Efficacy of Maintenance Electroconvulsive Therapy in Recurrent Depression: A Naturalistic Study
Abstract
BACKGROUND AND OBJECTIVE: The use of maintenance electroconvulsive therapy (mECT) in contemporary psychiatric practice is controversial. In the United Kingdom, the National Institute for Health and Clinical Excellence has recommended that mECT should not be used, although evidence underpinning this decision is lacking. Undertaking a randomized evaluation of this treatment would now be very difficult in the United Kingdom. The main aim of this study is to evaluate the efficacy of mECT in reducing recurrence in depression. METHOD: A retrospective analysis of 19 patients who had responded positively to an index and continuation course of ECT and then proceeded to receive mECT. We compared the number of hospital admissions and duration of hospital stay over 3 time periods: 2 years before ECT, during mECT, and up to 4 years after cessation of mECT. To account for secular trends in service use, we also compared the admission rates of this group with a matched sample who received successful index ECT followed by other maintenance therapies (comparison group). RESULTS: Participants received an average of 37 applications of mECT over a median period of 26 months. Inpatient hospital stay and rate of admissions to an acute psychiatric unit fell significantly during the period of mECT compared with the rates before the initiation of mECT. This reduction in bed use was maintained after termination of mECT. No reduction of service use was observed in the comparison group. CONCLUSIONS: The findings suggest that mECT may have a role in reducing the rate and duration of hospital stay of patients with major depressive disorder.
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Maintenance ECT was associated with fewer and shorter psychiatric hospitalizations over 8 years compared to similar periods of illness before use of maintenance ECT.
“A small “mirror-image” study found that maintenance ECT was associated with fewer and shorter psychiatric hospitalizations over 8 years compared to similar periods of illness before use of maintenance ECT (Gupta et al., 2008).”
From Prevention of Relapse and Recurrence in Adults with Major Depressive Disorder: Systematic Review and Meta-Analyses of Controlled Trials (2016) · cites this paper as Gupta et al., 2008
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“Maintenance ECT has been used to prevent the recurrence (ie, a new episode) of major depression and does not have any fixed end point, in contrast to continuation ECT (cECT) which is time limited (about 6 months), follows an index course of ECT, and is aimed to prevent relapses of the same episode.(3,4) The distinctio…”
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(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.bm01
Chapter 9. Cognitive Effects of ECT
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg09
Chapter 4. The Pre-ECT Medical Workup
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg04
Chapter 2. Patient Selection for ECT
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg02
Chapter 3. Patient Education and Informed Consent for ECT
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg03
Chapter 1. Introduction to ECT
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg01
Chapter 10. ECT Versus Other Neuropsychiatric Treatments
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg10
Chapter 6. ECT Technique, Part I: Managing the Individual Treatment
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg06
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.index
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg05
Chapter 8. Preventing Relapse After ECT: Maintenance ECT and Pharmacotherapy
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg08
Chapter 7. ECT Technique, Part II: Managing the Course of Treatments
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.lg07
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379422.fm01
- Authors
- Gupta, S., Tobiansky, R., Bassett, P., & Warner, J.
- Affiliations
- Barnet Enfield and Haringey Mental Health Trust (GB)
- Corresponding author
- Gupta, Susham
- Warner, James
- Venue
- The Journal of ECT
- Published
- 2008-09
- Volume
- 24
- Issue
- 3
- Pages
- 191-194
- ISSN
- 1095-0680 (ISSN-L)
- OpenAlex
- W2058995638
- Cited by
- 46
- References
- 9
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 14 · 2018: 3 · 2016: 1 · 2015: 5 · 2013: 2 · 2012: 3
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Ect (publishedVersion)
- PubMed (publishedVersion)
- 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
- maintenance electroconvulsive therapy, recurrent depression, major depressive disorder, depression recurrence, hospitalization, length of hospital stay, psychiatric inpatient care, NICE guidelines, treatment efficacy
- MeSH terms
- Adult, Aged, Aged, 80 and over, Clinical Protocols, Depression, Electroconvulsive Therapy, Hospitalization, Humans, Middle Aged, Patient Admission, Psychiatric Department, Hospital, Retrospective Studies, Time Factors, Treatment Outcome, Retreatment, Secondary Prevention
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