Schulze-Rauschenbach et al (Reference Schulze-Rauschenbach, Harms and Schlaepfer2005) found in their comparison of unilateral electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) that these two procedures have similar efficacy in the treatment of major depression. However, the rate of treatment response for ECT in their study was 46%, well below the figures found in other studies (Medical Research Council, 1965). The authors state that the response rate for ECT might have been higher if a higher dosage had been used, but that this would have increased the risk of side-effects. This argument is misleading, just as comparing a sub-therapeutic dose of amitriptyline and placebo would be. The authors should have compared the incidence of side-effects between treatments, but at therapeutic doses. This comparison would probably have confirmed the prevalent belief that ECT is more effective than rTMS in the treatment of major depression (Reference Aarre, Dahl and JohansenAarre et al, 2003).