indications for its use have changed little over the past two or three decades. Is it really the case that fewer people need ECT nowadays — or was it given needlessly to large numbers of people in the recent past? Since no research into the reasons for the decline in the use of ECT has been done, it remains impossible to answer this question with any certainty.