Skip Navigation LinksHome > September 2014 - Volume 30 - Issue 3 > Efficacy of Continuation/Maintenance Electroconvulsive Thera...
Journal of ECT:
doi: 10.1097/YCT.0000000000000085

Efficacy of Continuation/Maintenance Electroconvulsive Therapy for the Prevention of Recurrence of a Major Depressive Episode in Adults With Unipolar Depression: A Systematic Review

Brown, E. Denise RN, MN*; Lee, How RN, MN*; Scott, Daniel RN, MN; Cummings, Greta G. RN, PhD, FCAHS*

Supplemental Author Material
Collapse Box


Objective: Divergent opinion surrounds the use of continuation/maintenance electroconvulsive therapy (c/mECT) as a recurrence prevention strategy in depression because of limited data on efficacy and adverse effects. In an effort to synthesize what is known about its efficacy, a systematic review of controlled studies reporting efficacy of c/mECT for the prevention of relapse or recurrence of a depressive episode in adults with unipolar major depression was conducted.

Methods: Eleven electronic databases were searched with a 3-stage screening process conducted by the author with an independent review. Quality assessments and data extractions were performed on selected studies using preselected tools.

Results: Six studies met the inclusion criteria; these are as follows: 3 randomized controlled trials, 1 small nonrandomized controlled trial, and 2 retrospective chart reviews. All participants had undergone an index course of electroconvulsive therapy with positive effects before receiving c/mECT or control/comparison interventions. One randomized controlled trial and retrospective chart review showed no significant difference between c/mECT and control/comparison interventions; the remaining 4 studies showed a significantly superior effect of c/mECT for the prevention of recurrence of depression. Monotherapy of c/mECT was less efficacious than c/mECT in combination with antidepressant medication, as was c/mECT delivered on a schedule, which was unresponsive to early signs of recurrence.

Conclusions: This review suggests that c/mECT is efficacious for the prevention of relapse/recurrence of major depression and that efficacy is increased when c/mECT is provided in combination with antidepressant medication and at flexible treatment intervals, responsive to early signs of recurrence.

© 2014 by Lippincott Williams & Wilkins


Article Tools


Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.