Relapse prevention after index electroconvulsive therapy in treatment-resistant depression.
BACKGROUND
One-third of patients who suffer from depression are resistant to conventional treatments. An acute course of electroconvulsive therapy (ECT) can lead to remission of depressive symptoms in a substantial portion of the treatment-resistant patients. However, prevention of relapse with depressive symptoms after the index course of ECT can be challenging. We review pertinent studies on the topic and analyze the best strategies to avoid relapse and recurrence of depressive symptoms.


METHODS
We performed a systematic literature review of PubMed through April 2014 for clinical trials published in English to determine if continuation ECT (C-ECT), continuation medication, continuation psychotherapy, or combinations of these are the best strategy to avoid relapse and recurrence of depressive symptoms after an acute course of ECT. Clinical trials comparing ≥2 of the above strategies were included in the review.


RESULTS
Although there are few rigorous randomized clinical trials in this area, most studies suggest that combined C-ECT and continuation pharmacotherapy are the most effective strategy in relapse prevention.


CONCLUSIONS
C-ECT and continuation pharmacotherapy may be more effective than either alone for preventing relapse. However, more definitive randomized clinical trials are needed.
Department of Psychiatry and Health Behavior, The Medical College of Georgia at Georgia Regents University, Charlie Norwood VA Medical Center, Augusta, GA, USA. E-mail: nyoussef@gru.edu.
Nagy A
NA
Youssef
W Vaughn
WV
McCall
D000928:Antidepressive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D004565:Electroconvulsive Therapy; D006801:Humans; D011613:Psychotherapy; D055502:Secondary Prevention / Q000379:methods; D017211:Treatment Failure
D000928:Antidepressive Agents