In the Netherlands ECT is hardly used. Compared to countries such as USA, UK and Denmark, ECT is used 100 to 200 times less frequently per inhabitant. During the years 1981-1984 the Psychiatric Centre Bloemendaal served as a kind of regional centre for ECT for two Dutch provinces with a total population of 5.5 million inhabitants. During these years 35 non-geriatric patients were treated with a total of 38 courses of ECT. The indication in most cases (31 patients) was a severe, therapy-resistant major depression according to DSM-III. The mean duration of their current episodes was about two years. ECT was effective in 53% . A retrospective study, using medical-, nurse- and research files, to clinical parameters, revealed that ECT was significantly more effective in the subgroup of patients with a major depression with melancholia than in the non-melancholic group (p = 0.002), but not more effective in the subgroup with psychotic features than in the non-psychotic group. Furthermore a significant negative correlation (r = —0.36, p = 0.02) was found with the duration of the episode, indicating that ECT is less effective in longer-lasting depressions.