The enthusiasm for ketamine and TMS undoubtedly outstrips the evidence and is driven by financial motivations. But to call it "anecdata" is a bit harsh. The available evidence certainly eclipses some of the other recommendations in the comments (CBD, lsd/psilocybin - before I get angry responses, these look promising but the data just aren't there yet).
Where I totally agree with you is ECT. It is, with a bullet, the best-supported intervention for treatment-resistant depression, and it's not even close. It is an absolute tragedy that it has such an unfairly terrible reputation. Even before anesthesia was a universal element of ECT, it was never as bad as usually portrayed in popular culture.
It is harsh, but where's the fun in the comment section of an HN post on psychology without a little hyperbole?
My disdain comes from seeing people I'm close to repeatedly pushed towards those treatments by practitioners who, when asked to provide references supporting their endorsement supply anecdotes about past or current patients rather than DOIs. There are specific TMS protocols that appear to have some growing amount of evidence behind them, but ketamine still seems to be a wildly variable cash grab that requires further data before anything can be said about its efficacy.
The negative side effects of ECT can be dramatic and life-changing. I've known people who lost significant chunks of their memory (and that's with modern ECT), and they said it was worth it for them... but I have zero interest in risking that. If the alternative is killing yourself, it might be worth it, but for TRD without attempted or planned suicide, I have never even considered ECT seriously.
That can be a side-effect, especially with bilateral lead placement. With unilateral placement, it's pretty occasional. I wonder if knowing two people with the same problem indicates a local psychiatrist using bilateral approaches more than usual?
Where I totally agree with you is ECT. It is, with a bullet, the best-supported intervention for treatment-resistant depression, and it's not even close. It is an absolute tragedy that it has such an unfairly terrible reputation. Even before anesthesia was a universal element of ECT, it was never as bad as usually portrayed in popular culture.