Maintenance Electroconvulsive Therapy (M-ECT) After Acute Response Examining the Evidence for Who, What, When, and How?

Objective: To examine the evidence for maintenance electroconvulsive therapy (M-ECT) to help determine who, when, and how long ECT should be continued. Method: A review of published literature on the use of maintenance ECT (M-ECT) was conducted. It focused primarily on trials published since 1997, meeting the following additional criteria: randomized controlled trial or cohort study with a comparison (matched group or before and after), and at least 10 patients receiving M-/continuation ECT. Where such data are not available, recent case series were reviewed. Results: Relapse rates after discontinuation of ECT are very high. Maintenance ECT is an underused treatment option that can substantially reduce risks of relapse in patients with major depressive disorder and likely in bipolar disorder and schizophrenia as well. Little data are available for the use of M-ECT in neurological disorders, and no cost-effectiveness analyses in the maintenance setting were found. Conclusions: Whereas no clear answers emerge from the literature, there is now a growing body of evidence to suggest that for those who have not responded well to medications but have responded to ECT, M-ECT must be presented as an option to the patient and the family for consideration. Clear consensus guidelines for the use of M-ECT are needed.