ECT has never recovered in public esteem from the way it was presented in the film One Flew Over the Cuckoo’s Nest, but it works, three psychiatrists say in The Lancet. “Despite public and professional misgivings, ECT remains the most effective treatment for depression, especially if it presents with psychotic symptoms, such as delusions and hallucinations,” Professor Klaus Ebmeier, of the University of Edinburgh, and colleagues claim.

They also defend drugs as “the mainstay of antidepressant therapy” in the face of a campaign against them. “Recent moral panics about suicidal effects and dependence-inducing potential of antidepressants have tilted the balance of publicly perceived risk against them, but both their effectiveness and ready availability make them the likely choice for most patients,” they say.

Depression is a very common problem. About one in six people will suffer from the illness at some stage, but many endure it without treatment. It is twice as common in women as in men. Those suffering major depression have a risk of dying at least 60 per cent greater than those who escape it, in part because of their increased suicide risk. About half find that they are functionally impaired by the illness, in the sense that they can no longer do their jobs or lead a fully normal life.

The fashionable treatments are “talking therapies” such as cognitive behavioural therapy, which seeks to teach people how to understand and challenge their negative thoughts. The method works, though its popularity is more thanks to a lack of side-effects and patient choice than to overwhelming evidence of efficacy, the team say. They argue that antipathy to drugs is not backed by the evidence, which shows no increased risk of suicide with Prozac or Seroxat.

SHOCK THERAPY

• ECT was first used in 1938 by two Italian physicians to treat seizures in a schizophrenic patient. Today its use is limited to patients with severe depression
  
  
• An electric current is passed through the brain, inducing a seizure. The procedure is carried out under general anaesthetic, using muscle relaxants to prevent the violent jerking movements that could lead to broken bones
  
  
• When properly used ECT is effective in treating depression, but just how it works is in doubt. The most likely means is that ECT temporarily redirects the electrochemical processes of the brain

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