background Although antidepressant treatment with ect in severe depressive illness is as efficacious in the elderly as in patients of younger age, the chance of relapse is probably increased in the elderly. Therefore, from a clinical perspective it is very important to choose the best strategy for relapse prevention after treating the index episode. aim To study the existing research for optimal strategies in relapse prevention of severe depression in the elderly after a single course of ect.

methods (1) A systematic review of the literature considering relapse prevention in severely depressed elderly patients treated with ect. (2) A naturalistic follow through study of 10 patients over 2- 6 years.

results Randomized evidence is lacking. Results of studies in younger patients and studies with methodological shortcomings are currently the only available sources of information in this important clinical issue.

discussion An overview of the available research will be presented and discussed with respect to daily practice.