A Global Delphi-Based Expert Consensus on Relapse Prevention Strategies Following Successful Electroconvulsive...

Area of Science:

• Psychiatry
• Clinical Neuroscience

Background:

• Electroconvulsive therapy (ECT) is a highly effective treatment for major depressive disorder (MDD).
• High relapse rates (up to 50% within a year) following ECT necessitate robust relapse prevention strategies.
• Current guidelines lack consensus-based, operationalized recommendations for post-ECT relapse prevention.

Purpose of the Study:

• To identify common relapse prevention strategies after ECT.
• To evaluate the perceived effectiveness of these strategies among international ECT experts.
• To establish consensus-based, personalized clinical recommendations for relapse prevention.

Main Methods:

• A multi-round Delphi study involving 18 international ECT experts.
• Consensus defined as ≥80% agreement on Likert-scale responses.
• Data collection on clinical factors, pharmacotherapy, continuation ECT, psychotherapy, and novel treatments.

Main Results:

• Consensus reached on key factors influencing relapse: treatment resistance, comorbidities, prior ECT response.
• Pharmacotherapy (lithium + antidepressant) endorsed for all patients.
• Continuation ECT (tapering) recommended for high-risk patients; psychotherapy as adjunctive.
• No consensus on repetitive transcranial magnetic stimulation, esketamine, or optimal duration beyond 6 months.

Conclusions:

• Expert-based guidance for post-ECT relapse prevention in MDD is established.
• Pharmacotherapy and continuation ECT are core strategies, requiring personalization based on risk factors.
• Further research is needed to refine guidelines and improve long-term outcomes.