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A Review of Continuation Electroconvulsive Therapy: Application, Safety, and Efficacy

Trevino, Kenneth BA*; McClintock, Shawn M. PhD*†; Husain, Mustafa M. MD*

doi: 10.1097/YCT.0b013e3181efa1b2
Invited Review

Electroconvulsive therapy (ECT) is a neurostimulation therapeutic intervention that is highly effective and frequently used to treat certain psychiatric conditions, particularly major depressive disorder. Despite its high efficacy, a major limitation of ECT is the significant rate at which patients relapse after treatment. Providing additional ECT treatments after completion of a short-term course of ECT, referred to as continuation ECT (C-ECT), is a strategy used to reduce the risk of relapse. Specifically, C-ECT involves the administration of additional ECT treatments during the 6-month period after remission. This article summarizes the available literature regarding C-ECT including indication for use, patient selection, treatment guidelines/parameters, and safety. The efficacy of C-ECT is also discussed, with a focus on major depressive disorder and schizophrenia. On the basis of the current literature, indications for use and patient selection for C-ECT are predominately similar to those for a short-term ECT course. The treatment guidelines/parameters for C-ECT are recommended to be consistent with the parameters used to achieve remission, with the exception of greater intertreatment intervals during C-ECT. Although adverse cognitive effects can occur during C-ECT, the risk and severity of cognitive impairment are generally low, possibly because of the greater intertreatment intervals. Most research supports the use of C-ECT to prolong remission; however, methodologic limitations mitigate firm conclusions and generalizability of these findings. Nonetheless, the available evidence supports the use of C-ECT as a safe and effective method in relapse prevention.

From the *Neurostimulation Research Laboratory, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX; and †Division of Brain Stimulation and Therapeutic Modulation, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY.

Received for publication January 8, 2010; accepted June 11, 2010.

Reprints: Mustafa M. Husain, MD, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-8898 (e-mail: mustafa.husain@utsouthwestern.edu).

© 2010 Lippincott Williams & Wilkins, Inc.