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A Systematic Review of the Combined Use of Electroconvulsive Therapy and Psychotherapy for Depression

McClintock, Shawn M. PhD*†; Brandon, Anna R. PhD*; Husain, Mustafa M. MD*; Jarrett, Robin B. PhD*

doi: 10.1097/YCT.0b013e3181faaeca

Objective: Electroconvulsive therapy (ECT) is one of the most effective treatments for severe major depressive disorder. However, after acute-phase treatment and initial remission, relapse rates are significant. Strategies to prolong remission include continuation phase ECT, pharmacotherapy, psychotherapy, or their combinations. This systematic review synthesizes extant data regarding the combined use of psychotherapy with ECT for the treatment of patients with severe major depressive disorder and offers the hypothesis that augmenting ECT with depression-specific psychotherapy represents a promising strategy for future investigation.

Methods: The authors performed 2 independent searches in PsychInfo (1806-2009) and MEDLINE (1948-2009) using combinations of the following search terms: Electroconvulsive Therapy (including ECT, ECT therapy, electroshock therapy, EST, and shock therapy) and Psychotherapy (including cognitive behavioral, interpersonal, group, psychodynamic, psychoanalytic, individual, eclectic, and supportive). We included in this review a total of 6 articles (English language) that mentioned ECT and psychotherapy in the abstract and provided a case report, series, or clinical trial. We examined the articles for data related to ECT and psychotherapy treatment characteristics, cohort characteristics, and therapeutic outcome.

Results: Although research over the past 7 decades documenting the combined use of ECT and psychotherapy is limited, the available evidence suggests that testing this combination has promise and may confer additional, positive functional outcomes.

Conclusions: Significant methodological variability in ECT and psychotherapy procedures, heterogeneous patient cohorts, and inconsistent outcome measures prevent strong conclusions; however, existing research supports the need for future investigations of combined ECT and psychotherapy in well-designed, controlled clinical studies. Depression-specific psychotherapy approaches may need special adaptations in view of the cognitive effects of ECT.

From the *Department of Psychiatry, The 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 March 10, 2010; accepted August 30, 2010.

Reprints: Shawn M. McClintock, PhD, The University of Texas Southwestern Medical Center at Dallas, Department of Psychiatry, 5323 Harry Hines Blvd, Dallas, TX 75390-8898 (e-mail:

This publication was supported by Grant Number KL2RR024983 (Principal investigator [PI]: Milton Packer) from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH); Grant Number K23MH085007 (PI: A. Brandon) and Grant Number K24 MH-001571 (PI: R. B. Jarrett) from the National Institute of Mental Health (NIMH); and Grant Number 05T-682 (PI: M. M. Husain) from the Stanley Medical Research Institute.

Shawn M. McClintock PhD and Anna R. Brandon PhD contributed equally to this article.

© 2011 Lippincott Williams & Wilkins, Inc.