ECT vs Ketamine: NEJM Article Sets Up False Equivalency

Today, "Classics in ECT" features a fairly recent editorial in JAMA Psychiatry:

Modern Electroconvulsive Therapy: Vastly Improved yet Greatly Underused.

Sackeim HA.JAMA Psychiatry. 2017 Aug 1;74(8):779-780. doi: 10.1001/jamapsychiatry.2017.1670.PMID: 28658461 
The pdf is here.

From noted ECT researcher, Harold Sackeim, PhD, the editorial accompanied the below article in the same issue of JAMA Psychiatry:

Slade EP, Jahn DR, Regenold WT, Case BG. Association of Electroconvulsive Therapy With Psychiatric Readmissions in US Hospitals. JAMA Psychiatry. 2017;74(8):798‐804

The title of the editorial pretty much says it all. Dr. Sackeim reviews the state of contemporary ECT in the United States, noting that ECT is rarely used (data from the Slade et al. article: only 1.5% of general hospital inpatients with severe mood disorder receive ECT)  works much better than antidepressant medications, and has a much improved tolerability profile.

He concludes:

Nonclinical economic, cultural, and political factors greatly affect the availability and use of this intervention. Were we able to overcome these barriers, it is likely that un-told numbers of patients would experience better outcomes by receiving an intervention [ECT] that is often life altering and, for some, lifesaving.