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Comparative response to electroconvulsive therapy in medication-resistant bipolar I patients with depression and
Pierpaolo Medda1, Giulio Perugi, Sara Zanello
1Department of Psychiatry, University of Pisa, Pisa, Italy.
Objectives:
We compared the response with electroconvulsive therapy (ECT) of bipolar I patients resistant to pharmacological treatment, who presented depression or mixed state (MS).
Methods:
Ninety-six bipolar I patients according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition were included in the study (46 with major depressive episode and 50 with MS). Bilateral ECT was delivered using a brief pulse stimulator Mecta 5000Q (Mecta Corp, Lake Oswego, Ore) on a twice-a-week schedule. The patients were evaluated before ECT (baseline) and a week after the ECT course (final score), using the Hamilton Rating Scale for Depression (HAM-D), Mania Rating Scale, Brief Psychiatric Rating Scale (BPRS), and Clinical Global Improvement (CGI).
Results:
Global response rate (CGI
Limitations:
With the exception of anticonvulsants, concomitant psychotropic medications were permitted during ECT course, based on the physician's decision.
Conclusions:
Electroconvulsive therapy should be considered a viable treatment alternative in bipolar I patients with depression or MS who do not respond to conventional pharmacologic management. The only difference is that MS may present more residual agitation or psychotic features in comparison with depressive patients.
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