- Electroconvulsive therapy
- Continuation electroconvulsive therapy
- Maintenance electroconvulsive therapy
- Mood disorders
Background: Electroconvulsive therapy (ECT) is a highly effective treatment for mood disorders. Continuation ECT (C-ECT) and maintenance ECT (M-ECT) are required for many patients suffering from severe and recurrent forms of mood disorders. This is a review of the literature regarding C- and M-ECT. Methods: We conducted a computerized search using the words continuation ECT, maintenance ECT, depression, mania, bipolar disorder and mood disorders. We report on all articles published in the English language from 1998 to 2009. Results: We identified 32 reports. There were 24 case reports and retrospective reviews on 284 patients. Two of these reports included comparison groups, and 1 had a prospective follow-up in a subset of subjects. There were 6 prospective naturalistic studies and 2 randomized controlled trials. Conclusions: C-ECT and M-ECT are valuable treatment modalities to prevent relapse and recurrence of mood disorders in patients who have responded to an index course of ECT. C-ECT and M-ECT are underused and insufficiently studied despite positive clinical experience of more than 70 years. Studies which are currently under way should allow more definitive recommendations regarding the choice, frequency and duration of C-ECT and M-ECT following acute ECT.
Copyright © 2011 S. Karger AG, Basel
- Abrams R: Electroconvulsive therapy, ed 2. Oxford, Oxford University Press, 1992.
- Rohland BM, Carroll BT, Jacoby RG: ECT in the treatment of the catatonic syndrome. J Affect Disord 1993;29:255–261.
- American Psychiatric Association: Task Force on Electroconvulsive Therapy. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. Washington, American Psychiatric Association, 2001.
- Petrides G, Fink M, Husain MM, Knapp RG, Rush AJ, Mueller M, Rummans TA, O’Connor KM, Rasmussen KG Jr, Bernstein HJ, Biggs M, Bailine SH, Kellner CH: ECT remission rates in psychotic versus nonpsychotic depressed patients: a report from CORE. J ECT 2001;17:244–253.
- Birkenhager TK, van den Broek WW, Mulder PG, de Lely A: One-year outcome of psychotic depression after successful electroconvulsive therapy. J ECT 2005;21:221–226.
- Kellner CH, Fink M, Knapp R, Petrides G, Husain M, Rummans T, Mueller M, Bernstein H, Rasmussen K, O’Connor K, Smith G, Rush AJ, Biggs M, McClintock S, Bailine S, Malur C: Relief of expressed suicidal intent by ECT: a Consortium for Research in ECT study. Am J Psychiatry 2005;162:977–982.
- Small JG, Klapper MH, Kellams JJ, Miller MJ, Milstein V, Sharpley PH, Small IF: Electroconvulsive treatment compared with lithium in the management of manic states. Arch Gen Psychiatry 1988;45:727–732.
- Mukherjee S, Sackeim HA, Schnur DB: Electroconvulsive therapy of acute manic episodes: a review of 50 years’ experience [see comment]. Am J Psychiatry 1994;151:169–176.
- Valenti M, Benabarre A, Garcia-Amador M, Molina O, Bernardo M, Vieta E: Electroconvulsive therapy in the treatment of mixed states in bipolar disorder. Eur Psychiatry 2008;23:53–56.
- American Psychiatric Association: American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2006. Arlington, American Psychiatric Publishing, Inc., 2006.
- Sackeim HA, Haskett RF, Mulsant BH, Thase ME, Mann JJ, Pettinati HM, Greenberg RM, Crowe RR, Cooper TB, Prudic J: Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA 2001;285:1299–1307.
- Kalinowsky LB: Electric convulsive therapy, with emphasis on importance of adequate treatment. Arch Neurol Psychiatry 1943;50:652–660.
- Kerman EF: Electroshock therapy: with special reference to relapses and an effort to prevent them. J Nerv Mental Dis 1945;102:231–242.
- Fink M: Impact of the antipsychiatry movement on the revival of electroconvulsive therapy in the United States. Psychiatr Clin North Am 1991;14:793–801.
- American Psychiatric Association: Electroconvulsive therapy. Report of the task force on electroconvulsive therapy of the American Psychiatric Association. Washington DC, American Psychiatric Association, 1978.
- Kramer BA: Maintenance ECT: A survey of practice (1986). Convuls Ther 1987;3:260–268.
