Electroconvulsive Therapy: Continuation /Maintenance Therapy

Electroconvulsive Therapy: Continuation/Maintenance Therapy

Continuation/Maintenance Pharmacotherapy

For the most part, individuals referred for ECT have disorders that are associated with a high risk of recurrence, particularly during the first 6 months after remission (American Psychiatric Association 1993, 1994b, 1997; American Psychiatric Association Committee on ECT 2000). This phenomenon has been particularly well studied in major depression, for which the 1-year recurrence rate has been estimated to be about 50% or more (Sackeim 1994; Sackeim et al. 1990). For this reason, it is important to provide somatic continuation therapy (American Psychiatric Association Committee on ECT 2000). In most cases, psychotropic agents are used for this purpose. However, given evidence that patients who were medication-resistant during the index episode are particularly unlikely to maintain remission while undergoing continuation pharmacotherapy (Sackeim et al. 1990), the clinician treating a medication-resistant patient who responds to ECT should consider, with the patient, one of two options: 1) giving the patient a different type or class of medication after ECT than had previously been used (for patients with major depression, the clinician should consider using agents from more than one medication class), or 2) considering the use of continuation ECT (see subsection below) (American Psychiatric Association Committee on ECT 2000; Sackeim 1994). Patients with a history of relatively frequent illness recurrences should be given prophylactic medication for a longer period (maintenance therapy).

Continuation/Maintenance ECT
In recent years there has been a resurgence of interest in the use of ECT for prophylactic purposes (Petrides 1998; Rabheru and Persad 1997), possibly because of the failure of pharmacological C/M ECT in many cases.

Electroconvulsive Therapy Introduction Indications