Preventing relapse in patients with major depressive disorder after an effective acute course of electroconvulsive therapy

ObjectiveMajor depressive disorder (MDD) is a highly prevalent debilitating mental health disorder with a lifetime risk of 11-15% in Australia. The most effective treatment for severe depression is electroconvulsive therapy (ECT), but it is associated with high relapse rates. This review aimed to investigate non-ECT interventions for preventing relapse of MDD after an effective acute course of ECT.MethodThe search covered electronic databases, specifically PubMed, PsycINFO and Embase, and clinical trials registered with clinicaltrials.gov and Cochrane Register of controlled trials up to 1 June 2022. Medical Subject Headings and key words used in the search were 'electroconvulsive therapy', 'depressive disorder', 'continuation', 'maintenance', 'prevention', 'prophylaxis', 'relapse' and 'recurrence'.ResultsA total of fifteen articles were included in the review. Interventions investigated by the studies were lithium, lithium + nortriptyline, escitalopram, imipramine, phenelzine, amitriptyline, venlafaxine and cognitive behavioural therapy (CBT).ConclusionsLithium was investigated the most, demonstrating good outcomes either as monotherapy or combination therapy with nortriptyline or venlafaxine. Imipramine, phenelzine, amitriptyline and CBT demonstrated encouraging results, while escitalopram failed to show a favourable outcome. Clinicians aiming to reduce the risk of relapse after an effective acute course of ECT could consider lithium, nortriptyline, venlafaxine and CBT.