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Cited by 3Electroconvulsive Therapy StudiesTreatment of Major DepressionTranscranial Magnetic Stimulation Studies

Challenges in maintaining remission after ECT – insights from a six-month follow up study

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van Diermen, Linda, Lambrichts, Simon, Berwouts, Jesse, Hebbrecht, Kaat, van den Ameele, Seline, Coppens, Violette, Belge, Jean-Baptiste, Schrijvers, Didier +1 more·2025·Journal of Psychiatric Research
DOI 10.1016/j.jpsychires.2025.01.009
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Abstract

Introduction Electroconvulsive therapy (ECT) is a widely recognized treatment for severe depressive disorders, particularly in cases of inadequate response to pharmacological interventions or when rapid symptom relief is essential. Although ECT demonstrates high efficacy, a notable proportion of patients relapse after a successful ECT course.Methods This study investigated clinical baseline characteristics and residual depressive symptoms associated with relapse - defined as a Montgomery-Åsberg Depression Rating Scale (MADRS) score >15, restart of ECT, or suicide attempt - within six months after successful ECT. Data were obtained from the PROTECT study, a single-site, prospective cohort study conducted at the University Psychiatric Center Duffel, Belgium.Results - Among the 65 patients who completed the ECT course, 40 patients (62%) achieved remission. At six months, 32 patients were reassessed, and 18 (56%) of them experienced relapse. No significant associations were identified between relapse and baseline factors, including age, social circumstances, baseline depression severity, psychomotor symptoms, cognitive functioning, treatment resistance, lithium use, or the presence of psychotic or melancholic features. Residual depressive symptoms at the end of the ECT course also did not predict relapse.Discussion - The observed high relapse rate underscores the critical need for robust continuation and maintenance strategies following ECT. Future research should prioritize larger cohorts to better identify predictors of relapse and optimize post-ECT treatment protocols.

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Authors
van Diermen, L., Lambrichts, S., Berwouts, J., Hebbrecht, K., van den Ameele, S., Coppens, V., Belge, J.-B., Schrijvers, D., & Birkenhäger, T.
Affiliations
  • KU Leuven (BE)
  • University of Antwerp (BE)
  • Radboud University Nijmegen (NL)
ORCID
Venue
Journal of Psychiatric Research
Publisher
Elsevier BV
Published
2025-02
Volume
182
Pages
116-121
ISSN
0022-3956 (ISSN-L)
DOI
10.1016/j.jpsychires.2025.01.009
OpenAlex
W4406147108
Cited by
3
References
51
Citations by year
2026: 2 · 2025: 1
FWCI
2.01
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Psychiatric Research (publishedVersion)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
  • ORBi (University of Liège) (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
Keywords
electroconvulsive therapy, relapse, remission maintenance, severe depression, residual depressive symptoms, predictors of relapse, treatment resistance, lithium, suicide attempts, PROTECT trial
MeSH terms
Adult, Aged, Major Depressive Disorder, Electroconvulsive Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales, Recurrence, Remission Induction, Treatment Outcome

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