Maintenance electroconvulsive therapy for recurrent refractory mania

Although there are some reports on the efficacy of maintenance electroconvulsive therapy (mECT) in rapid cycling bipolar disorder there is scant data about the use of mECT in the non-rapid cycling form of this condition.

We report the case of a 45-year-old man diagnosed with bipolar affective disorder at the age of 32 who had 5 manic episodes in 6 years. These episodes were severe, required hospitalization and had poor response to lithium carbonate, sodium valproate, carbamazepine, haloperidol and chlorpromazine (either alone or in combination). The patient was treated with electroconvulsive therapy (ECT) during his last hospitalization and since then his treatment has included mECT and chlorpromazine (400 mg/day) and he has remained euthymic during the past 21 months.

This case describes the utility of mECT in medication refractory bipolar disorder.