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Evaluating maintenance electroconvulsive therapy in Bipolar Disorders: 3-year mirror-image study.

Santiago Madero1, Gerard Anmella2, Maria Sagué-Vilavella3

  • 1Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Barcelona Clínic Schizophrenia Unit (BCSU), Institute of Neuroscience, Hospital Cliníc de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de investigación biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain.

Journal of Affective Disorders
|October 29, 2021
PubMed
Summary

Maintenance electroconvulsive therapy (mECT) significantly reduces psychiatric hospitalizations and days in patients with bipolar disorder (BD). This real-world study confirms mECT

Keywords:
Bipolar disorder (BD)Electroconvulsive therapy (ECT)Maintenance electroconvulsive therapy (mECT)Psychiatric hospitalization

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Clinical Medicine

Background:

  • Maintenance electroconvulsive therapy (mECT) is an underutilized treatment for bipolar disorder (BD).
  • Real-world effectiveness data for mECT in BD is limited.
  • Understanding mECT's impact on hospitalization is crucial for treatment guidelines.

Purpose of the Study:

  • To evaluate the real-life effectiveness of mECT in reducing psychiatric hospitalizations for individuals with bipolar disorder.
  • To compare hospitalization rates and durations before and during mECT treatment.
  • To assess the mood-stabilizing effects of mECT in a naturalistic setting.

Main Methods:

  • A 3-year naturalistic mirror-image study design was employed.
  • Intra-subject comparisons of psychiatric hospitalizations were conducted.
  • Statistical analyses included McNemar test, Wilcoxon signed-rank test, and generalized estimating equation (GEE) models.

Main Results:

  • Maintenance electroconvulsive therapy (mECT) demonstrated a 62.2% effectiveness in preventing psychiatric hospitalizations in bipolar disorder (BD) patients (p<0.01).
  • A significant reduction in both the number of hospitalizations and hospitalization days was observed during mECT compared to the pre-treatment period (p<0.01).
  • Mean annual hospitalizations decreased by 76% (RR=0.24) and mean annual hospitalization days by 86% (RR=0.14) during mECT.

Conclusions:

  • Maintenance electroconvulsive therapy (mECT) is effective in reducing psychiatric hospitalizations and associated days for individuals with bipolar disorder (BD).
  • The findings suggest a significant mood-stabilizing effect of mECT in BD patients.
  • This naturalistic study provides evidence supporting the use of mECT for managing bipolar disorder across various mood states.