Why are the most effective treatments for depression gatekept?

33F, I have been enduring TRD and chronic suicidality for the better part of 19 years, and I am on a waitlist for TMS. I wish I could have elective ECT because the pain I live with is becoming unbearable.

In researching ECT/TMS I've come across several statements like "ect is the most effective treatments for MDD" "80% of patients improve after TMS, and around 20% experience full remission."

If this is so, why is it so difficult for people with years long history of MDD being kept so far from these treatments?

I've been thinking about Jeff Baena's recent suicide. I miss Chester Bennington too. I'm certain these men endured pain and loneliness for a long time, coping however they could. Some suicides are impulsive, but many are simply the natural outcome of inadequate and exhausting "treatment" of a horrid illness that the majority of people don't live with or understand.

If suicide prevention really is important, then why push moderately effective, trial and error medications (that come with a black box warning for suicide) as treatment? Why not give those who are suffering treatments that are shown to drastically improve their symptoms? I'd love to hear your thoughts.

If you've read this, thank you.