The Efficacy of ECT in Mixed Affective States

Devanand, D. P.; Polanco, Pedro; Cruz, Rubén García; Shah, Sajjad Ali; Paykina, Natalya; Singh, Kiran Deep; Majors, L. Frank

doi:10.1097/00124509-200003000-00004

Cited by 65 publications

(38 citation statements)

References 9 publications

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“…As in this study along with other comparable studies 18,19,20 , it is also highly efficacious in Bipolar-mixed disorders.…”

Section: Resultsupporting

confidence: 81%

Electroconvulsive therapy in mood diorders

Adhikari

2015

J Chitwan Med Coll

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Electroconvulsive therapy (ECT) is one of the less used somatic treatments in mood disorders, especially depressive phase. ECT use has importance during acute bipolar episode when patient extremely violent, suicidal and extreme psychomotor retardation. The aim of this study was to know about socio-demographic profile and therapeutic efficacy of the use of ECT in mood disorders. Methods: This is a prospective comparative study between patients who received ECT and who did not. Psychopathology was evaluated using Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS) between the groups at admission, at discharge, at 1st month, at 6th month and at 12th month. Modified ECT was performed using general anesthetic agent. Results: Twenty five patients received ECT as compared to 32 patients who were non-receivers. There was significant decrease in HDRS in ECT receiver as compared to non-receivers in patients with depression (both unipolar and bipolar) at discharge, 1st month, and 12th month; in YMRS in patient with mania at discharge, 1st month and at 12th month. Discussion: There was significant improvement in overall psychopathology and psycho-social status of patients who received ECT as compared to non-receivers. The improvement was shown by decrement in scores in HDRS and YMRS at the time of discharge, 1st month, 6th month and 1st year which were statistically significant.

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“…As in this study along with other comparable studies 18,19,20 , it is also highly efficacious in Bipolar-mixed disorders.…”

Section: Resultsupporting

confidence: 81%

Electroconvulsive therapy in mood diorders

Adhikari

2015

J Chitwan Med Coll

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“…Ciapparelli et al 13 found that mixed state patients (n = 41) had a significantly greater decrease in depression rating scores, a greater reduction in suicidality, and a more rapid response than bipolar depressed patients (n = 23). Contrary to these findings, Devanand et al 14 reported that mixed state patients (n = 10) required a greater number of ECT treatments than bipolar depressed and manic patients to achieve response. This most recent contribution of Medda et al 1 to the literature on ECT in mixed states provides strong evidence for the utility of ECT in pharmacotherapy-resistant mixed state bipolar patients; after a course of ECT in 197 patients, 41.6% responded and 30.5% remitted.…”

Section: E1152mentioning

confidence: 85%

Electroconvulsive Therapy for Bipolar Disorder: Evidence Supporting What Clinicians Have Long Known

Kellner

Ahle²,

Geduldig³

2015

J. Clin. Psychiatry

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T he effectiveness of electroconvulsive therapy (ECT) as an acute antidepressant is well known; less commonly known is the effectiveness of ECT as a mood stabilizer, that is, as an antimanic treatment, and by extension, an antimixed state treatment. In this issue of the Journal, Medda and colleagues' 1 report of the high effectiveness of ECT in a cohort of nearly 200 bipolar patients with mixed affective states adds important evidence to this knowledge base. In this commentary, we review the evidence for the effectiveness of ECT in all phases of bipolar disorder.There is no reason to suspect that ECT would be any less effective for bipolar depression than for unipolar depression, yet this remains a commonly held belief. Similarly, many practitioners seem to think that there is only meager evidence for ECT's effectiveness in bipolar depression, but this is untrue. There is a long history of clinical use of ECT for bipolar depression and a systematic evidence base that is catching up with this experience.In a study of the efficacy of ECT in a cohort of 220 unipolar (n = 170) and bipolar (n = 50) depressed patients, Bailine et al 2 found no significant difference in remission rates between the 2 groups when remission was defined as a score of less than or equal to 10 on the 24-item Hamilton Depression Rating Scale (HDRS 24 ). Similarly, recent studies by Dierckx et al 3 and Narayanaswamy et al 4 comparing ECT response and remission rates among bipolar and unipolar depressed patients found no significant difference in the efficacy of ECT. Some studies have also shown that bipolar depressed patients require fewer treatments to achieve "responder" or "remitter" status. In the study of Sienaert et al, 5 bipolar depressed patients (n = 13) required approximately 7-8 treatments to achieve response or remission status, whereas unipolar depressed patients (n = 51) required, on average, 9-11 treatments to achieve response or remission. Likewise, in a reanalysis of data by Daly et al, 6 bipolar patients (n = 66) showed a 54.9% reduction (SD = 31.9%) in HDRS score compared with a 43.9% reduction (SD = 29.8%) among unipolar patients (n = 162) after 6 ECT treatments. Medda et al7 reviewed the efficacy of ECT in all 3 depressive subtypes; response rates were high for all (unipolar, 88.2%, n = 17; bipolar I, 69.6%, n = 67; and bipolar II, 73.1%, n = 46). However, bipolar I depressed patients exhibited higher residual manic and psychotic symptomatology, as measured by the Young Mania Rating Scale (YMRS) and Brief Psychiatric Rating Scale (BPRS).Electroconvulsive therapy has long been used as a "rescue" treatment for refractory mania. In contemporary psychiatric practice, most, even severely, manic patients eventually respond to pharmacotherapy-usually a combination of mood stabilizers and tranquilizers, often at high doses. For those who do not, ECT is an important and usually quickly effective alternative treatment.In a review of the use of ECT in mania over a period of 50 years, Mukherjee et al 8 concluded that 80% of 589 manic ...

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“…Among the most common, and the mildest side effects, are headache [16][17][18], nausea or myalgias [19], as well as effects at a cognitive level that are often self-limited and require symptomatic management [20][21][22]. Other more severe but uncommon side effects include cardiac, pulmonary and cerebrovascular disorders.…”

Section: Discussionmentioning

confidence: 99%

Electroconvulsive Therapy: Solution or a Cause of Tardiv Dyskinesia?

María¹

2017

J Depress Anxiety

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The Efficacy of ECT in Mixed Affective States

Cited by 65 publications

References 9 publications

Electroconvulsive therapy in mood diorders

Electroconvulsive therapy in mood diorders

Electroconvulsive Therapy for Bipolar Disorder: Evidence Supporting What Clinicians Have Long Known

Electroconvulsive Therapy: Solution or a Cause of Tardiv Dyskinesia?

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