The use of electroconvulsive therapy (ECT) in major depression typically involves sequential treatment trials. Most patients fail one or more antidepressant medications before receiving ECT, and those who respond to ECT usually receive continuation pharmacotherapy (CP). This report reviews the relations of medication resistance during the acute episode to short-term response to ECT and the use of CP and continuation ECT as methods to prevent relapse. Research contradicts the long-held view that failure to respond to adequate trials of anti-depressant medication has no impact on response to ECT. Detailed recommendations are given for future research.Leonard, Barry is the author of 'Literature Review on Electroconvulsive Therapy Ect, 1980-1995' with ISBN 9780756706715 and ISBN 0756706718.