The Role of Electroconvulsive Therapy (ECT) in Bipolar Disorder: Effectiveness in 522 Patients with Bipolar Depression, Mixed-state, Mania and Catatonic Features

Abstract

Objective:We evaluated the effectiveness of Electroconvulsive Therapy (ECT) in the treatment of Bipolar Disorder (BD) in a large sample of bipolar patients with drug resistant depression, mania, mixed state and catatonic features.Method:522 consecutive patients with DSM-IV-TR BD were evaluated prior to and after the ECT course. Responders and nonresponders were compared in subsamples of depressed and mixed patients. Descriptive analyses were reported for patients with mania and with catatonic features.Results:Of the original sample only 22 patients were excluded for the occurrence of side effects or consent withdrawal. After the ECT course, 344 (68.8%) patients were considered responders (final CGIi score ≤2) and 156 (31.2%) nonresponders. Response rates were respectively 68.1% for BD depression, 72.9% for mixed state, 75% for mania and 80.8% for catatonic features. Length of current episode and global severity of the illness were the only statistically significant predictors of nonresponse.Conclusion:ECT resulted to be an effective and safe treatment for all the phases of severe and drug-resistant BD. Positive response was observed in approximately two-thirds of the cases and in 80% of the catatonic patients. The duration of the current episode was the major predictor of nonresponse. The risk of ECT-induced mania is virtually absent and mood destabilization very unlikely. Our results clearly indicate that current algorithms for the treatment of depressive, mixed, manic and catatonic states should be modified and, at least for the most severe patients, ECT should not be considered as a “last resort”.

Bipolar depression: a major unsolved challenge

“…Among nonpharmacological treatments, acute bipolar depression is responsive to ECT (Itagaki et al 2017;Perugi et al 2017;Bahji et al 2019), although optimal treatment to follow successful ECT remains uncertain. Other biomedical treatments may be of value in bipolar depression.…”

<p>Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives</p>

“…Response rates of catatonia to ECT are excellent, with most modern studies reporting response in 80-100% of cases, including in the setting of non-response to benzodiazepine. 44,59,[70][71][72][73] Response rates approached 80% in a literature review of catatonia in children and adolescents with diverse underlying etiologies. 74 Lower response rates (59% and 71%) described in two retrospective studies 75,76 may be attributable to study populations with higher rates of underlying psychotic disorder, delay in appropriate treatment, and/or recent use of dopamine antagonists.…”

The Treatment of Bipolar Depression: Current Status and Future Perspectives

“…Although there are limited RCTs of electroconvulsive therapy (ECT) in mania and bipolar depression, there is a wide consensus that ECT is an effective treatment for both acute mania and bipolar depression even in pharmacotherapyresistant patients [92]. In large sample of drug-resistant bipolar depressed patients, at the end of an ECT course, an antidepressant response was seen in 201 out of 295 individuals (68.1%) [93] and another trial suggests ECT may be more effective than pharmacological treatment in treatment-resistant bipolar depression [94].…”