Life After ECT: Maintenance Strategies and Relapse Prevention

Finishing a course of electroconvulsive therapy (ECT) is a huge turning point for someone who has been suffering from poor mental health. ECT is usually used when depression is severe, treatment-resistant or when symptoms need to improve quickly. If you want to learn more about ECT, what it involves and some common misconceptions, this article is the perfect place to start.

After ECT treatment, the most common and understandable question is: What happens after ECT treatment? How do you approach ECT aftercare in a way that protects the progress you’ve fought for? And what actually helps with ECT relapse prevention, especially during the months when the risk is highest?

This article walks through evidence-based maintenance strategies for the phase after ECT. The goal isn’t to “be fine forever” but to stay supported, spot changes early, and have a plan that holds up in real life.

You’ve Completed ECT: What Comes Next?

It’s common to feel a mix of relief, hope and even unease when thinking of ECT aftercare. Some people feel lighter for the first time in years. Others feel a quiet fear underneath it: “What if it comes back?” That fear doesn’t reflect that you’re ungrateful, but usually means you understand how hard-won this improvement is and, as expected, you want to protect it.

A helpful way to think about this stage is that ECT isn’t the end of care. It’s the start of a new phase:

• Acute treatment (ECT) helps reduce symptoms fast and powerfully.
• Maintenance (ECT aftercare) helps you keep those gains and lowers relapse risk.

Maintenance doesn’t require perfection. It requires a structured follow-up and a plan with identifiable early warning signs so you don’t have to figure everything out when you’re already slipping.

If you’re reading this as a loved one: your role matters too. Post-ECT recovery can look better from the outside while still feeling fragile inside for the reasons mentioned above. What helps those most in this stage is steady support, not pressure to “be normal now.”

Why Relapse After ECT Is So Common

It is one of the most effective treatments for severe depression, but ECT relapse prevention is still needed, as it is common to relapse after initial improvement. Studies repeatedly find that roughly 40% of people relapse within the first six months after a successful ECT course, even when continuation medication is used. This makes sense, seeing as the first six months after treatment tend to be the most vulnerable period.

It is worth saying clearly: a relapse does not mean ECT failed. ECT can work extremely well for acute relief, but the issue is that symptom relief doesn’t automatically equal long-term protection.

Think of ECT as a powerful reset for a brain-and-body system that’s been stuck. It can rapidly shift mood-related circuits but many of the reasons that made depression possible may still be there underneath, including:

• Biological vulnerability (stress systems, mood circuitry)
• Sleep disruption, reduced activity, rumination loops
• Ongoing stressors (health, relationships, finances, caregiving)
• A history of treatment resistance (common in people who need ECT)

So when someone searches “life after ECT”, what they’re often really asking is: How do I stop the reset from slowly slipping back? The answer is rarely one magic step. It’s a maintenance strategy we’ve hinted at before.

Current Options for Maintaining Recovery After ECT

Clinicians often refer to this stage as continuation therapy after ECT; the treatments used after ECT to reduce relapse risk. The most protective approach is often multimodal, meaning more than one support is used together.

Continuation medication

For many people, medication becomes part of the plan and often comes in the form of an antidepressant, sometimes augmented, often with lithium, depending on your history and the judgment of the clinician.

What the evidence suggests:

• Continuation medication can reduce relapse risk compared with no active continuation treatment.
• It’s often strongest when it’s part of a broader plan, not the only pillar.

One important reality is that many people received ECT because medication alone wasn’t enough before. That doesn’t mean medication won’t help now, but just explains why follow-up needs to be active, personalised and flexible.

At this time, some practical questions to ask your clinician are: “What is my relapse-watch window? How often should we follow up, and what’s the step-up plan if symptoms start returning?”

Continuation ECT (C-ECT)

Some people continue ECT treatment at a lower rate than initially, and taper use every few weeks or monthly. This helps because it can sustain improvement, especially for those people who respond strongly to ECT and relapse quickly without it. With this approach however, there are some difficulties to be aware of:

• It requires ongoing hospital visits, anaesthesia and recovery time.
• Some people worry about cumulative cognitive or memory effects over longer courses. This is something to discuss openly with your treating team.

