{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:43:05Z","timestamp":1787013785093,"version":"build-2736575974"},"reference-count":50,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T00:00:00Z","timestamp":1623888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Electroconvulsive therapy (ECT) is an effective acute treatment for severe and\/or medication\u2010resistant depression but maintaining remission following completion of a course remains a clinical challenge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>EFFECT\u2010Dep Trial (ISRCTN23577151) participants with a DSM\u2010IV major depressive episode who met remission criteria after a randomly assigned course of twice\u2010weekly brief\u2010pulse bitemporal (1.5\u00a0\u00d7\u00a0seizure threshold) or high\u2010dose (6\u00a0\u00d7\u00a0seizure threshold) right unilateral ECT were monitored for relapse for 12\u00a0months. In line with the pragmatic trial design, all patients received treatment\u2010as\u2010usual individualised pharmacotherapy during and after ECT; no remitter received continuation ECT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 61\u00a0remitters, 24 (39.3%) relapsed, one (1.6%) withdrew from the study while in remission and the remaining 36 (59.0%) stayed well for a year. Most relapses occurred within the first six months, resulting in a cumulative six\u2010month relapse rate of 31.1%. In a multivariable Cox proportional hazards regression model, older age (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.039) and psychotic features at pre\u2010ECT baseline (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.037) were associated with a more favourable long\u2010term prognosis while a greater number of previous depressive episodes (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.028) and bipolar II (but not bipolar I) diagnosis (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.030) were associated with a worse long\u2010term outcome. Electrode placement and medication resistance prior to ECT had no effect on relapse. Adjusting for covariates, fewer patients treated with lithium relapsed in the overall group (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.008) and in the unipolar depression subgroup (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.027).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Long\u2010term outcome following high\u2010dose right unilateral ECT does not differ from bitemporal ECT. Prognosis is particularly favourable in older adults, psychotic depression and patients maintained on lithium.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acps.13331","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T11:43:33Z","timestamp":1621943013000},"page":"218-229","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Relapse following bitemporal and high\u2010dose right unilateral electroconvulsive therapy for major depression"],"prefix":"10.1111","volume":"144","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7653-8531","authenticated-orcid":false,"given":"Ana","family":"Jelovac","sequence":"first","affiliation":[{"name":"Department of Psychiatry Trinity College Dublin St. Patrick's University Hospital Dublin 8 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