Long-Term Maintenance ECT: A Retrospective Review of Efficacy and Cognitive Outcome

Abstract

Continuation and maintenance electroconvulsive therapy (ECT) are used to prevent relapse of depression after a successful course of index ECT. Such a course of treatment is typically extended for as long as a year. However, some patients seem to require longer courses of maintenance ECT. Little is known about the outcomes of long-term use (> 1 year) of maintenance ECT. We reviewed our maintenance ECT practice for the year 2000 and found that 43 patients had been receiving maintenance ECT for more than a year. This retrospective study reviews the outcomes of these patients. All patients had depression associated with either unipolar or bipolar disorder or schizoaffective disorder. These patients had multiple medication or psychotherapy trials or both and multiple hospitalizations before receiving maintenance ECT. Effects on depressive symptoms, level of functioning, health care use, frequency of hospitalizations, and cognition are discussed. We conclude that extended maintenance ECT is efficacious and well tolerated and reduces hospital use for a population of chronically depressed patients refractory to medication.

Two-Year Follow-Up of Cognitive Functions in Schizophrenia Spectrum Disorders of Adolescent Patients Treated with Electroconvulsive Therapy

“…These results support other long-term studies that have found no cognitive differences at follow-up (Cohen et al 2000;Russell et al 2003). When we analyzed the results with a repeated-measures method, no significant interaction time · group was found.…”

“…However, the sample of that study was composed of patients with different diagnoses (schizophrenia, depression and bipolar disorder), and the assessment was performed during maintenance ECT. No long-term studies of verbal fluency are found in the literature, and other studies conducted with adolescent samples with severe mood disorders have found no significant differences in attention at long term follow-up (Cohen et al 2000;Russell et al 2003).…”

“…Regarding long-term studies with a follow-up longer than 1 year, there are to our knowledge only three studies that have analyzed the cognitive effects of ECT in adult samples (Russell et al 2003;Johanson et al 2005;MacQueen et al 2007). Johanson et al (2005) analyzed the cognitive effects of ECT in 55 patients with depression who were followed up 20-24 years after the ECT treatment.…”

“…The authors concluded that the patients who received ECT had significantly lower scores in memory and verbal learning tests. Nevertheless, Russell et al (2003) carried out a retrospective study of 43 patients with different diagnoses (depression, bipolar disorder, and schizoaffective disorder) who had received at least 1 year of maintenance ECT and found no significant differences in cognitive domains assessed with the MiniMental State Exam between baseline and follow-up evaluations.…”

The maintenance of modified electroconvulsive therapy combined with risperidone is better than risperidone alone in preventing relapse of schizophrenia and improving cognitive function

“…However, there is still no definitive conclusion to the question of whether maintenance ECT is responsible for cognitive impairment. Several studies have suggested that cognitive function remains stable during maintenance ECT, and cognitive function during the maintenance stage of treatment does not differ between ECT and pharmacotherapy groups 22,23,24 . In the current study, relative to the baseline evaluation, patients showed statistically significant improvement in verbal memory and visual memory at the final evaluation.…”