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Clinical Practice Recommendations for Continuation and Maintenance Electroconvulsive Therapy for Depression

Outcomes From a Review of the Evidence and a Consensus Workshop Held in Australia in May 2017

Gill, Shane P., FRANZCP*†‡; Kellner, Charles H., MD§

doi: 10.1097/YCT.0000000000000484
Original Studies

Objectives Continuation or maintenance electroconvulsive therapy (ECT) is often provided as a strategy for post-ECT relapse prevention. However, the evidence has been insufficient until recently to produce clear consensus on what best practice maintenance ECT (mECT) should be like in a real world ECT clinical service. The aims of this article are to help fill this gap and to provide a comprehensive set of practical, clinically-based recommendations for ECT clinicians and services.

Methods A workshop was held at the Royal Australian and New Zealand College of Psychiatry Congress in Adelaide on April 30, 2017. This workshop was hosted by the authors. After a presentation on the state of the evidence, the 30 participants were asked to work in small groups to develop consensus recommendations on different aspects of mECT. These were then collated into one comprehensive set of clinical recommendations for the practice of mECT.

Results These best practice recommendations are set out below.

Conclusions These recommendations will assist ECT services and clinicians to provide best practice mECT according to currently available evidence.

From the *South Australian Psychiatry Branch Training Committee;

Central Adelaide Local Health Network;

Fullarton Hospital, Ramsay Health Care, South Australia, Australia; and

§New York Community Hospital, Brooklyn, NY.

Received for publication September 28, 2017; accepted November 21, 2017.

Reprints: Shane P. Gill, FRANZCP, SAPBTC Administration and Learning Services Building, Glenside Campus, 226 Fullarton Rd, Glenside, SA 5065, Australia (e-mail:

C.H.K. received National Institute of Mental Health grant support for research, honoraria for writing electroconvulsive therapy sections for Up To Date and Psychiatric Times, Cambridge University Press Royalties, and honoraria for teaching an electroconvulsive therapy course at North-Well Health System. S.P.G. has no conflicts of interest or financial disclosures to report.

Consensus opinions obtained from the workshop participants and presentations and materials provided by the authors are kept by S.P.G. and can be sought from him via email.

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