The Efficacy and Tolerability of Continuation and Maintenance Electroconvulsive Therapy for Depression

Abstract

Electroconvulsive therapy (ECT) is a highly effective treatment for severe and treatment-resistant depression, but relapse rates remain high despite maintenance pharmacotherapy. Continuation or maintenance ECT (C/M-ECT) offers the potential to prevent relapses in the most unwell patients, but there remains disagreement among guidelines regarding its efficacy and tolerability. This review aims to summarize and assess the current evidence for the efficacy and tolerability of continuation and maintenance ECT for depression, including data from randomized and observational studies, which included an appropriate control group. Twenty studies were found meeting inclusion criteria. There was evidence from 14 studies suggesting that relapse rates are reduced in those receiving C/M-ECT. There was evidence from 6 studies suggesting that C/M-ECT had no effect on global cognitive function. Detailed neuropsychological testing was limited, but within studies that assessed specific cognitive domains, there was not consistent evidence for deficits in C/M-ECT compared with the control group. The certainty of evidence across outcomes was low or very low because of inclusion of observational studies, heterogeneity of study design, and patient populations. The findings add further weight to evidence suggesting that C/M-ECT is a viable treatment option to prevent relapse in severe depression and provides clinicians with further evidence for the benefits and risks of C/M-ECT when discussing treatment options with patients. Future research should focus on randomized or well-designed prospective studies with sufficient follow-up to determine longer-term outcomes, while including a standardized, detailed neurocognitive battery to assess potential adverse effects.

Effect of Continuation-Maintenance Electroconvulsive Therapy on Hospitalization: A Retrospective Mirror-Image Study

“… 10 , 26 , 27 In regards to the cognitive adverse effect, data from previous studies indicated that the continuation and maintenance ECT do not appear to have a harmful effect for global cognitive function. 28 , 29 …”

“…10,26,27 In regards to the cognitive adverse effect, data from previous studies indicated that the continuation and maintenance ECT do not appear to have a harmful effect for global cognitive function. 28,29 Strengths of this study was the inclusion of patients with various psychiatric diagnoses. The study also used objective measures of hospitalization and admission days before and after continuation-maintenance ECT, which adds to the validity of the findings.…”

Caracterização do comprometimento cognitivo da esquizofrenia resistente a clozapina

“…Additionally, it well known that ECT is effective for depression (Rowland et al, 2023) but it's efficacy on depressive symptoms was not evaluated in patients with CRS in the Chinese studies (Wang et al, 2018), whereas in the US study depressive symptoms were evaluated by the Hamilton Depression Rating Scale (Hamilton, 1960), which is not as specific as the Calgary Depression Rating Scale, designed for the evalution of depressive symptoms in schizophrenia (Bressan et al, 1998).…”