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Electroconvulsive Therapy as Maintenance Treatment in Psychiatric Disorders

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Abstract

Purposeof 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.

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  1. Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India

    Ilambaridhi Balasubramanian, Bandita Abhijita & Vikas Menon

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Conceptualization: Vikas Menon; literature search and data analysis: Ilambaridhi Balasubramanian, Bandita Abhijita; writing—original draft preparation: Bandita Abhijita; writing—review and editing: Ilambaridhi Balasubramanian, Vikas Menon. All authors read and approved the final manuscript.

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Balasubramanian, I., Abhijita, B. & Menon, V. Electroconvulsive Therapy as Maintenance Treatment in Psychiatric Disorders. Curr Behav Neurosci Rep 11, 1–13 (2024). https://doi.org/10.1007/s40473-023-00266-3

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