I have very mixed feelings about ECT. Although I've seen it help many patients, I've also seen it induce near-catatonic states and mood swings in more patients than I would like. There is also limited research on the long-term effects of ECT and whether or not ECT actually provides enough long-term relief from symptoms to be worth the discomfort and physical and psychological risk.

Ketamine and Propofol have, in my opinion, a better cost-benefit ratio, and I like that they don't induce a seizure-like response in the brain. Recent research on consciousness would seem to suggest that altering the structure of the brain under anesthesia, when the consciousness is not able to access it, may be very disorienting and uncomfortable for the consciousness.

Furthermore, advances in consciousness research have allowed development of techniques like Transcranial Magnetic Stimulation, which are much less invasive, although in my opinion inducing an electromagnetic current in the brain by any form is like using a hammer to adjust your rearview mirror.

I think unusual conscious experiences and fresh ways of looking at the world allow the consciousness to participate in positive reorganization of neural networks, which is one of the reasons I think psychotherapy and introspection are such important parts of psychiatric treatment. Medication and other physical treatments can correct the wiring, but if you repair a computer and then only download viruses all day, the computer won't last long. Retraining patterns of thought is just as important as reorganizing neural pathways.

These are just my opinions, and have nothing to do with the particulars of my job or the policies of my hospital.