Maintenance electroconvulsive therapy (ECT) has been shown to be an effective treatment modality in preventing relapse in major depression following acute treatment. Nevertheless, clinical experience suggests that are obstacles to pursuing this form of long-term treatment. A retrospective chart review was conducted on 17 patients recommended for maintenance ECT following inpatient ECT for major depression over a 2-year period. Eleven (64.7%) accepted the recommendation and six (35.3%) refused. The two groups did not differ with respect to age, race, gender or number of medical codiagnoses. Patients who agreed to undergo maintenance ECT tended to live at home while all but one who refused lived in institutional settings ( p < 0.01). The type of social support available approached statistical significance ( p < 0.12), as did MMSE score ( p < 0.1 1). Patients with family support or MMSE scores lower than 27 tended to accept outpatient ECT (relative risk 7.00, 95% CI (0.69, 70.78)). These findings suggest that patients living in the community and with significant Family involvement are more likely to comply with outpatient ECT than those living in institutions and supported by professional personnel irrespective of cognitive status or other clinical or demographic factors