Related Experiment Video
Updated: May 10, 2026
09:55
Neuroimaging-Guided TMS–EEG for Real-Time Cortical Network Mapping
Published on: June 13, 2025
Relapse following successful electroconvulsive therapy for major depression: a meta-analysis
Ana Jelovac1, Erik Kolshus, Declan M McLoughlin
1Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland.
Summary
Early relapse after electroconvulsive therapy (ECT) is common, with over 50% of patients relapsing within a year. Maintenance therapy, particularly with tricyclic antidepressants, is crucial for preventing relapse in major depressive episodes.
Area of Science:
- Neuroscience
- Psychiatry
- Clinical Medicine
Background:
- High rates of early relapse are frequently observed following electroconvulsive therapy (ECT).
- Current treatment guidelines provide limited guidance on optimal post-ECT maintenance therapy.
- Effective strategies are needed to improve long-term well-being after successful ECT.
Purpose of the Study:
- To systematically review existing evidence on post-ECT relapse rates.
- To identify effective maintenance therapies for preventing relapse after ECT for major depressive episodes.
- To highlight gaps in current research regarding post-ECT relapse prevention.
Main Methods:
- A systematic literature search was conducted for peer-reviewed studies published before January 2013.
- Studies reporting relapse rates in major depressive episode responders to acute ECT were included.
- Meta-analyses were performed where appropriate to synthesize findings.
Main Results:
- Over 51% of patients relapsed within 12 months of successful ECT, with most relapses occurring within the first 6 months.
- Continuation pharmacotherapy and continuation ECT showed similar 6-month relapse rates.
- Antidepressant medication in randomized controlled trials halved the 6-month relapse risk compared to placebo (NNT=3.3).
- Tricyclic antidepressants have the strongest evidence for post-ECT relapse prevention.
Conclusions:
- A substantial risk of relapse exists within the first year following ECT, particularly in the initial 6 months.
- Continuation therapy is necessary but insufficient to prevent all relapses.
- Evidence for newer antidepressants and augmentation strategies in post-ECT relapse prevention is limited.
Related Concept Videos
01:30Electroconvulsive Therapy
Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early years,...
01:23Antidepressant Drugs: MAOIs and Other Agents
Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
01:26Psychosis: Goals of Pharmacotherapy
Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation. For...
01:18Depression: Overview
Depression is a prevalent mental illness marked by persistent sadness and lack of interest in previously enjoyable activities. It can take several forms, including major depression, persistent depressive disorder, and bipolar I and II disorders. Symptoms range from emotional changes like chronic worry to physical changes like sleep disturbances and suicidal thoughts. From a neurobiological perspective, depression is believed to be triggered by abnormalities in the brain's prefrontal cortex,...
01:28Antidepressant Drugs: Tricyclics, SSRIs, and SNRIs
Tricyclic Antidepressants (TCAs), including Desipramine (Norpramin), Imipramine (Tofranil), Clomipramine (Anafranil), and Amitriptyline (Elavil), inhibit serotonin and norepinephrine reuptake and also block other receptors. They are used for depression, pain conditions, and insomnia. Common adverse effects include anticholinergic effects, sedation, orthostatic hypotension, and weight gain. They have a narrow therapeutic window and so require plasma-level monitoring. Abrupt discontinuation can...
01:05Long-term Depression
Long-term depression, or LTD, is one of the ways by which synaptic plasticity—changes in the strength of chemical synapses—can occur in the brain. LTD is the process of synaptic weakening that occurs over time between pre and postsynaptic neuronal connections. The synaptic weakening of LTD works in opposition to synaptic strengthening by long-term potentiation (LTP) and together are the main mechanisms that underlie learning and memory.