title: Individualized continuation electroconvulsive therapy and medication as a bridge to relapse prevention after an index course of electroconvulsive therapy in severe mood disorders: a naturalistic 3-year cohort study.
abstract: Electroconvulsive therapy (ECT) is recognized as an effective acute treatment for mood disorders but is associated with high risk of relapse. To minimize this risk, we introduced as a routine individually tapered continuation ECT with concomitant medication (C-ECT + Med) after an index series in January 2000. In August 2002, a chart review of all patients (n = 41) who had received C-ECT + Med for more than 4 months was carried out. Sixteen patients also participated in an extensive interview. Mean duration of administered C-ECT at follow-up was 1 year, but for most patients (63%), C-ECT had been terminated. For 49% of patients, adjustments between ECT sessions had been made due to early signs of relapse. Two weeks was the most common interval between sessions for patients with ongoing C-ECT. The frequency of lithium-treated patients had increased from 12% before index to 41% during C-ECT. However, the rated response to the drug varied. Need for hospital care 3 years before and after the initiation of C-ECT + Med was compared in a second evaluation of the cohort. The number of patients hospitalized, number of admissions, and total days in hospital were all significantly reduced. Hospital days were reduced by 76% (P < 0.001). Three patients with previously cumulative years in hospital are described as case vignettes after 6 years with no or minimal need for further hospitalization. This study supports previous findings that individually tapered C-ECT + Med can maintain initial response to ECT and serve as a bridge to long-term relapse prevention.
authors.affiliation: Department of Psychiatry, Karolinska University Hospital, Huddinge, Stockholm, Sweden. hodeberg@gmail.com
authors.forename: Håkan
authors.initials: H
authors.lastname: Odeberg
authors.forename: Bruce
authors.initials: B
authors.lastname: Rodriguez-Silva
authors.forename: Pirjo
authors.initials: P
authors.lastname: Salander
authors.forename: Björn
authors.initials: B
authors.lastname: Mårtensson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D002908:Chronic Disease; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003863:Depression / Q000150:complications / Q000523:psychology / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology* / Q000628:therapy*; D018802:Patient-Centered Care; D011618:Psychotic Disorders / Q000628:therapy; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000150:complications; D016896:Treatment Outcome
chemical_list: D011619:Psychotropic Drugs