Continuation and maintenance electroconvulsive therapy in elderly depressed patients

The need for continuous pharmacotherapy in depressed elderly patients has been documented. Electroconvulsive therapy (ECT) as prophylactic treatment is rarely reported in this age group. In the present case-series study we describe our experience with continuous ECT in six elderly (age 68- 83 years) patients. All patients suffered from recurrent major depressive disorder at least once yearly. They did not respond to adequate antidepressive pharmacotherapy and required ECT (unilateral, twice weekly) for their acute recurrent episode. ECT resulted in initial relief of affective symptoms that enabled their discharge from the hospital. Continuous ECT was administrated (range 6-25 ECTs) on an ambulatory basis, unilaterally once monthly for at least 6 months. The severity of depression and cognitive functioning were assessed by Hamilton Depression Rating Scale (HAM-D) and the Mini Mental State Examination (MMSE). Continuous ECT prevented successfully the recurrence of major depressive episodes and the need for hospitalization for a time period of at least 2 years, with HAM-D scores during this period of less than 15. No cognitive deterioration was in three patients with 'pseudodementia' (MMSE < 24). It is concluded that continuous ECT may be an efficacious treatment in drug-resistant elderly patients with recurrent major depressive disorder.