- American Psychiatric Association: Task Force on Electroconvulsive Therapy. The practice of electroconvulsive therapy: Recommendations for Treatment, Training, and Privileging. Washington, American Psychiatric Association, 1990.
- Fink M, Abrams R, Bailine S, Jaffe R: Ambulatory electroconvulsive therapy: report of a task force of the association for convulsive therapy. Association for convulsive therapy. Convuls Ther 1996;12:42–55.
- Petrides G: Continuation ECT: a review. Psychiatric Ann 1998;28:517–523.
- Monroe RR Jr: Maintenance electroconvulsive therapy. Psychiatr Clin North Am 1991;14:947–960.
- National Institute for Clinical Excellence (NICE): Guidance on the Use of Electroconvulsive Therapy (Technology Appraisal 59). NICE, London, 2003.
- Freeman C: Editorial for ECT. J ECT 2006;22:1–3.
- Cole C, Tobiansky R: Electroconvulsive therapy: NICE guidance may deny many patients treatment that they might benefit from. BMJ 2003;327:621.
- Procopio M: Nice guidelines and maintenance ECT. Br J Psychiatry 2003;183:263.
- Frederikse M, Petrides G, Kellner C: Continuation and maintenance electroconvulsive therapy for the treatment of depressive illness: a response to the National Institute for Clinical Excellence report. J ECT 2006;22:13–17.
- Chanpattana W, Chakrabhand ML, Sackeim HA, Kitaroonchai W, Kongsakon R, Techakasem P, Buppanharun W, Tuntirungsee Y, Kirdcharoen N: Continuation ECT in treatment-resistant schizophrenia: a controlled study. J ECT 1999;15:178–192.
- Chanpattana W, Kramer BA: Acute and maintenance ECT with flupenthixol in refractory schizophrenia: sustained improvements in psychopathology, quality of life, and social outcomes. Schizophr Res 2003;63:189–193.
- Rami L, Bernardo M, Valdes M, Boget T, Portella MJ, Ferrer J, Salamero M: Absence of additional cognitive impairment in schizophrenia patients during maintenance electroconvulsive therapy. Schizophr Bull 2004;30:185–189.
- Suzuki K, Awata S, Takano T, Ebina Y, Iwasaki H, Matsuoka H: Continuation electroconvulsive therapy for relapse prevention in middle-aged and elderly patients with intractable catatonic schizophrenia. Psychiatry Clin Neurosci 2005;59:481–489.
- Suzuki K, Awata S, Takano T, Ebina Y, Shindo T, Harada N, Matsuoka H: Adjusting the frequency of continuation and maintenance electroconvulsive therapy to prevent relapse of catatonic schizophrenia in middle-aged and elderly patients who are relapse-prone. Psychiatry Clin Neurosci 2006;60:486–492.
- Shimizu E, Imai M, Fujisaki M, Shinoda N, Handa S, Watanabe H, Nakazato M, Hashimoto K, Iyo M: Maintenance electroconvulsive therapy (ECT) for treatment-resistant disorganized schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2007;31:571–573.
- Hustig H, Onilov R: ECT rekindles pharmacological response in schizophrenia. Eur Psychiatry 2009;24:521–525.
- Wengel SP, Burke WJ, Pfeiffer RF, Roccaforte WH, Paige SR: Maintenance electroconvulsive therapy for intractable Parkinson’s disease. Am J Geriatr Psychiatry 1998;6:263–269.
- Wachtel LE, Contrucci-Kuhn SA, Griffin M, Thompson A, Dhossche DM, Reti IM: ECT for self-injury in an autistic boy. Eur Child Adolesc Psychiatry 2009;18:458–463.
- Bonds C, Frye MA, Coudreaut MF, Cunningham M, Spearing M, McGuire M, Guze B: Cost reduction with maintenance ECT in refractory bipolar disorder. J ECT 1998;14:36–41.
- Gupta S, Austin R, Devanand D: Lithium and maintenance electroconvulsive therapy. J ECT 1998;14:241–244.
- Kramer BA: A seasonal schedule for maintenance ECT. J ECT 1999a;15:226–231.
- Kramer BA: A naturalistic review of maintenance ECT at a university setting. J ECT 1999b;15:262–269.
- Gagne GG Jr, Furman MJ, Carpenter LL, Price LH: Efficacy of continuation ECT and antidepressant drugs compared to long-term antidepressants alone in depressed patients [see comment]. Am J Psychiatry 2000;157:1960–1965.
