ECT

ECT is a truly bi-modal treatment, effective both in the treatment of acute mania and depression in bipolar disorder. Although the methodology to study ECT has not had the same rigour as that with mood stabilizer medications, it is reported to be as effective as, if not more effective than, medications most of the time. It has broad spectrum efficacy and is an underutilized treatment in refractory bipolar disorder. It is relatively safe to use in pregnancy and in the presence of medical conditions. Bilateral ECT is more effective than unilateral ECT in Bipolar Disorder, and patients commonly need more than 6 treatments, and it is not uncommon for patients to require 10-15 treatments. ECT should be continued through the phase of ECT-induced mania or depression to achieve full euthymia. Anticonvulsants should be discontinued when ECT is being used in order to ensure seizures. Lithium dose should be reduced to decrease risk of acute neurotoxicity after ECT. Despite the fact that the long-term cognitive side effects are less severe and common than feared, ECT continues to be unacceptable to many patients. (Black et al, 1987; McCabe et al, 1977; Mukherjee et al, 1994; Small et al, 1988). There is work suggesting that maintenance ECT, once every 4-6 weeks, may be an option in some patients who are totally refractory to, unable to tolerate or use medication.

References
Black DW, Winokur G, Nasrallah H. 1987. Treatment of Mania: A Naturalistic Study of ECT vs Lithium in 438 patients. J Clin Psychiatry. 48. 132-139.

McCabe MS, Norris B. 1977. ECT vs Chlorpromazine in Mania. Biological Psychiatry. 12. 245-254.

Mukherjee S, Sackheim HA, Schnurr DB. 1994. ECT of Acute Manic Episodes: a Review. Am J. Psychiatry. 151. 169-176.

Small JG, Klapper MH, Kellarns JJ. 1988. ECT compared with Lithium in the Management of Manic States. Arch Gen Psychiatry. 45. 727-732.