Efficacy of maintenance electroconvulsive therapy in recurrent depression: a naturalistic study

The use of maintenance electroconvulsive therapy (mECT) in contemporary psychiatric practice is controversial. In the United Kingdom, the National Institute for Health and Clinical Excellence has recommended that mECT should not be used, although evidence underpinning this decision is lacking. Undertaking a randomized evaluation of this treatment would now be very difficult in the United Kingdom. The main aim of this study is to evaluate the efficacy of mECT in reducing recurrence in depression.

A retrospective analysis of 19 patients who had responded positively to an index and continuation course of ECT and then proceeded to receive mECT. We compared the number of hospital admissions and duration of hospital stay over 3 time periods: 2 years before ECT, during mECT, and up to 4 years after cessation of mECT. To account for secular trends in service use, we also compared the admission rates of this group with a matched sample who received successful index ECT followed by other maintenance therapies (comparison group).

Participants received an average of 37 applications of mECT over a median period of 26 months. Inpatient hospital stay and rate of admissions to an acute psychiatric unit fell significantly during the period of mECT compared with the rates before the initiation of mECT. This reduction in bed use was maintained after termination of mECT. No reduction of service use was observed in the comparison group.

The findings suggest that mECT may have a role in reducing the rate and duration of hospital stay of patients with major depressive disorder.