Just to follow up on that point, I think neurostimulation and older medications are all things that.... I've practised ECT and I've seen some pretty incredible responses.
That being said, ECT is a daunting prospect for a patient. It has a number of benefits and side effects. So do monoamine oxidase inhibitors. Again, it always comes down to the fact that the treatment may or may not be available and the question of whether it is the right treatment for that patient. Patients have different reasons for saying yes or no to those treatments.
I've also seen many people receive ECT, monoamine oxidase inhibitors and many psychiatric medication combinations and experience only side effects with no benefit.