CHAPTER 13: Management of Patient's Post-ECT Course - Continuation/Maintenance ECT

Written by Juli Lawrence

13.3. Continuation/Maintenance ECT

13.3.1. General

a) Continuation/Maintenance ECT should be available in programs administering ECT.

b) Continuation/maintenance ECT may be given on either an inpatient or outpatient basis. In the latter case, the recommendations presented in Section 11.1 apply.

13.3.2. Indications for Continuation ECT

a) history of recurring episodic illness which has been responsive to ECT; and

b) either 1) pharmacotherapy alone has not proved effective in preventing relapse or cannot be safely administered for such a purpose; or 2) patient preference; and

c) the patient is agreeable to receive continuation ECT, and is capable, with the assistance of others, of complying with the treatment plan.

13.3.3. Delivery of Treatments

a) Various formats exist for delivering continuation ECT. The timing of treatments should be individualized for each patient, and should be adjusted as necessary with consideration of both beneficial and adverse effects.

b) The duration of continuation ECT should be guided by the factors described in 13.1(b) and 13.1(c).

13.3.4. Maintenance ECT

a) Maintenance ECT is indicated when a need for maintenance treatment (Section 13.1(d)) exists in patients already receiving continuation ECT (Section 13.3.2).

b) Maintenance ECT treatments should be administered at the minimum frequency compatible with sustained remission.

c) The continued need for maintenance ECT should be reassessed at least every three months. This assessment should include consideration of both beneficial and adverse effects.

13.3.5. Pre-ECT Evaluation for Continuation/Maintenance ECT

Each facility using continuation/maintenance ECT should devise procedures for pre-ECT evaluation in such cases. The following recommendations are suggested, with the understanding that additions to or increased frequency of evaluative procedures should be included whenever clinically indicated.

a) Prior to each treatment:

1) interval psychiatric evaluation (this evaluation may be done monthly if treatments are at an interval of 2 weeks or less AND the patient has been clinically stable for at least 1 month)

2) interval medical history and vital signs (this exam may be done by the ECT psychiatrist or anesthetist at the time of the treatment session), with additional examination as clinically indicated

b) Updating of overall clinical treatment plan at least every three months.

c) Assessment of cognitive function at least every three treatments.

d) At least every six months:

1) consent for ECT

anesthesia preoperative examination

e) Laboratory tests at least yearly.

13.4 Continuation/Maintenance Psychotherapy

Psychotherapy, whether on an individual, group, or family basis, represents a useful component of the clinical management plan for some patients following an index ECT course.

next: Chapter 2: 2.1. - Indications for Use of ECT
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