- Chanpattana W: Combined ECT and clozapine in treatment-resistant mania. J ECT 2000;16:204–207.
- Stewart JT: Lithium and maintenance ECT. J ECT 2000;16:300–301.
- Fox HA: Extended continuation and maintenance ECT for long-lasting episodes of major depression. J ECT 2001;17:60–64.
- Kho KH: Treatment of rapid cycling bipolar disorder in the acute and maintenance phase with ECT. J ECT 2002;18:159–161.
- Russell JC, Rasmussen KG, O’Connor MK, Copeman CA, Ryan DA, Rummans TA: Long-term maintenance ECT: a retrospective review of efficacy and cognitive outcome. J ECT 2003;19:4–9.
- Vaidya NA, Mahableshwarkar AR, Shahid R: Continuation and maintenance ECT in treatment-resistant bipolar disorder. J ECT 2003;19:10–16.
- Tsao CI, Jain S, Gibson RH, Guedet PJ, Lehrmann JA: Maintenance ECT for recurrent medication-refractory mania. J ECT 2004;20:118–119.
- Wijkstra J, Nolen WA: Successful maintenance electroconvulsive therapy for more than seven years. J ECT 2005;21:171–173.
- Abraham G, Milev R, Delva N, Zaheer J: Clinical outcome and memory function with maintenance electroconvulsive therapy: a retrospective study. J ECT 2006;22:43–45.
- Suzuki K, Awata S, Takano T, Ebina Y, Numata S, Saito A, Ito K, Matsuoka H: Resolution of SPECT-determined anterior cerebral hypoperfusion correlated with maintenance ECT-derived improvement in residual symptoms in a case of late-life psychotic depression. Clin Nucl Med 2006;31:253–255.
- Sienaert P, Peuskens J: Electroconvulsive therapy: an effective therapy of medication-resistant bipolar disorder [see comment]. Bipolar Disord 2006;8:304–306.
- Nascimento AL, Appolinario JC, Segenreich D, Cavalcanti MT, Brasil MA: Maintenance electroconvulsive therapy for recurrent refractory mania [see comment]. Bipolar Disord 2006;8:301–303.
- Yero SA, McKinney T, Petrides G, Goldstein I, Kellner CH: Successful use of electroconvulsive therapy in 2 cases of persistent sexual arousal syndrome and bipolar disorder. J ECT 2006;22:274–275.
- Balke LD, Varma A: A case of long-term maintenance ECT in a 78-year-old with depression and possible Parkinson’s disease. CNS Spectr 2007;12:325–326.
- Bozkurt A, Karlidere T, Isintas M, Ozmenler NK, Ozsahin A, Yanarates O: Acute and maintenance electroconvulsive therapy for treatment of psychotic depression in a pregnant patient. J ECT 2007;23:185–187.
- Zisselman MH, Rosenquist PB, Curlik SM: Long-term weekly continuation electroconvulsive therapy: a case series. J ECT 2007;23:274–277.
- Gupta S, Tobiansky R, Bassett P, Warner J: Efficacy of maintenance electroconvulsive therapy in recurrent depression: a naturalistic study. J ECT 2008;24:191–194.
- Odeberg H, Rodriguez-Silva B, Salander P, Martensson B: Individualized continuation ECT and medication as a bridge to relapse prevention following an index course of ECT in severe mood disorders: a naturalistic 3- year cohort study. J ECT 2008;24:183–190.
- O’Connor DW, Gardner B, Presnell I, Singh D, Tsanglis M, White E: The effectiveness of continuation-maintenance ECT in reducing depressed older patients’ hospital re-admissions. J Affect Disord 2009.
- Wijkstra J, Nolen WA, Algra A, van Vliet IM, Kahn RS: Relapse prevention in major depressive disorder after successful ECT: a literature review and a naturalistic case series [see comment]. Acta Psychiatr Scand 2000;102:454–460.
- Swoboda E, Conca A, Konig P, Waanders R, Hansen M: Maintenance electroconvulsive therapy in affective and schizoaffective disorder. Neuropsychobiology 2001;43:23–28.
- Datto CJ, Levy S, Miller DS, Katz IR: Impact of maintenance ECT on concentration and memory. J ECT 2001;17:170–174.
