Patients who inappropriately demand electroconvulsive therapy

It is the authors' experience in our large, tertiary care electroconvulsive therapy (ECT) practice that some patients seem to demand continued ECT treatment, although the opinion of their clinicians is that ECT has not been beneficial. In this paper, through representative case examples, we outline some of the reasons why such patients request ECT and some of the reasons for their reported benefit other than true clinical improvement. We argue that some ECT patients are primarily motivated by the primary or secondary gain of being medical patients and that this needs to be considered by the clinician so as not to administer the treatments unnecessarily.