Unmodified electroconvulsive therapy: Concerns about reporting in a retrospective study.

Sir,

Ray[1] described a chart review of unmodified electroconvulsive therapy (ECT) in the Central Institute of Psychiatry, Ranchi, India, during 1990–1995. We are concerned about the casual and offhand manner in which the paper was written and the data presented.

Ray[1] states that there is a lack of recent study on unmodified ECT other than a few surveys on the pattern of ECT practice based on respondent reports. This is absolutely incorrect. There is one large retrospective study[2] and two prospective studies.[34] All these studies were conducted in India and two,[23] in fact, were published in the Indian Journal of Psychiatry. None of these three landmark publications are referenced by Ray.[1] Ray[1] also does not cite and reference the position statement and guideline on unmodified ECT, jointly issued by the Indian Psychiatric Society, the Indian Association of Private Psychiatry, and the Indian Association of Biological Psychiatry,[5] which was also published in the Indian Journal of Psychiatry. This position statement and guideline[5] is the most comprehensive and authoritative document on the subject published to date, providing clarity on subjects that Ray[1] deems to be obscure.

Ray[1] provides a poor description of the clinical features of the sample, no information about the ECT stimulation details, and no data and statistical analysis to support a large number of claims and conclusions, such as that there was a significant positive correlation between subconvulsive stimuli and age, total number of ECT sessions, and depression, and that there was no relationship between subconvulsive stimulation and post-ECT confusion.

In the paper,[1] Table 1 refers to cognitive decline with no explanation of how this was defined and assessed; this shortcoming characterizes other constructs referred to in the paper, as well. The paper states that there were no chart notes documenting the occurrence of post-ECT headache, a well-known adverse effect of unmodified ECT;[5] how accurate, then, could the rest of the information in the charts be?

Finally, there are no authors from the institution from which the data were obtained and no institutional approval for the conduct of the study and the use of the data. This concern must have escaped the reviewers of the manuscript during their blinded review.

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Conflicts of interest

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