Continuation therapy following ECT: directions for future research.

The use of electroconvulsive therapy (ECT) in major depression typically involves sequential treatment trials. Most patients fail one or more antidepressant medications before receiving ECT, and patients who respond to ECT usually receive continuation pharmacotherapy. Indeed, ECT is the only somatic treatment in psychiatry that is typically discontinued when it is found to be effective. This paper reviews the relations of medication resistance during the acute episode to short-term response to ECT and the use of continuation pharmacotherapy and continuation ECT as methods to prevent relapse. Recent research contradicts the long-held view that failure to respond to adequate trials of anti-depressant medication has no impact on response to ECT. Further, recent research has documented high relapse rates following ECT and has questioned the efficacy of using traditional antidepressant medications for continuation pharmacotheraphy when patients have established resistance to those same agents during treatment of the acute episode. Continuation ECT has strong potential as a method to prevent early relapse, but its efficacy has never been demonstrated in controlled research. In each of these areas, detailed recommendations are given for future research.