Electroconvulsive therapy (ECT) is one of the few psychiatric treatments that are stopped, often abruptly, after sufficient improvement has been achieved. However, most psychiatric illnesses require continuation treatment after response for months or years. Most research on the topic of prophylaxis after ECT has been performed with depression. This chapter reviews the post-ECT prophylaxis predominantly following ECT for depression. For other disorders, data on prophylactic treatment are presented when available.
Another important topic with treatment termination after ECT is the reevaluation of patients. Depression or other psychiatric conditions for which ECT is indicated may mask underlying psychiatric disorders. Depression can obscure the presence of a personality disorder or axis 1 disorders such as anxiety disorders. Conversely, depression can give the impression that a personality disorder is distinctly present, yet sometimes after successful ECT treatment the inaccuracy of this initial impression becomes obvious. Post-ECT reevaluation is clinically important because proper treatment of underlying or comorbid illness is essential for good outcome.
|Title of host publication||Electroconvulsive and Neuromodulation Therapies|
|Publisher||Cambridge University Press|
|Number of pages||10|
|Publication status||Published - 15 Jul 2009|
Bibliographical notePublisher Copyright: © Cambridge University Press 2009
Comorbid anxiety disorder may have contributed to several study outcomes mentioned in this chapter, as it was not accounted for. The higher post-ECT relapse rate reported by Sackeim et al. (2001) than van den Broek et al. (2006) in patients who had failed medication before ECT may have resulted from exceptionally high incidence and
severity of comorbid anxiety disorders. The Sackeim et al. patients were chronically ill and so probably had relatively severe anxiety comorbidity, which should predispose to worse outcome. Likewise, the Lauritzen et al. (1996) observation of better six-month outcome with paroxetine than imipramine may have resulted from comorbid anxiety disorder, as anxiety disorder is more responsive to paroxetine than imipramine.