Efficacy of Continuation/Maintenance Electroconvulsive Therapy for the Prevention of Recurrence of a Major Depressive Episode in Adults With Unipolar Depression

Abstract

This review suggests that c/mECT is efficacious for the prevention of relapse/recurrence of major depression and that efficacy is increased when c/mECT is provided in combination with antidepressant medication and at flexible treatment intervals, responsive to early signs of recurrence.

Electroconvulsive therapy: a life course approach for recurrent depressive disorder

“…A recent systematic review has provided more evidence for efficacy of continuation and maintenance ECT therapy; however, the studies included within it were highly prone to bias 9. In addition, evidence for the safety and efficacy of ECT in the older population is provided by a case report of a patient who received 172 ECT treatments, up to the age of 89 10…”

“…In addition, more randomised control trials are needed to determine whether continuation or maintenance ECT schedules are better given on a set schedule or more flexibly at varied intervals after the initial series of treatment ECTs 9. Also, more emphasis should be given to carers’ views in the first-line treatment of recurrent depression.…”

Risikofaktoren für Rückfall nach Elektrokonvulsionstherapie bei depressiven Erkrankungen

“…In unserer Analyse war der rückfallpräventive Effekt der Kombination aus E-EKT und Pharmakotherapie der alleinigen Pharmakotherapie überlegen. Dies steht im Einklang mit anderen Studien [3,4,21] und zwei systematischen Reviews [22,23]. In den ersten drei Monaten nach der Akutbehandlung erlitten 40 % der Patienten ohne E-EKT in unserer Untersuchung Rückfälle vs. 10 % mit E-EKT (▶Abb.…”

“…In letzter Zeit haben individualisierte Ansätze an Bedeutung gewonnen. Ein symptomtitrierter Algorithmus [7] mit fester wöchentlicher E-EKT im ersten Monat und einer darauf folgenden flexiblen, symptomadaptierten Komponente ergab vielversprechende Ergebnisse [3,22,25]. Eine bedarfsadaptierte Komponente in der E-EKT erscheint also untersuchenswert, wenngleich die klinische Praxis und die Refinanzierung problematisch sein könnten.…”

Recovery is a core goal of psychiatrists

“…This does not eschew the utility of these approaches for many individuals. Wand (2015) dismisses the utility of electroconvulsive therapy (ECT), ignoring, inter alia, a systematic review of six studies that shows improved relapse prevention and a reduction in recurrence in major depressive disorder (Brown et al, 2014), and recent randomized controlled trial (RCT) evidence of the utility of ECT in augmenting clozapine response in people with treatment refractory schizophrenia (Petrides et al, 2015). Any experienced clinician will testify to the life-saving benefits of ECT in patients with psychotic depression who are not eating or drinking and would otherwise die.…”