This naturalistic study followed the course of 27 patients who received continuation therapy with outpatient electroconvulsive therapy (ECT) after responding well to an index course of ECT for major depression. The continuation outpatient ECT protocol consisted of weekly treatments for the 1st month after remission, followed by a gradual tapering to monthly treatments. All patients were free of psychotropic medications during their continuation course of ECT. Patients who completed the continuation ECT protocol were significantly (p = 0.04) less likely to experience a relapse of depressive symptoms necessitating hospitalization during a 5-month follow-up period than were those who failed to follow the protocol. Indications for use of continuation ECT are discussed and areas for future research are identified.