Advocates of this approach assume that clinical decision-making should be informed by a hierarchy of knowledge, at the top of which stands data from placebo-controlled randomized controlled trials (Devereux & Yusuf, 2003; Cipriani et al., 2009). In keeping with this now well-established approach, this review of the effectiveness of ECT pays particular attention to comparisons of ECT and simulated-ECT [SECT], in which the usual general anaesthesia is administered but the electric shock is not.