Invited ReviewA Review of Continuation Electroconvulsive Therapy Application, Safety, and EfficacyTrevino, Kenneth BA*; McClintock, Shawn M. PhD*†; Husain, Mustafa M. MD*Author Information 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: [email protected]). The Journal of ECT: September 2010 - Volume 26 - Issue 3 - p 186-195 doi: 10.1097/YCT.0b013e3181efa1b2 Buy Metrics Abstract 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. © 2010 Lippincott Williams & Wilkins, Inc.