title: Relapse prevention in major depressive disorder after successful ECT: a literature review and a naturalistic case series.
abstract: OBJECTIVE
  Medication-resistance in major depressive disorder (MDD) may be related to high relapse rates after successful ECT when continued medication (C-MED) is used to prevent relapse. An alternative could be to continue ECT (C-ECT).
  
  
  METHODS
  Patients with medication-resistant MDD responding to ECT were offered C-ECT without medication. Follow-up was 6 months. Publications from a literature search were screened against prespecified criteria.
  
  
  RESULTS
  With C-ECT the 6-month relapse-rate was 50% (6/12, 95% CI:21-79) in our medication-resistant group. In the review we found with C-ECT 29% (7/24,CI:13-51) in 'unknown' medication resistance and no data about medication-resistant depression. With C-MED at 6 months: no data were found concerning medication-resistant depression, 28% (35/124,CI:20-36) in 'unknown' resistance and 13% (2/15,CI:2-41) in non-resistance. With C-MED at 12 months, 73% (16/22,CI:50-90), 50% (16/32,CI:32-68) and 27% (8/30,CI:12-46) were found, respectively.
  
  
  CONCLUSIONS
  The efficacy of C-MED is related negatively to medication resistance before ECT. This may also be the case for C-ECT. Further studies with C-ECT are urgently needed.
authors.affiliation: Department of Psychiatry, University Medical Centre Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Wijkstra
authors.forename: W A
authors.initials: WA
authors.lastname: Nolen
authors.forename: A
authors.initials: A
authors.lastname: Algra
authors.forename: I M
authors.initials: IM
authors.lastname: van Vliet
authors.forename: R S
authors.initials: RS
authors.lastname: Kahn
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000494:pharmacology; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004351:Drug Resistance; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents