ECT vs Ketamine: NEJM Article Sets Up False Equivalency

Today, "Classics in ECT" brings you a study in Acta Neurologica Scandinavica
from 1987:

A double-blind evaluation of electroconvulsive therapy in Parkinson's disease with "on-off" phenomena.

Andersen K, Balldin J, Gottfries CG, Granérus AK, Modigh K, Svennerholm L, Wallin A.

Acta Neurol Scand. 1987 Sep;76(3):191-9.

PMID:

 

2446463
The pdf is here.

To my knowledge, this is the only sham-controlled, blinded study of ECT in Parkinson's Disease (PD).
11 non-depressed patients with severe PD received  active or sham (anesthesia, muscle relaxation,
no stimulus) ECT, had comprehensive symptom ratings, and pre- and post-ECT course lumbar punctures (n=7).
Real ECT resulted in significant improvement in PD symptoms for up to 6 weeks. No change in CSF
neurotransmitter metabolites was found.
There is a considerable literature (over 300 PubMed citations) about ECT for PD, mostly case reports
or series. There is little doubt that ECT has beneficial effects on the core motor symptoms of PD, as well
as co-morbid depression and other psychiatric symptoms. Maintenance ECT is indicated for most
patients who show acute response.
I continue to be amazed and dismayed that this indication for ECT has never received widespread
acceptance.