Brief reportMaintenance electroconvulsive therapy up to 12 years
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)
- et al.
Continuation/maintenance treatment with nortriptyline versus combined nortriptyline and ECT in late-life psychotic depression: a two-year randomized study
Am. J. Geriatr. Psychiatry
(2008) - et al.
The effectiveness of continuation-maintenance ECT in reducing depressed older patients' hospital re-admissions
J. Affect Disord.
(2010) - et al.
Stimulus intensity, seizure threshold and seizure duration
Psychiatr. Clin. North Am.
(1991) - et al.
Efficacy and safety of continuation and maintenance electroconvulsive therapy in depressed elderly patients: a systematic review
Am. J. Geriatr. Psychiatry
(2012) - American Psychiatric Association, 2001. The Practice of Electroconvulsive Therapy: Recommendations for Treatment,...
- et al.
Maintenance electroconvulsive therapy and cognitive function
Br. J. Psychiatry
(1997) - et al.
Absence of cognitive impairment after more than 100 lifetime ECT treatments
Am. J. Psychiatry
(1991) - et al.
Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence
Arch. Gen. Psychiatry
(1991) - et al.
Efficacy of continuation CT and antidepressant drugs compared to long-term antidepressants alone in depressed patients
Am. J. Psychiatry
(2000) Circular manic-depressive reaction modified by “prophylactic electroshock”
Am. J. Psychiatry
(1961)
Maintenance electroconvulsive therapy and seizure duration
Convuls. Ther.
Relapse following successful electroconvulsive therapy for major depression: a meta-analysis
Neuropsychopharmacology
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