This is often where the question becomes: Can we keep the momentum of brain stimulation without living in the hospital?

Psychotherapy

Therapy can be a major stabiliser after ECT, especially when it’s focused on relapse prevention skills, not just insight.

Common options include:

• Cognitive Behavioural Therapy (CBT)
• Behavioural activation
• Mindfulness-based therapies
• Relapse-prevention focused therapy

Therapy can help you:

• Notice early warning signs before they escalate
• Build coping strategies that still work under stress
• Protect routines (especially sleep and activity)
• Reduce isolation and avoidance (two common relapse accelerators)

Therapy alone may not be enough for everyone post-ECT – but therapy + biological treatment is often stronger than relying on one pillar. Research suggests multimodal approaches may demonstrate superior efficacy compared to single-strategy maintenance.

Can At-Home Brain Stimulation Help Maintain Recovery?

ECT works partly by stimulating brain circuits involved in mood regulation. The effects can be dramatic, but as mentioned earlier, without maintenance, they often fade. A growing idea in depression treatment is that after a high-intensity intervention, lower-intensity support may help sustain the improvements.

This is where at-home options like transcranial direct current stimulation (tDCS) come into the conversation, including tDCS after ECT. tDCS uses a gentle electrical current through scalp electrodes. It does not require anaesthesia or hospital scheduling, is well tolerated with no serious side effects and has undergone decades of research and clinical trials.

It’s not designed to replace ECT per se for severe depression, but it may be a practical maintenance tool for many people as part of a broader plan.

Flow’s comparison of ECT vs tDCS explains the positioning clearly:

• ECT: high-intensity, hospital-based, acute treatment for severe cases
• tDCS: lower-intensity, non-invasive, useful for maintenance and ongoing support

How tDCS Works as a Maintenance Treatment

tDCS typically delivers a low-level electrical current through electrodes placed on the scalp, aiming to influence mood-related brain regions, mostly the dorsolateral prefrontal cortex (DLPFC). Compared with ECT, the intensity is roughly 400× weaker, and sessions are usually about 30 minutes, making it easier to slot into everyday life. Many people read, stretch or watch TV during this form of treatment.

If you’ve been through ECT, tDCS may feel appealing because it can be:

• Less invasive
• Easier to repeat consistently
• More compatible with day-to-day routines
• Useful as a “maintenance layer” alongside medication and therapy

That said, research is still developing, and protocols vary, so it’s best to treat this as something to discuss with a clinician rather than decide on your own.

Is tDCS Right for Your Post-ECT Maintenance Plan?

If you’re looking for brain-stimulation support but frequent hospital visits aren’t realistic, or if you’re concerned about the cognitive/memory burden of extended ECT schedules, tDCS could be the right option for you. It can also be relevant if you responded well to ECT and want to protect those gains with a steady routine, or if you’d like a non-pharmacological layer to complement medication, not replace it. For some people, it’s especially appealing when the person values autonomy and consistency, as tDCS is a treatment that can be done at home with clear structure.

It can be framed like this:

• You want ongoing brain-stimulation support, but regular hospital visits aren’t feasible
• You’re worried about memory/cognitive side effects with longer ECT schedules
• You did well with ECT and want a routine that helps maintain progress
• You want a non-medication add-on alongside meds and therapy
• You value autonomy + consistency.

With in-home treatment, a common question about safety arises. In short, at home tDCS is safe, but it is important to point out that tDCS is not an emergency treatment. If severe symptoms return with rapid deterioration, contact your care team urgently. For more about the safety of tDCS, click here.

You Can Stay Well: Hope and Support After ECT

If you’re anxious about relapse after ECT, remember that recovery can last. With the many practical after-care methods, it has become easier to keep maintaining recovery after ECT. It is important to note that your first plan may not be your last, but this forms part of the process.

When designing your personalised ECT aftercare, it is important to keep it concrete: build a relapse-prevention method with your clinical team, note your early warning signs and prepare an action plan. If you’re exploring Flow, an assessment can help you track symptoms and establish a baseline.

Family is important in this phase too, don’t go it alone. Support matters most in the maintenance phase, not just during the crisis.

If you’re not sure if Flow is for you, take this quiz to find out if this treatment is right.