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Manic symptoms: an indication for bilateral ECT.

J G Small, I F Small, V Milstein

    Biological Psychiatry
    |February 1, 1985
    PubMed
    Summary
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    Patients with mania unresponsive to unilateral electroconvulsive therapy (ECT) showed significant improvement after switching to bilateral ECT. Bilateral ECT is more effective for manic symptoms than unilateral ECT.

    Area of Science:

    • Neuroscience
    • Psychiatry

    Background:

    • Unilateral electroconvulsive therapy (ECT) is a common treatment for mood disorders.
    • Pilot observations suggested that some manic patients unresponsive to unilateral ECT improved with bilateral ECT.

    Purpose of the Study:

    • To retrospectively evaluate the efficacy of switching from unilateral to bilateral ECT in manic patients.
    • To compare outcomes between patients switched to bilateral ECT, those treated with unilateral ECT alone, and controls.

    Main Methods:

    • Retrospective study comparing three groups: 25 patients switched from unilateral to bilateral ECT, 25 age/sex-matched controls, and 25 concurrent controls treated with unilateral ECT alone.
    • Evaluation of demographic variables, DSM-III diagnoses, electroencephalographic (EEG) findings, neuropsychological tests, and psychopathology ratings.

    Related Experiment Videos

  • Specific assessment of manic symptoms using dedicated scales.

    • Main Results:

    • No significant differences were found in demographic variables, EEG, neuropsychological tests, ECT parameters, or general psychopathology ratings between groups.
    • Patients switched to bilateral ECT showed significantly more manic symptoms (unrestrained behavior, elevated mood, hurried speech) compared to controls.
    • Patients responding to unilateral ECT alone had minimal manic features, while those with significant manic features benefited from the switch to bilateral ECT.

    Conclusions:

    • Switching from unilateral to bilateral ECT is highly effective for manic patients who do not respond to unilateral treatment.
    • Bilateral ECT appears more effective in treating the specific manic features of mania than unilateral ECT.
    • This finding supports the use of bilateral ECT for treatment-resistant mania.