In general, maintenance ECT (i.e., one treatment per month, on average) has been efficacious, safe, well tolerated, and cost effective compared with maintenance pharmacotherapy,113? 115 with its greatest impact consisting of reducing relapse, recurrence, and rehospitalization in treatment-resistant patients. A recently published multicenter, randomized, controlled trial showed similar efficacy for continuation ECT or nortriptyline plus lithium at 6 months, with more than half of the patients either experiencing disease relapse or dropping out of the study.116 SUMMARY In recent years, the technique of ECT has become more sophisticated,117 and this has made the treatment safer in the general hospital setting, where growing numbers of high-risk patients are seen.
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