Maintenance pharmacotherapy after electroconvulsive therapy in inpatients with major depressive disorder: 198 prescriptions in a real-world clinical setting

BMC Psychiatry. 2025 Oct 9;25(1):957. doi: 10.1186/s12888-025-07445-4.

ABSTRACT

BACKGROUND: Although antidepressant monotherapy is recommended for patients with major depressive disorder (MDD), they often do not respond to it, necessitating alternatives such as electroconvulsive therapy (ECT). However, maintenance pharmacotherapy after ECT has remained unestablished. This study, conducted at 240 facilities throughout Japan, aimed to explore maintenance pharmacotherapy after ECT for 3,749 inpatients with MDD.

METHODS: The patients were divided into two groups, one that underwent ECT (ECT group, N = 521) and another that did not (non-ECT group, N = 3,273), for the comparison of clinical characteristics and prescription details at discharge. The primary outcome of this study was the prescription rate of antidepressant monotherapy at discharge, while the secondary outcomes included prescription rates of specific combination regimens, such as antidepressant plus lithium.

RESULTS: We identified 198 prescription patterns involving antidepressants in the ECT group. Analysis by drug category revealed distinctive patterns: there was no statistically significant difference in prescription rates for antidepressant monotherapy between the ECT and non-ECT groups (N = 118, 22.6% vs. N = 932, 28.4%). In contrast, the prescription rate for the combination of antidepressant and antipsychotic medications was significantly higher in the ECT group (N = 188, 36.0% vs. N = 941, 28.7%). The combination of antidepressant and mood stabilizer was also more frequent in the ECT group (N = 35, 6.7% vs. N = 130, 3.9%), although this difference did not reach statistical significance after Bonferroni correction. At the drug level, additional distinctive patterns emerged: among antidepressant monotherapies, nortriptyline use was significantly more common in the ECT group (N = 9, 1.7% vs. N = 11, 0.3%). For mood stabilizers, restricting the analysis to lithium revealed a markedly higher rate in the ECT group (N = 30, 5.7% vs. N = 35, 1.0%).

CONCLUSIONS: These findings highlight the complexity of treatment decisions managing of MDD after ECT and emphasize the need for structured prospective research on the effectiveness of specific maintenance pharmacotherapies after ECT.

PMID:41068670 | DOI:10.1186/s12888-025-07445-4