Continuation and maintenance ECT in treatment-resistant bipolar disorder

Continuation and maintenance electroconvulsive therapy (c/mECT) is a treatment alternative for the long-term management of mood and psychotic disorders, especially in chronic, recurring, medication-resistant illnesses and in patients who are medication-intolerant, are non-compliant, and have a high risk of suicide with medications. A MEDLINE search was performed with maintenance electroconvulsive therapy (ECT), continuation ECT, and prophylactic ECT as keywords. The relevant literature was obtained and reviewed. Despite methodologic flaws, the overwhelming majority of the studies report the effectiveness of c/mECT in bipolar mood disorder. We also reviewed the charts of 13 patients with mood disorder receiving maintenance ECT in the ECT service of a Veterans Administration medical center. Despite good results, c/mECT is underused in the treatment of bipolar mood disorder. More research with better study design is needed to define the predictors of response to c/mECT and to develop c/mECT treatment protocols for treatment-resistant bipolar patients.