Relapse prevention after index electroconvulsive therapy in treatment-resistant depression

BACKGROUND: One-third of patients who suffer from depression are resistant to conventional treatments. An acute course of electroconvulsive therapy (ECT) can lead to remission of depressive symptoms in a substantial portion of the treatment-resistant patients. However, prevention of relapse with depressive symptoms after the index course of ECT can be challenging. We review pertinent studies on the topic and analyze the best strategies to avoid relapse and recurrence of depressive symptoms. METHODS: We performed a systematic literature review of PubMed through April 2014 for clinical trials published in English to determine if continuation ECT (C-ECT), continuation medication, continuation psychotherapy, or combinations of these are the best strategy to avoid relapse and recurrence of depressive symptoms after an acute course of ECT. Clinical trials comparing ≥2 of the above strategies were included in the review. RESULTS: Although there are few rigorous randomized clinical trials in this area, most studies suggest that combined C-ECT and continuation pharmacotherapy are the most effective strategy in relapse prevention. CONCLUSIONS: C-ECT and continuation pharmacotherapy may be more effective than either alone for preventing relapse. However, more definitive randomized clinical trials are needed.