Changes in Problem-Solving Capacity After a Single Electroconvulsive Treatment.

To the Editor: F idalgo et al 1 published the review “Biological markers in noninvasive brain stimulation trials in major depressive disorder: a systematic review,” in which they limited the scope of the review to transcranial magnetic stimulation and transcranial direct current stimulation. By doing so, they imply that electroconvulsive therapy (ECT) is an invasive brain stimulation technique. In medicine, the term invasive typically refers to procedures that breach the integument or require implantation of some device into the body. Electroconvulsive therapy is decidedly a noninvasive procedure, and by far the most effective and evidencebased brain stimulation technique. The incorrect categorization of ECT indirectly promulgated in their article perpetuates the stigmatization of ECT. Contemporary ECT is safe and well tolerated, with cognitive effects typically far less bothersome than ECT of the past. We trust that the title of the systematic review of Fidalgo et al was inadvertently chosen and hope that they agree that ECT is a completely noninvasive technique. Vagus nerve stimulation and deep brain stimulation are invasive, whereas transcranial magnetic stimulation, transcranial direct current stimulation, and ECT are not.