Continuation Electroconvulsive Therapy vs Pharmacotherapy for Relapse Prevention in Major Depression

Abstract

With the recognition that for most patients, mood disorders are chronic relapsing illnesses, physicians and researchers have turned their attention from acute treatment strategies to the evaluation of relapse prevention strategies. Electroconvulsive therapy (ECT) has repeatedly been demonstrated as an extremely effective acute treatment for major depressive episodes.^1-3 It is also used clinically as a continuation and maintenance treatment, despite a lack of well-designed trials to support such use.⁴ We evaluated the role of continuation ECT (C-ECT) as a relapse prevention strategy compared with a combination pharmacotherapy (C-Pharm) strategy, lithium carbonate plus nortriptyline hydrochloride, in a multicenter randomized controlled trial. Because treatment options for relapse prevention are limited, evidence-based validation of C-ECT will provide important information for physicians and patients on which to base treatment decisions.