Extended continuation and maintenance ECT for long-lasting episodes of major depression

While most major depressive episodes are relatively short lasting, a substantial minority of patients with severe mood disorders respond poorly to available treatments and remain ill for extended periods of time. The possible role of continuation and maintenance electroconvulsive therapy (ECT) in the management of such patients has not been clearly established. Three patients are reported whose long-lasting, relatively medication refractory episodes of major depression were treated with ECT for both acute and continuation and maintenance purposes. Although relapses occurred despite treatment, the frequency, severity, and duration of relapses were apparently diminished by ECT. Relapses occurred with diminishing frequency over the course of individual episodes, and were typically reversed by three or four closely spaced ECT treatments. No medical complications occurred. While complaints of memory difficulty were common, Mini-Mental Status Examinations 6 weeks after ECT were unimpaired. Continuation and maintenance ECT appears to be a safe and effective treatment modality for long-lasting episodes of major depression. Recommendations for clinical management are proposed.