Continuation and maintenance electroconvulsive therapy (ECT) is used to prevent relapse and recurrence of depressive episodes in those patients who have failed previous continuation and/or maintenance pharmacotherapy and who have also responded to an acute course of ECT. These patients frequently have histories of medication-resistant depression, medication intolerance, and/or comorbid medical conditions that complicate the management of their psychiatric illness. Previous studies of continuation and maintenance ECT, mostly consisting of case reports and retrospective chart reviews, as well as several prospective studies, support the practice of continuation and maintenance ECT as a viable treatment option for these difficult-to-treat patients. However, continuation and maintenance ECT have come under fire recently because of concerns of insufficient controlled studies demonstrating its efficacy, its long-term benefits, and its risks. This article thus reviews the most recent data available on the use of continuation and maintenance ECT in the treatment of depressive disorders. Although few new prospective controlled studies exist in the literature, published and emerging data continue to support the use of continuation and maintenance ECT, particularly in those individuals with medication-refractory, ECT-responsive, and relapse-prone depression.