Psychedelics are still grinding their way through the testing and licensing processes. One of the reasons ketamine had so much buzz was because it was initially

Psychedelics are still grinding their way through the testing and licensing processes. One of the reasons ketamine had so much buzz was because it was initially going to be used for this group of patients. In England (where the author works) ECT really is used for people who are very severely ill. They will have been through several different types of medications first. When psychedelics get approval those will go into the roster of things to try before ECT. It's possible for someone to write an advance directive that says they want ECT to be used, so I guess there's some people for whom it's not used as a last resort.