Methods for maintaining the effects of electroconvulsive therapy in depression treatment in various parts of the world

Introduction: Electroconvulsive therapy (ECT) is one of the most effective treatments in psychiatry. The aim of this study is to present innovative methods for preventing the recurrence of depression after ECT treatment using continuation ECT (c-ECT), maintenance ECT (m-ECT), and pharmacotherapy, as well as to compare different approaches to the use of these methods across different parts of the world. Materials and methods: A review of the available literature was performed by searching the PubMed and Google Scholar databases using the following keywords: “c-ECT”, “m-ECT”, “continuation electroconvulsive therapy”/”kontynuacja terapii elektrowstrząsowej”, “maintenance electroconvulsive therapy”/”podtrzymująca terapia elektrowstrząsowa”, “major depressive disorder”/”duże zaburzenia depresyjne”, “continuation pharmacotherapy”/”kontynuacja farmakoterapii” for original papers, meta-analyses, and review papers both in Polish and English, published from 1999 to 2023. The SANRA scale was used to maintain the quality of the narrative review. Results: In maintenance treatment, c-ECT and m-ECT achieve effects comparable to those of pharmacological treatment. The most effective method is a combination of pharmacological therapy and c-ECT. c-ECT and m-ECT can reduce the time and cost, and the number of hospitalisations. At the same time, one of the major trends in ECT practice over the past 20 years has been the shift from inpatient to outpatient treatment. Conclusions: c-ECT and m-ECT are underutilised and understudied despite positive clinical experience spanning over 70 years. Although they are used all over the world, there are no specific guidelines or standardised methods for conducting this therapy. Studies that are currently underway should provide recommendations regarding the selection, frequency, and duration of c-ECT and m-ECT.