One-year follow-up after discontinuing maintenance electroconvulsive therapy

Electroconvulsive therapy (ECT) has been established as an effective method in the treatment of severe depressive or psychotic disorders. Its efficacy is greatest in severe major depressive disorder (MDD) with or without psychotic symptoms. However, maintaining remission after a successful course of short-term ECT is often difficult owing to resistance to medication in these patients. Therefore, the relapse rate after short-term ECT is high; 40% to 60% of patients relapse even with adequate antidepressant continuation therapy. The risk of relapse is greatest during the first months after discontinuation of short-term ECT. Continuation/maintenance (c/m) ECT is an option in maintaining remission, but systematic data and clinical guidelines are lacking. The point at which to discontinue this treatment has not been adequately established.

Altogether 45 consecutive patients treated with c/mECT after short-term ECT to prevent relapse were followed up 1 year after discontinuation of this treatment.

Twenty (44%) of 45 patients relapsed during follow-up, all within the first 8 months. Patients having a diagnosis other than MDD (bipolar disorder, depressive episode type I, schizophrenia, and schizoaffective disorder) were more likely to relapse than MDD patients.

Almost half of the patients relapsed in 1 year after discontinuation of c/mECT, most of these within the first 3 months and all within the first 8 months. The risk of relapse is greater in the patients with diagnoses other than MDD. When discontinuing c/mECT, patients should be carefully followed up; and for those at risk of relapse, even permanent mECT should be considered. To the best of our knowledge, the present study is the first to report the prognosis of patients after discontinuing c/mECT.