Cognitive-behavioral therapy as continuation treatment to sustain response after electroconvulsive therapy in depression: a randomized controlled trial.
BACKGROUND
Although electroconvulsive therapy (ECT) is the most effective acute antidepressant intervention, sustained response rates are low. It has never been systematically assessed whether psychotherapy, continuation ECT, or antidepressant medication is the most efficacious intervention to maintain initial treatment response.


METHODS
In a prospective, randomized clinical trial, 90 inpatients with major depressive disorder (MDD) were treated with right unilateral ultra-brief acute ECT. Electroconvulsive therapy responders received 6 months guideline-based antidepressant medication (MED) and were randomly assigned to add-on therapy with cognitive-behavioral group therapy (CBT-arm), add-on therapy with ultra-brief pulse continuation electroconvulsive therapy (ECT-arm), or no add-on therapy (MED-arm). After the 6 months of continuation treatment, patients were followed-up for another 6 months. The primary outcome parameter was the proportion of patients who remained well after 12 months.


RESULTS
Of 90 MDD patients starting the acute phase, 70% responded and 47% remitted to acute ECT. After 6 months of continuation treatment, significant differences were observed in the three treatment arms with sustained response rates of 77% in the CBT-arm, 40% in the ECT-arm, and 44% in the MED-arm. After 12 months, these differences remained stable with sustained response rates of 65% in the CBT-arm, 28% in the ECT-arm, and 33% in the MED-arm.


CONCLUSIONS
These results suggest that ultra-brief pulse ECT as a continuation treatment correlates with low sustained response rates. However, the main finding implicates cognitive-behavioral group therapy in combination with antidepressants might be an effective continuation treatment to sustain response after successful ECT in MDD patients.
Psychologische Hochschule Berlin, Berlin; Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin.
Eva-Lotta
EL
Brakemeier
Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin.
Angela
A
Merkl
Department of Psychiatry, Charité, Campus Mitte, Berlin.
Gregor
G
Wilbertz
Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin.
Arnim
A
Quante
Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin.
Francesca
F
Regen
Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin.
Nicole
N
Bührsch
Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin.
Franziska
F
van Hall
Department of Psychology, Humboldt Universität zu Berlin, Berlin.
Eva
E
Kischkel
Center for Psychiatric and Psychotherapeutic Care and Rehabilitation, Dr. K. Fontheim's Hospital, Liebenburg.
Heidi
H
Danker-Hopfe
Center for Psychiatric and Psychotherapeutic Care and Rehabilitation, Dr. K. Fontheim's Hospital, Liebenburg.
Ion
I
Anghelescu
Center for Psychiatric and Psychotherapeutic Care and Rehabilitation, Dr. K. Fontheim's Hospital, Liebenburg.
Isabella
I
Heuser
Department of Psychology, Humboldt Universität zu Berlin, Berlin.
Norbert
N
Kathmann
Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin; Dahlem Institute for Neuroimaging of Emotion, Free University of Berlin, Berlin, Germany. Electronic address: malek.bajbouj@charite.de.
Malek
M
Bajbouj
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
D000928:Antidepressive Agents
Cognitive-behavioral group psychotherapy; continuation-treatment; electroconvulsive therapy; major depressive disorder; survival time; sustained response