Occurence of ultra-rapid cycling during electroconvulsive therapy in bipolar depression

Treatment of bipolar depression with antidepressants has often been reported to be associated with a certain risk of rapid cycling (RC). Also, non-pharmacological treatment approaches such as sleep deprivation or light therapy can induce affective shifts. Moreover, during electroconvulsive therapy (ECT), which is considered a powerful antidepressant treatment, manic switches and episodes of rapid cycling can occur.

Here we report the case of a 66-year-old female patient with bipolar depression, who underwent electroconvulsive therapy because of a therapy-refractory depressive episode.

During ECT, highly frequent mood alternations were observed, fulfilling the criteria of ultra rapid cycling (URC). These symptoms were successfully treated with lithium carbonate while ECT was continued.

To our knowledge, this is the first case report of URC during ECT. URC might be considered a rare but potential side effect of ECT. In our case, lithium was used successfully for the treatment of URC and might be suggested in similar cases, where anticonvulsants are not the first choice of treatment. However, in view of the risk of cognitive side effects the combination of ECT and lithium requires a careful clinical monitoring.