Stopping ECT in a Client Who Has Returned to Baseline After 7 Sessions
It is appropriate to discontinue ECT for a client who has returned to baseline after 7 sessions, but careful post-ECT management is necessary to prevent relapse.
Considerations When Stopping ECT
- ECT is effective for resolving acute illness but will not prevent relapse, making an effective continuation strategy essential 1
- Patients should be monitored for 24-48 hours after the final ECT session for potential tardive seizures (late-onset seizures that may occur after full recovery from anesthesia) 1
- Cognitive side effects are typically most pronounced immediately after completing ECT but generally resolve within months 1
Post-ECT Management Plan
Immediate Follow-up (First Week)
- Monitor for immediate cognitive side effects which may include impairments in:
- Concentration and attention
- Verbal and visual delayed recall
- Verbal fluency 1
- Watch for potential tardive seizures, which are rare but have been observed 6 hours after the seventh treatment in some cases 1
- Treat minor side effects such as headache, nausea, and confusion conservatively (e.g., acetaminophen for headaches) 1
Short-term Management (First 3 Months)
- Implement appropriate pharmacotherapy before completing the ECT course 1
- The treatment regimen should be tailored to the presenting disorder:
- Antidepressant for unipolar major depressive disorder
- Mood stabilizer for bipolar illness
- Combined pharmacotherapies as clinically indicated 1
- Monitor closely during the first 3 months as this is the highest risk period for relapse 2, 3
Long-term Management
- Regular follow-up appointments to monitor psychiatric symptoms and medication efficacy 1
- Be aware that cognitive functioning typically returns to baseline level within several months after ECT 1
- Consider that almost half of patients (44%) may relapse within one year after discontinuing ECT, with most relapses occurring within the first 8 months 2
Special Considerations
- If the client experiences signs of relapse, consider:
- Medication adjustments
- Possible resumption of ECT 4
- Patients who have shown good response to ECT but have a history of multiple failed medication trials may benefit from maintenance ECT, though this is more commonly used in adults with mood disorders 1
- Cognitive monitoring is advisable to follow and evaluate the course of potential side effects 5
Potential Cognitive Effects to Monitor
- Short-term postictal confusion (immediately after treatment)
- Anterograde amnesia (difficulty forming new memories for up to 3 months)
- Retrograde amnesia (difficulty retrieving memories formed before treatment) 5
- Most cognitive effects are temporary, with studies showing complete recovery with return to pre-ECT functioning noted at follow-up testing 8-9 months after treatment 1