Maintenance ECT Interrupted Due to COVID: New Data From Belgium

Out on PubMed, in Acta Psychiatrica Scandinavica, from researchers in Belgium, is this study:

Relapse after abrupt discontinuation of maintenance electroconvulsive therapy during the COVID-19 pandemic.

Lambrichts S, Vansteelandt K, Crauwels B, Obbels J, Pilato E, Denduyver J, Ernes K, Maebe PP, Migchels C, Roosen L, Buggenhout S, Bouckaert F, Schrijvers D, Sienaert P.Acta Psychiatr Scand. 2021 Jun 4. doi: 10.1111/acps.13334. Online ahead of print.PMID: 34086984

The abstract is copied below:

Objective: Maintenance electroconvulsive therapy (M-ECT) is considered an effective relapse prevention strategy in severe mood and psychotic disorders. How long M-ECT should be continued, and what the outcome is after its discontinuation has not been adequately studied. In our tertiary psychiatric hospital, M-ECT treatments were suspended at the start of the COVID-19 pandemic. We aimed to determine the 6-month relapse rate and time to relapse after abrupt discontinuation of M-ECT and to assess the impact of patient and treatment characteristics on the risk of relapse.

Methods: Eighty-one patients whose M-ECT was discontinued abruptly were followed up prospectively for 6 months, or until relapse (i.e., hospital admission, restart of ECT, change of pharmacotherapy or suicide (attempt)). We used multivariable Cox proportional hazards models to assess the impact of patient and treatment characteristics on the risk of relapse.

Results: Thirty-six patients (44.44%) relapsed within 6 months following abrupt discontinuation of M-ECT. A greater number of previous acute ECT courses, a diagnosis of psychotic disorder (compared to major depressive disorder or bipolar disorder) and a shorter interval between M-ECT treatments at the time of discontinuation were significantly associated with increased risk of relapse.

Conclusion: Almost half of the patients relapsed, similar to the relapse rate after a successful acute course of ECT. Patients with a shorter interval between M-ECT treatments at the time of discontinuation seem to be at increased risk, as well as patients with a diagnosis of psychotic disorder, compared to patients with mood disorders.

Keywords: COVID-19; Discontinuation; Maintenance Electroconvulsive Therapy; Relapse.

And from the text:

In conclusion, more than half of the patients remained well within 6 months following abrupt discontinuation of M-ECT. Also, almost half of the patients relapsed, similar to the relapse rate after an acute course of ECT. Patients with a shorter interval between M-ECT treatments at the time of discontinuation seem to be at increased risk, as well as patients with a diagnosis of psychotic disorder compared to patients with mood disorders. These patient and treatment characteristics can aid in the decision-making process when considering discontinuation of M-ECT. In case M-ECT is stopped, close monitoring should be ensured to detect early signs of relapse.

Simon Lambrichts and colleagues in Pascal Sienaert's group in Belgium have taken excellent advantage of an experiment of nature: COVID-enforced discontinuation of maintenance ECT. Their data, in a fairly large cohort of patients, show just how important and effective maintenance ECT is for some of our most ill and vulnerable patients. The results are very similar to those of Methfessal et al., from Germany, discussed in the blog post of May 25, 2021.

This very well presented paper deserves a full read, ~15 minutes.