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What we found missing is the bio-psycho-social aspect of an overall treatment plan. It is our understanding that pharmacotherapy, ECT, psychotherapy, and sociotherapy should be well-orchestrated parts of an overall strategy, not just isolated measures that patients have to go through in a particular sequence. To achieve complete remission and to prevent chronification, the integrated use of all available resources is required, while taking into account the patients�� wishes. Apart from that we would like to point out that the ��high rate of early recurrence�� associated with ECT, can be deduced without difficulty from the abrupt termination of a highly effective intervention. In case of antidepressant therapy, successful treatment is continued over several months. Consequently, ECT is increasingly and successfully used as a maintenance therapy. Unfortunately, patients are frequently informed too late, not adequately or not at all because of irrational concerns and the treatment��s alleged stigma (2). Since the efficacy of ECT declines with increasing duration and treatment resistance of the disease (3), not starting the treatment in time is detrimental to the patient. For this reason, the psychiatric societies of Germany (DGPPN), Austria (?GPP), Switzerland (SGPP), and South Tyrol (SIP) called for the timely and adequate use of ECT in a joint statement issued in 2012 (4). Earlier in 2003, the German Medical Association and, in 2004, the Austrian ?GPP pleaded for the evidence-based use of ECT. These statements from German-speaking countries are in line with those from international psychiatric societies. Footnotes Conflict of interest statement The authors declare that no conflict of interest exists.""About 15 000 new cases of kidney cancer are diagnosed in Germany annually, of which approximately 90% are renal cell carcinoma (RCC) and 10% transitional cell carcinoma (TCC) (1). The observed annual increase in the incidence of renal cell carcinoma of approximately 2% (2) can partly be attributed the rapid progress in tomographic imaging. The detection of the tumor in the early T1a stage (48�C65%) (3, 4) as an incidental finding is advantageous as it allows curative treatment of small renal cell carcinomas in many cases (5). Historically, radical nephrectomy was considered to be the treatment of choice even for small renal tumors (6). In the meantime, partial nephrectomy has replaced this approach as it PLX 4720 preserves the organ while offering the same oncological efficacy with regard to tumor control (7, 8). Criteria for resection surgery include, in addition to oncological guidelines, especially the patient��s suitability for anesthesia, and the anticipated reduction in renal function. The growing interest in minimally invasive procedures has been triggered by the finding that the number of functional nephrons after tumor resection is directly related to patient survival (8).