Maintenance electroconvulsive therapy (M-ECT) is used to prevent recurrence of depression. Indications regarding patient selection criteria and efficacy are uncertain, in part because data are lacking. Comparison of M-ECT patients (N = 21) with controls demonstrates that M-ECT is chosen for patients whose course is characterized by multiple hospitalizations and failure to adequately respond to other therapies. M-ECT patients were exposed, on average, to 10 different psychotropic medications, including five trials of tricyclic antidepressants. Greater than half of their cumulative hospitalizations were for ECT. Their rate of rehospitalization decreased by 67% after institution of prophylactic M-ECT, demonstrating treatment efficacy. A tendency toward relapse and rehospitalization remains when M-ECT patients are compared to controls.