title: A systematic review of the combined use of electroconvulsive therapy and psychotherapy for depression.
abstract: OBJECTIVE
  Electroconvulsive therapy (ECT) is one of the most effective treatments for severe major depressive disorder. However, after acute-phase treatment and initial remission, relapse rates are significant. Strategies to prolong remission include continuation phase ECT, pharmacotherapy, psychotherapy, or their combinations. This systematic review synthesizes extant data regarding the combined use of psychotherapy with ECT for the treatment of patients with severe major depressive disorder and offers the hypothesis that augmenting ECT with depression-specific psychotherapy represents a promising strategy for future investigation.
  
  
  METHODS
  The authors performed 2 independent searches in PsychInfo (1806-2009) and MEDLINE (1948-2009) using combinations of the following search terms: Electroconvulsive Therapy (including ECT, ECT therapy, electroshock therapy, EST, and shock therapy) and Psychotherapy (including cognitive behavioral, interpersonal, group, psychodynamic, psychoanalytic, individual, eclectic, and supportive). We included in this review a total of 6 articles (English language) that mentioned ECT and psychotherapy in the abstract and provided a case report, series, or clinical trial. We examined the articles for data related to ECT and psychotherapy treatment characteristics, cohort characteristics, and therapeutic outcome.
  
  
  RESULTS
  Although research over the past 7 decades documenting the combined use of ECT and psychotherapy is limited, the available evidence suggests that testing this combination has promise and may confer additional, positive functional outcomes.
  
  
  CONCLUSIONS
  Significant methodological variability in ECT and psychotherapy procedures, heterogeneous patient cohorts, and inconsistent outcome measures prevent strong conclusions; however, existing research supports the need for future investigations of combined ECT and psychotherapy in well-designed, controlled clinical studies. Depression-specific psychotherapy approaches may need special adaptations in view of the cognitive effects of ECT.
authors.affiliation: Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8898, USA. shawn.mcclintock@utsouthwestern.edu
authors.forename: Shawn M
authors.initials: SM
authors.lastname: McClintock
authors.forename: Anna R
authors.initials: AR
authors.lastname: Brandon
authors.forename: Mustafa M
authors.initials: MM
authors.lastname: Husain
authors.forename: Robin B
authors.initials: RB
authors.lastname: Jarrett
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000009:adverse effects; D006801:Humans; D011613:Psychotherapy; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents