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Continuation ECT Role — MRCPsych Paper B MCQ

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HardMood DisordersContinuation ECT RoleMRCPsych Paper B

A 68-year-old man with severe recurrent depression achieves stable remission following an acute course of electroconvulsive therapy (ECT). He has previously relapsed despite maintenance antidepressant treatment. According to current NICE NG222, which statement most accurately describes relapse prevention after his response to ECT?

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Correct answer: B — Use antidepressant medication or a psychological intervention, consider lithium augmentation, and note that NICE makes no routine recommendation for maintenance ECT

Explanation lettering: C = shown as A · A = shown as B · E = shown as C · B = shown as E

A is correct. NICE NG222 recommends that, following response to acute ECT, antidepressant medication should be started or continued, or a psychological intervention provided, to prevent relapse; lithium augmentation of antidepressant medication may also be considered. NICE found insufficient evidence to make a routine clinical recommendation for maintenance ECT and instead made a research recommendation. Previous failure of pharmacological maintenance does not itself create a NICE indication for continuation ECT, so B overstates the guidance. Continuation ECT does not replace medication and is not the sole relapse-prevention option, excluding C and D. E is also too absolute: NICE does not declare maintenance ECT universally prohibited, and its ECT service standards explicitly recognise that maintenance ECT is delivered in specialist practice.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), recommendations 1.13.6 and 1.13.9 and rationale on preventing relapse. 2022; reviewed 2026. https://www.nice.org.uk/guidance/ng222/chapter/recommendations