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Cognitive-behavioral therapy (CBT) as a continuation treatment after electroconvulsive therapy (ECT) has been little studied. Investigators in Germany studied 60 patients with recurrent major depression who had responded (50% decrease in symptoms) or remitted (score on the 24-item Hamilton Rating Scale for Depression [HRSD], ≤10) to an average of 18 right unilateral ultra-brief-pulse ECTs (mean age, 61; HRSD score pre-ECT, 30; at randomization, 8.5). They were then randomized to maintenance with medication alone or in combination with ECT on a fixed schedule or with 15 weekly sessions of group CBT. Medications included a wide range of antidepressants taken by 100% of the CBT and medication groups and 96% of the ECT group; a second antidepre…