Editor’s Roundup for Issue #3 of 2021

Abstract

E lectroconvulsive therapy (ECT) faces more stigmatizing hurdles than many other medical treatments.Providing ECT to patients who lack capacity to consent is one of these hurdles and has been addressed before in the Journal of ECT. 1,2 The literature is uniform in its agreement that ECT is therapeutic when it is applied after receipt of surrogate consent. In this issue, Takamiya et al 3 provide further evidence that ECT is just as helpful with surrogate consent as with consent directly from the patient. Although the relief of suffering is the principal rationale for providing ECT, including under surrogate consent, Yamazaki et al 4 remind us that early strategic administration of ECT can hasten discharge from the hospital.Recent clinical trials of ECT in elderly persons with depression have focused on unipolar depression, whereas bipolar depression in the elderly is less studied. So we welcome the report from Morcos et al, 5 which shows that the administration of ECT in elderly persons with depression produces benefit without persistent cognitive impairment.The tight relationship between sleep and mood disorders is explored by Hines et al 6 in an open study of transcranial magnetic stimulation (TMS) for depression in active duty soldiers undergoing a polysomnogram (PSG) before and after TMS. The PSG revealed that TMS enhanced rapid eye movement sleep, which is the opposite effect of what is seen with ECT and PSG. 7 On the other hand, increases in total sleep time with TMS was dependent on clinical response, 6 mirroring what Rosenquist et al 8 reported with subjective improvement in sleep with TMS.The negative symptoms of schizophrenia are notoriously resistant to most somatic interventions. So, it is with interest that we read the report from Dharani et al 9 that transcranial direct current stimulation was superior to sham in ameliorating negative symptoms.