A survey of psychiatrists in northwest England concerning their use of maintenance electroconvulsive therapy.

Dr. Lim’s practice audit of maintenance electroconvulsive therapy (M-ECT) in the elderly (Lim, 2006) describes a group of older people treated with M-ECT in Australia but does not describe the views of Australian psychiatrists regarding the use of this form of treatment. We explored the views of psychiatrists in northwest England regarding the use of M-ECT in the 1990s: our study group was a subset of the cohort reported in Benbow et al. (1998), namely those respondents to a first-stage questionnaire who stated that they had used M-ECT (25%) or were prepared to consider its use (67%). A second-stage questionnaire inquired specifically about practice in relation to M-ECT, defined as the regular administration of ECT in order to minimize the likelihood of further episodes of illness, and was sent to 85 individuals of whom 77 responded, giving a response rate of 87.5%. Of these respondents, 49% stated that they had not prescribed maintenance treatment within the past 10 years; 42% estimated that they had prescribed one or two courses; 8% three to four courses and 1% five to six courses. None had prescribed more than six courses, so the experience of any one individual was relatively limited. Indications for maintenance ECT were given as failure of prophylactic mood stabilizing drugs (75%), rapid relapse after repeated courses of ECT (75%), toxicity of mood stabilizing drugs (51%), and patient preference (27%). In response to further questions, 4% of respondents said that they would consider using M-ECT after one or two relapses, 35% after three or four relapses, 27% after five or six relapses, 10% after seven or eight relapses and 3% after more than eight relapses. A single respondent stated that they would not require any. Some 95% of respondents stated that they would try lithium treatment before considering M-ECT and 79% would try carbamazepine first. M-ECT was reported as being used by 45% of respondents for recurrent depressive illness, by 18% for bipolar manic depressive illness, by 8% for schizoaffective illness and by 3% for schizophrenia. None reported using M-ECT for recurrent mania. Age was not generally regarded as a contraindication: 3% of respondents stated that they would not prescribe M-ECT for people over the age of 65 years, a further 9% would not prescribe it for people aged over 80 years, and an additional 5% stated that they would not prescribe it for people aged over 90 years. Most people (73%) stated that they did not have an age limit, and 52% did not regard concurrent dementia as a contraindication to its use. With regard to the frequency of M-ECT, 20% of respondents stated that they would prescribe M-ECT weekly, 30% fortnightly, 12% three weekly, 16%