Lithium, antidepressant prevent relapse after ECT in patients with MDD

A recent Delphi-based expert consensus has released guidelines on preventing relapse after a successful electroconvulsive therapy (ECT) for patients with major depressive disorder (MDD).

A global panel of 18 ECT experts formed the multiround Delphi study, which defined consensus as ≥80-percent agreement on Likert-scale responses.

Consensus was reached on the following clinical factors that influence relapse prevention: treatment resistance, psychiatric comorbidities, and prior ECT response. The experts endorsed pharmacotherapy with lithium and an antidepressant (eg, tricyclic antidepressant, venlafaxine, or a prior effective antidepressant) as essential relapse prevention strategy to all patients.

“While pharmacotherapy and continuation ECT are core strategies, personalized adjustments based on clinical risk factors remain essential,” the authors said.

For patients at high risk of relapse and with severe or psychotic depression, the Delphi study recommended ECT continuation by means of tapering instead of abrupt cessation. Psychotherapy was also deemed beneficial as adjunctive rather than a standalone treatment.

On the other hand, there was no consensus reached regarding the role of repetitive transcranial magnetic stimulation, esketamine, or optimal treatment duration of relapse prevention beyond 6 months.

“Further empirical research is needed to refine guidelines and improve long-term outcomes,” the authors said.

“ECT is a highly effective treatment for depression, yet relapse rates up to 50 percent within a year are reported,” they noted.