Failure to respond to adequate pharmacological treatment for major depression is now the most common indication for the use of electroconvulsive therapy (ECT). The advantages of ECT with respect to both speed and quality of response are clinically important issues, but surprisingly few studies have examined the efficacy of ECT in relation to newer antidepressant agents such as selective serotonin reuptake inhibitors (SSRIs). A total of 39 subjects with major depression and with at least two failed antidepressant trials (mean 4.9 trials) were randomized to either paroxetine treatment (n=18) or right unilateral (RUL) ECT (n=21). Up to the end of the study treatment we found a reduction in the HAMD score of 59% for the ECT group and of 29% for the paroxetine group (P<0.001 paired t-test). In the ECT group, 71% of subjects fulfilled the response criteria (at least a 50% decrease in total HAMD score). The present study found ECT to be superior to paroxetine in medication-resistant major depression, in terms of both degree and speed of response.

Objective: The higher incidence of man‐to‐woman transsexuals compared to woman‐to‐man transsexuals varies markedly from country to country. This is the first survey of the sex ratio to be made in Germany. Method: It covers 1785 patients who between 1964 and 1998 were diagnosed as transsexual at the four largest German centres offering treatment. Results: From 1970 to 1994 the sex ratio remained constant at 2:1 in favour of man‐to‐woman transsexuals. Over the past 4 years, however, it has altered considerably and reached 1.2:1. Conclusion: Up to 1994 our results do not support the assumption that transsexualism is gradually becoming equally prevalent in both sexes. The drop in the sex ratio after 1994 can be explained either as a reduction of an overhang of male‐to‐female transsexuals or as an artificial phenomenon caused by recent developments in therapy and by the views of transsexuals' groups on the treatment they are offered.

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Prelingual deafness has a strong impact on the course of schizophrenia. In the long run, many of these patients belong to a "minority within a minority".

Gender identity change in intersexual patients is rare. We report on the transsexual development of a patient with male pseudohermaphroditism. The case report emphasizes the importance of a thorough differential diagnosis.