Efficacy of continuation ECT and antidepressant drugs compared to long-term antidepressants alone in depressed patients

Objective: The purpose of this study was to evaluate the efficacy of contin uation ECT in depression. Method: The authors used retrospective chart review to identify 29 patients who received continuation ECT plus long-term antidepressant treatment afte r a positive response to acute treatment with ECT for a depressive episode (continuation ECT group). A retrospective case-controlled approach was used to ascertain a matching group of 29 patients who received long-term antide pressant treatment alone after responding positively to acute ECT (antidepr essant-alone group). All 58 patients (46 with unipolar depression, 12 with bipolar disorder) had been chronically depressed before receiving acute ECT . Data from medical records were analyzed by using survival analysis and pr oportional hazards regression to determine outcome and risk factors. Results: The mean duration of the follow-up period for all patients was 3.9 years (5.4 years for the continuation ECT patients and 2.4 years for the a ntidepressant-alone patients). Outcome was significantly better in the cont inuation ECT group. The cumulative probability of surviving without relapse or recurrence at 2 years was 93% for continuation ECT patients and 52% for antidepressant-alone patients. At 5 years, survival declined to 73% for co ntinuation ECT patients, but fell to 18% for antidepressant-alone patients. Mean survival times were 6.9 years for the continuation ECT patients and 2 .7 years for the antidepressant-alone patients. Conclusions: The findings provide strong support for the efficacy of contin uation ECT plus long-term antidepressant treatment in preventing relapse an d recurrence in chronically depressed patients who have responded to acute treatment with ECT.