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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*

doi: 10.1097/YCT.0000000000000085

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.

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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:

The authors have no conflicts of interest or financial disclosures to report.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

© 2014 by Lippincott Williams & Wilkins