Sir: We read with interest the article by Davies and Wilson (Psychiatric Bulletin, June 2001, 25, 215-216) on the rate of missed-fits during electroconvulsive therapy (ECT). We have recently completed a retrospective survey of the missed-fit rate in our hospital's ECT department. Of the 70 patients who received ECT between January and December 2001, case notes were obtained for 68. Eighty per cent of the patients were on antidepressants, 47% on antipsychotics, 19% on benzodiazepines and 3% on antiepileptic drugs, and no medication was recorded for one patient.

The total number of ECT treatments given was 481. Of these, only five resulted in missed-fits. These patients were not on benzodiazepines or antiepileptic drugs. The stimulus dose applied in all five cases was appropriate to the patients' age and gender. All of them went on to fit successfully later in the course. In addition, different junior doctors were involved in the administration of ECT on the above occasions.

The rate of missed-fits in our survey was very low, 1.04%, which is comparable with the rate reported by the authors (1.8%) in their third audit-year. Our ECT department is consultant-led, with theoretical teaching and clinical supervision, as well as random checks to ensure that correct procedures are followed. A stimulus-dosing protocol is strictly adhered to.

As a result of this survey, restimulation guidelines are being drafted and will be included in ECT dosing policy. It is also proposed that this survey will become an annual event in our department.