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.
From the *Faculty of Nursing, University of Alberta; and †Alberta Health Services, Edmonton, Alberta, Canada.
Received for publication June 18, 2013; accepted September 18, 2013.
Reprints: Greta G. Cummings, RN, PhD, FCAHS, Faculty of Nursing, University of Alberta, 5-110 Edmonton Clinical Health Academy, 11405 87 Ave, Edmonton, Alberta, Canada T6G 1C9 (e-mail: firstname.lastname@example.org).
The authors have no conflicts of interest or financial disclosures to report.
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