The Best Maintenance Treatment After ECT?

Steven Dubovsky, MD

A provocative but limited finding

Cognitive-behavioral therapy (CBT) as a continuation treatment after electroconvulsive therapy (ECT) has been little studied. Investigators in Germany studied 60 patients with recurrent major depression who had responded (50% decrease in symptoms) or remitted (score on the 24-item Hamilton Rating Scale for Depression [HRSD], ≤10) to an average of 18 right unilateral ultra-brief-pulse ECTs (mean age, 61; HRSD score pre-ECT, 30; at randomization, 8.5). They were then randomized to maintenance with medication alone or in combination with ECT on a fixed schedule or with 15 weekly sessions of group CBT. Medications included a wide range of antidepressants taken by 100% of the CBT and medication groups and 96% of the ECT group; a second antidepressant was taken by 53%, 72%, and 28%, respectively; many also took antipsychotics, a “mood stabilizer,” or both.

In an intent-to-treat analysis, sustained response at 12 months (the primary outcome measure) differed between the three groups at a level that the investigators called significant (P=0.05). In post hoc analyses, sustained response rates were 65% with CBT maintenance versus 28% with ECT maintenance (P=0.02; medication maintenance, 33%; P=0.06). Among completers, no group differences in response rates were seen at 12 months.

CITATION(S):

Brakemeier E-L et al. Cognitive-behavioral therapy as continuation treatment to sustain response after electroconvulsive therapy in depression: A randomized controlled trial. Biol Psychiatry 2013 Dec 16; [e-pub ahead of print].