Efficacy of continuation/maintenance electroconvulsive therapy for the prevention of recurrence of a major depressive episode in adults with unipolar depression: a systematic review.

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.