Electroconvulsive Therapy as Maintenance Treatment in Psychiatric Disorders

Purpose of Review Following symptom remission with acute electroconvulsive therapy (ECT), maintenance ECT (M-ECT) is often used to prevent relapse. This review provides a concise summary of the evidence for M-ECT in various psychiatric disorders, outlines the cognitive adverse effects of M-ECT, and discusses clinical considerations while using M-ECT. Recent Findings Adjunctive M-ECT has considerable evidence for relapse prevention efficacy in depressive and psychotic disorders, preliminary evidence for efficacy in bipolar disorders, and insufficient evidence in other disorders such as obsessive-compulsive disorder. Careful selection of candidates for M-ECT may yield better results. Older adults represent a subgroup where M-ECT may be a safe and effective option for maintaining clinical remission. No significant cognitive adverse effects have been observed with M-ECT in controlled trials. Because no guidelines exist to inform decision-making on the duration and frequency of M-ECT sessions, clinicians may be better off using a symptom-driven, risk-benefit approach with periodic reassessment of the need for M-ECT every 3-6 months and following a tapering schedule for stopping M-ECT. Major gaps in available evidence include a lack of controlled observations and heterogeneity in sampling and ECT administration parameters that limit the generalizability of findings. Summary Adjuvant M-ECT is a safe and effective treatment option for maintaining clinical remission and improving patient-reported outcomes in depressive and psychotic disorders. For other disorders, insufficient evidence exists. There is a need for more rigorous, controlled efficacy and cost-effectiveness trials comparing M-ECT against maintenance pharmacotherapy, across contexts and indications, to inform clinical recommendations.