Caution should be advised when recommending increased use of ECT based on low quality evidence.

On the basis of a meta-analysis that compared patients with unipolar depression against patients with bipolar depression who received electroconvulsive treatment (ECT), Bahji et al. (1) concluded that their findings supported increased utilization of ECT in patients with treatment-refractory bipolar depression and urged for more clinicians to use ECT in both unipolar and bipolar depression. However, due to several methodological limitations in their meta-analysis their recommendations do not seem supported by the evidence. This article is protected by copyright. All rights reserved.