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Review: maintenance antidepressants reduce risk of relapse in the 6 months following ECT in people with major depression

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Question: What is the risk of relapse after electroconvulsive therapy (ECT) for major depression, and what is the most effective maintenance therapy to prevent relapse?

Outcomes: Relapse rates 6 months after last ECT, defined as the proportion of participants meeting the relapse criteria for each study. People taking maintenance antidepressants were compared with those receiving continuation ECT (C-ECT) at a reduced schedule.


Design: Systematic review with meta-analyses.

Data sources: EMBASE, PubMed, CINAHL, PsycINFO and Cochrane Library databases were searched from inception to January 2013, supplemented by a hand search of reference lists.

Study selection and analysis: Prospective studies in adults (aged 18 years or older) with a major depressive episode (unipolar or bipolar, according to formal diagnostic criteria or clinical judgement) who received an acute course of ECT. Clinical outcomes had to be assessed by patient interviews at least 3 months after ECT. Exclusions: retrospective studies, studies with fewer than 10 participants, comorbid dementia, unstable medical conditions, non-affective psychosis or neurological disease. Two reviewers rated the study quality and extracted …

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  • Sources of funding Health Research Board; Friends of St Patrick's Hospital.


  • Competing interests CK is a Co-Principal Investigator on the National Institute of Mental Health-funded study, Prolonging Remission in Depressed Elderly (PRIDE), which compares pharmacotherapy alone versus pharmacotherapy combined with continuation ECT to prevent relapse in geriatric depression.

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