Long term electroconvulsive treatment as maintenance and prophylactic therapy of affective disorders

Electroconvulsive treatment (ECT) is well established as an effective and safe therapy of acute depressive and manic syndromes. It is often combined with pharmacological treatment, which is furthermore used as maintenance treatment after a successful ECT to avoid relapses. Unfortunately, this regimen fails from time to time. Even though some patients are compliant and well treated with effective drugs in adequate dosages, they seem to be resistant against all other therapies apart from ECT.

Long term ECT as maintenance or prophylactic therapy can be quite promising. Although there are hardly any controlled and prospective studies, a number of open studies and case reports encourage to consider maintenance ECT as an efficacious and well tolerated treatment alternative. Moreover, many clinicians still hesitate to use this procedure, as they fear adverse effects like enduring cognitive impairment or other clinical complications.

In order to discuss possibilities and limitations of long term ECT, data on the state of the art, own cases, experiences and recommendations for clinical practice will be presented.