One-year follow-up after discontinuing maintenance electroconvulsive therapy

Area of Science:

• Psychiatry
• Neurology
• Clinical Psychology

Background:

• Electroconvulsive therapy (ECT) is effective for severe depressive and psychotic disorders, especially major depressive disorder (MDD).
• Maintaining remission after short-term ECT is challenging due to medication resistance, leading to high relapse rates (40-60%).
• Continuation/maintenance (c/m) ECT is used to prevent relapse, but guidelines and data on discontinuation are limited.

Purpose of the Study:

• To evaluate the relapse rates and prognosis of patients after discontinuing c/m ECT.
• To identify factors associated with relapse following c/m ECT cessation.

Main Methods:

• A follow-up study of 45 consecutive patients treated with c/m ECT after short-term ECT.
• Patients were monitored for 1 year after discontinuing c/m ECT.

Main Results:

• 44% (20 of 45) of patients relapsed within 1 year of discontinuing c/m ECT.
• All relapses occurred within the first 8 months, with most happening in the first 3 months.
• Patients with diagnoses other than MDD (e.g., bipolar disorder, schizophrenia) had a higher relapse risk.

Conclusions:

• Relapse is common after c/m ECT discontinuation, particularly within the initial months.
• Non-MDD patients face a greater risk of relapse.
• Close patient monitoring post-c/m ECT is crucial; permanent mECT may be considered for high-risk individuals.