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Post-ECT Maintenance — MRCPsych Paper B MCQ

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ModerateMood DisordersPost-ECT MaintenanceMRCPsych Paper B

A 45-year-old woman with recurrent unipolar depression achieves stable remission following a course of ECT. She has no contraindication to antidepressant treatment and wishes to reduce her risk of relapse. Which ongoing treatment plan is most consistent with NICE guidance?

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Correct answer: B — Start or continue an antidepressant or structured psychological intervention, and consider lithium augmentation

NICE NG222 recommends that, after depression responds to ECT, clinicians start or continue an antidepressant medication or a psychological intervention to prevent relapse and provide ongoing care. Lithium augmentation of antidepressant medication may also be considered. Therefore, B is correct. Continuation or maintenance ECT can be used selectively, particularly after previous post-ECT relapse, but routine twice-weekly ECT alone is inappropriate. Withholding relapse prevention assumes incorrectly that ECT is curative. Psychological intervention is an option but is not obligatorily the sole treatment, so D is too absolute. For unipolar depression, NICE describes lithium as augmentation of an antidepressant rather than routine post-ECT lithium monotherapy, excluding E.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), recommendations 1.13.8–1.13.9. 2022; reviewed 2026. https://www.nice.org.uk/guidance/ng222/chapter/Recommendations