What is it about?

Electroconvulsive therapy (ECT) is a highly effective and safe treatment for severe depression. During ECT, a small electric current is passed through the brain while the patient is under general anesthesia, so they don't feel or notice anything. This causes a brief convulsion, which has been found to lead to positive effects on depression by helping to restore healthy brain activity. However, many patients experience a relapse after successful treatment. Relapse happens when a person who was feeling better after treatment starts to experience depression symptoms again. This study asked a group of international experts how best to prevent relapse after ECT. The experts agreed that all patients should receive medication following ECT, with a combination of lithium and an antidepressant being the most recommended. For patients at higher risk of relapse, continuing ECT with a gradual tapering process is important. Tapering means slowly reducing the frequency of ECT sessions rather than stopping them suddenly, which might help to maintain the benefits of treatment. The experts also identified certain factors that increase the risk of relapse, such as having recurrent depression, psychiatric comorbidities, previous relapse after ECT, and more severe or psychotic symptoms at the time of treatment. Psychotherapy can also be usefull, but it should be used alongside other treatments. The study provides expert advice on how to personalize relapse prevention based on each patient’s unique needs

Featured Image

Why is it important?

Relapse after successful treatment remains a challenge in managing severe depression, with up to 50% of patients experiencing relapse within the first year after electroconvulsive therapy (ECT). While several strategies for relapse prevention are available and studied, there hasn’t been a clear, operationalized consensus on how to apply them following ECT. What makes this study unique is that it provides a global, expert-based consensus, offering practical recommendations that can be directly applied in clinical practice. By focusing on personalized treatment and identifying key factors that influence relapse risk, the study helps clinicians make more informed decisions. This work is timely, as it provides clearer guidance on relapse prevention, ultimately supporting better long-term outcomes for patients worldwide.

Perspectives

As a practicing psychiatrist, I often witness the challenges of treating depression. Patients can improve with treatment, only to later experience a return of their symptoms, with all the personal and social consequences that follow. In clinical practice, I’ve seen firsthand how there’s often hesitation about which relapse prevention strategy to choose for a specific patient, despite evidence supporting various approaches. This uncertainty can sometimes lead to delays in relapse prevention and increase the risk of relapse. This study is particularly meaningful to me because it provides clearer, practice-based advice that can be directly applied in clinical decision-making. By drawing on the extensive expertise of the international panel of experts, it offers more confidence in making informed choices and ultimately aims to reduce the risk of relapse and improve patient outcomes. The collaboration with these international experts was not only an invaluable learning experience but also an incredibly rewarding and pleasant one. I hope this work will help clinicians navigate these difficult decisions with more clarity and precision, benefiting both patients and healthcare systems.

MD Jordy Rovers
Radboud Universiteit

Read the Original

This page is a summary of: A Global Delphi-Based Expert Consensus on Relapse Prevention Strategies Following Successful Electroconvulsive Therapy for Major Depressive Disorder, American Journal of Psychiatry, March 2026, American Psychiatric Association,
DOI: 10.1176/appi.ajp.20250641.
You can read the full text:

Read

Contributors

The following have contributed to this page