Treatment refractory depression in the elderly: The role of maintenance electroconvulsive therapy

Abstract

Treatment refractory depression is a major concern for primary care and mental health specialists alike. This is particularly so in the elderly, who are most vulnerable to the effects of depression on physical and psychosocial functioning, as well as suicide. Electroconvulsive therapy (ECT) is the most effective treatment for depression refractory to medication. Patients who are refractory to medication and subsequently respond to ECT are at high risk of relapse following ECT, and as such maintenance treatment has particular salience in the medication refractory population. The use of ECT as maintenance treatment will be reviewed in this article, with a particular focus on the use of this modality in elderly patients who are refractory to medications.