Elsevier

Journal of Affective Disorders

Volume 156, 1 March 2014, Pages 228-231
Journal of Affective Disorders

Brief report
Maintenance electroconvulsive therapy up to 12 years

https://doi.org/10.1016/j.jad.2013.11.005Get rights and content

Abstract

Background

Maintenance electroconvulsive therapy (m-ECT) is effective in preventing recurrences of depressive episodes. There is little information on long-term m-ECT extending over several years and its impact on cognitive functions. This study was an attempt to determine the efficacy and side effects of long-term m-ECT.

Method

Depressive episodes and admissions before m-ECT for a period equal to the duration of m-ECT and during m-ECT were compared using medical records. Cognitive functions assessed by Mini-Mental State Examination (MMSE) before and after m-ECT were compared along with the review of Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG).

Results

17 patients had m-ECT that extended from 6 to 153 months (mean 39, SD=44.46). The average number of episodes before and during m-ECT was 2.47 (SD=2.23) and 0.88 (SD=1.31) respectively (Wilcoxon ranked test Z=3.06, r=0.55, two-tailed p=0.002). Average number of admissions dropped from 2.05 (SD=1.88) to 0.23 (SD=0.43) during m-ECT (Z=3.471, r=0.71, p=0.001). The average time to recurrence was 24.24 months (SD=25.20) with longest depression free survival of 105 months. There was no significant difference in MMSE score before and after the commencement m-ECT or progressive deterioration in NUCOG score.

Limitations

This study was limited by retrospective nature of data collection, small sample size, confounding effects of antidepressants along with m-ECT and absence of a highly sensitive cognitive screening tool that can capture all types of cognitive impairments following m-ECT.

Conclusions

In a naturalistic setting the efficacy of m-ECT may extend over several years while cognitive functions remain largely unaffected.

Introduction

Electroconvulsive Therapy (ECT) is an effective treatment for depressive disorders, but relapse is common after discontinuation despite continued antidepressant treatment (Jelovac et al., 2013, Sackeim et al., 2001). Continuation ECT (c-ECT) refers to treatments in the first 6 months following remission to prevent relapse (American Psychiatric Association, 2001). Maintenance ECT (m-ECT) is the treatment extending beyond 6 months to prevent recurrences, which, unlike c-ECT, has no fixed end point. Several studies support the use of m-ECT in preventing recurrences (Gagné et al., 2000, Navarro et al., 2008, Nordenskjöld et al., 2013, O'Connor et al., 2010, van Schaik et al., 2012). There is little information on efficacy and adverse effects, particularly on cognitive functions with long-term m-ECT. In this study we report the efficacy and cognitive side effects of long-term m-ECT.

Section snippets

Methods

We identified the participants for this retrospective study from the medical records of Goulburn Valley Health (GV Health), which is a teaching hospital affiliated to The University of Melbourne. The inclusion criteria were: (1) Diagnosis of depressive episode or recurrent depressive disorder based on the International Classification of Diseases, Tenth Edition (ICD-10) criteria. (2) Remission from depression after an acute course of ECT. (3) Treatment with m-ECT. Exclusion criteria were (1)

Results

There were 17 patients who had m-ECT (Table 1).

Efficacy

The findings of our study are reflective of real world scenario where in a naturalistic setting long-term m-ECT is associated with significantly fewer depressive episodes and hospital admissions without marked cognitive deficits detectable by the measures used. This study has examined the outcome of m-ECT of a very long duration; probably the longest ever reported (Barnes et al., 1997, Hastings, 1961, Karliner, 1980, Thornton et al., 1990). The results suggest that m-ECT exerts its beneficial

Conclusion

m-ECT appears to be effective in preventing recurrence of depressive episodes over several years without marked impairment in cognitive functions in appropriately selected patients, typically those with multiple recurrences and unsatisfactory response to pharmacotherapy alone. Long-term m-ECT needs to be studied using larger samples.

Role of funding source

Nothing declared.

Conflict of interest

Disclosure of interest for Dr. Joan Prudic: Scienomics – advisory Board and Travel, there is no disclosure of interest for other authors

Acknowledgements

The authors acknowledge the help from the members of GVAMHS ECT team: Tanya Sutton, the ECT co-ordinator, Dale Lehrke, Clinical Nurse Educator and Cheryle Clarke, the ECT Nurse. We thank Dianne Doller, Abhishek Kumar, Jenny Keryk and Brenda Freeman for data collection.

References (25)

  • M.R. Jarvis et al.

    Maintenance electroconvulsive therapy and seizure duration

    Convuls. Ther.

    (1993)
  • A. Jelovac et al.

    Relapse following successful electroconvulsive therapy for major depression: a meta-analysis

    Neuropsychopharmacology

    (2013)
  • Cited by (14)

    View all citing articles on Scopus
    View full text