- Rami-Gonzalez L, Salamero M, Boget T, Catalan R, Ferrer J, Bernardo M: Pattern of cognitive dysfunction in depressive patients during maintenance electroconvulsive therapy. Psychol Med 2003;33:345–350.
- Vothknecht S, Kho KH, van Schaick HW, Zwinderman AH, Middelkoop H, Blansjaar BA: Effects of maintenance electroconvulsive therapy on cognitive functions. J ECT 2003;19:151–157.
- Rami L, Bernardo M, Boget T, Ferrer J, Portella MJ, Gil-Verona JA, Salamero M: Cognitive status of psychiatric patients under maintenance electroconvulsive therapy: a one-year longitudinal study. J Neuropsychiatry Clin Neurosci 2004;16:465–471.
- Kellner CH, Knapp RG, Petrides G, Rummans TA, Husain MM, Rasmussen K, Mueller M, Bernstein HJ, O’Connor K, Smith G, Biggs M, Bailine SH, Malur C, Yim E, McClintock S, Sampson S, Fink M: Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: a multisite study from the Consortium for Research in Electroconvulsive therapy (CORE). Arch Gen Psychiatry 2006;63:1337–1344.
- Navarro V, Gasto C, Torres X, Masana G, Penades R, Guarch J, Vazquez M, Serra M, Pujol N, Pintor L, Catalan R: Continuation/maintenance treatment with nortriptyline versus combined nortriptyline and ECT in late-life psychotic depression: A two-year randomized study. Am J Geriatr Psychiatry 2008;16:498–505.
- Smith GE, Rasmussen KG, Cullum CM, Felmlee-Devine MD, Petrides G, Rummans TA, Husain MM, Mueller M, Bernstein HJ, Knapp RG, O’Connor MK, Fink M, Sampson S, Bailine SH, Kellner CH: A randomized controlled trial comparing the memory effects of continuation electroconvulsive therapy versus continuation pharmacotherapy: results from the Consortium for Research in ECT (CORE) study. J Clin Psychiatry 2010;71:185–193.
- Lisanby SH, Sampson S, Husain MM, Petrides G, Knapp RG, McCall V, Young RC, Prudic J, Kellner CH: Toward individualized post-electroconvulsive therapy care: piloting the symptom-titrated, algorithm-based longitudinal ECT (STABLE) intervention. J ECT 2008;24:179–182.
- Barnes RC, Hussein A, Anderson DN, Powell D: Maintenance electroconvulsive therapy and cognitive function. Br J Psychiatry 1997;170:285–287.
- Beale M, Kellner C: Electroconvulsive therapy and drug interactions. Psychiatric Clin North Am: Annual Drug Ther 1996;3:119–133.
- UK ECT Review Group: Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003;361:799–808.
- Pettinati HM, Stephens SM, Willis KM, Robin SE: Evidence for less improvement in depression in patients taking benzodiazepines during unilateral ECT. Am J Psychiatry 1990;147:1029–1035.
- Bailine SH, Safferman A, Vital-Herne J, Bernstein S: Flumazenil reversal of benzodiazepine-induced sedation for a patient with severe pre-ECT anxiety. Convulsive Therapy 1994;10:65–68.
- Kellner C, Burns C, Bernstein H, Monroe R: Electrode placement in maintenance ECT. Convuls Ther 1991;7:61–62.
- Aziz M, Mehringer AM, Mozurkewich E, Razik GN: Cost-utility of 2 maintenance treatments for older adults with depression who responded to a course of electroconvulsive therapy: results from a decision analytic model. Can J Psychiatry2005;50:389–397.
- Dew R, McCall WV: Efficiency of outpatient ECT. J ECT 2004;20:24–25.
Georgios Petrides, MD
The Zucker Hillside Hospital
7559 263rd street, Glen Oaks, NY 11004 (USA)
Tel. +1 718 470 8569, E-Mail firstname.lastname@example.org
Received: November 19, 2009
Accepted after revision: June 19, 2010
Published online: July 29, 2011
Number of Print Pages : 12
Number of Figures : 0, Number of Tables : 2, Number of References : 76
Neuropsychobiology (International Journal of Experimental and Clinical Research in Biological Psychiatry, Pharmacopsychiatry, Biological Psychology/Pharmacopsychology and Pharmacoelectroencephalography)
Vol. 64, No. 3, Year 2011 (Cover Date: July 2011)
Journal Editor: Strik W. (Bern)
ISSN: 0302-282X (Print), eISSN: 1423-0224 (Online)
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