Drs. Parvin and Swartz asserted that the low remission and high relapse rates we documented in a study of electroconvulsive (ECT) in major depression in community settings were due to patient selection factors. Specifically, they speculated that in community settings a substantial proportion of patients treated with ECT have the atypical subtype of depression, while melancholic and catatonic subtypes are under-represented. They also claimed that atypical depression does not respond to ECT, while melancholia and catatonia are predictive of positive outcome. They further speculated that excluding patients with a pre-ECT baseline Mini Mental State Examination (MMSE) score below 15 increases the representation of atypical depression. Finally, they claimed that we did not prove that the low rates of response and remission to ECT were due to premature ECT termination. The findings in this study contradict each of these assertions.
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