There are a lot of things to think about electroconvulsive therapy and maintenance strategy for major depressive disorder

Abstract

Electroconvulsive therapy (ECT) is the most promising therapeutic modality for drug-resistant major depressive disorder (MDD). However, it has been reported that almost 40% of ECT-treated MDD patients experienced a relapse within 6 months. Major Randomized Controlled Trials recommended the combination of lithium (Li) and an antidepressant was more effective for maintenance therapy of post ECT MDD than an antidepressant alone. Moreover, a recent meta-analyses recommended that maintenance electroconvulsive therapy (M-ECT) combined with pharmacotherapy maintains significantly higher remission rates than pharmacotherapy alone since acute ECT was introduced. The factors causing a relapse of depression following ECT has not been assessed in some detail. Relapse often occurs after inadequate ECT, after a partial remission caused by the inadequate remission assessment with a combination pharmacological therapy during ECT, or after misdiagnosis. We found a significantly higher relative risk rate of developing bipolar disorder (BP) in the patients experienced a relapse of depression within 3 months after initial course of ECT than in those without relapse (RR = 2.91, 95% CI = 1.59-5.33). M-ECT combined with Li in maintenance therapy could be useful for maintaining remission of drug-resistant MDD, because both M-ECT and Li could prevent not only depressive but manic episodes. However, even if there is an increased risk of initial recurrence of episodes, minimum prescription or ECT for maintaining remission of MDD with achieving adequate diagnosis could reduce physical and economical adverse consequence of treatments and contribute to long-term QOL and ADL improvements of MDD and BP patients.