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Typically, patients receiving ECT acutely have already failed several medication trials. Thus, many clinicians use continuation and maintenance ECT to prevent relapse. In a multisite study, 201 patients with single or recurrent unipolar major depressive episodes who had responded to acute ECT were randomized to open continuation treatment with ECT or pharmacotherapy.
In the acute phase, 531 participants received ECT three times weekly; 64% were considered “remitted” (≥60% score reduction on the 24-item Hamilton Rating Scale for Depression [HRSD]; final score, ≤10). Continuation treatments were nortriptyline (mean serum level, 81 ng/mL) plus lithium (mean serum level, 0.53 mEq/L) or 10 sessions of bitemporal ECT at 1.5 times the seizure thres…