Treatment of mania: a naturalistic study of electroconvulsive therapy versus lithium in 438 patients

The efficacy of electroconvulsive therapy (ECT), adequate lithium therapy, inadequate lithium therapy, and neither ECT nor lithium therapy was compared by reviewing the charts of 438 patients hospitalized because of mania over a 12-year period. A significantly (p less than .05) greater percentage (78%) of patients who received ECT had "marked improvement" than did those who received either adequate or inadequate lithium treatment (62% and 56%, respectively) or neither treatment (37%). Of the patients with schizoaffective disorder, manic type, 87.5% who received ECT showed "marked improvement"; almost 70% of patients who failed to respond to adequate lithium had "marked improvement" with ECT. Unilateral and bilateral ECTs were equally effective. Psychosis was not useful in predicting treatment response. ECT was demonstrated to be an effective treatment for mania.